Zobrazení zdroje stránky Lambertskaarup7353

Concerns about patient bedside change-of-shift reporting at a community hospital in northern Indiana stimulated the development of this qualitative phenomenological study. A review of the literature revealed a research deficit in acute care nurses' perceptions of bedside reporting in relation to compliance. The research question addressed in this study was, "What are acute care nurses' perceptions of the change-of-shift report at the patients' bedside?" Personal interviews were conducted on 7 medical, surgical, and intensive care unit nurse participants at a community hospital in northern Indiana. Five themes were identified from the collected data, which included the time factor, continuity of care, visualization, and challenges in the communication of discreet information.This article introduces health care managers to the theories and philosophies of John Kotter and William Bridges, 2 leaders in the evolving field of change management. For Kotter, change has both an emotional and situational component, and methods for managing each are expressed in his 8-step model (developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short-term wins, don't let up, and making it stick). Bridges deals with change at a more granular, individual level, suggesting that change within a health care organization means that individuals must transition from one identity to a new identity when they are involved in a process of change. According to Bridges, transitions occur in 3 steps endings, the neutral zone, and beginnings. The major steps and important concepts within the models of each are addressed, and examples are provided to demonstrate how health care managers can actualize the models within their health care organizations.Outcomes research has historically been driven by single-center investigations. However, multicenter studies represent an opportunity to overcome challenges associated with single-center studies, including generalizability and adequate power. In hand surgery, most clinical trials are single-center studies, with few having randomized controls and blinding of both participants and assessors. This pervasive issue jeopardizes the integrity of evidence-based practice in the field. [https://www.selleckchem.com/products/caspofungin-acetate.html click here] Because healthcare payers emphasize applying the best available evidence to justify medical services, multicenter research collaborations are increasingly recognized as an avenue for efficiently generating high-quality evidence. Although no study design is perfect, the potential advantages of multicenter trials include generalizability of the results, larger sample sizes, and a collaboration of experienced investigators poised to optimize protocol development and study conduct. As the era of single-center studies shifts toward investment in multicenter trials and clinical registries, investigators will inevitably be faced with the challenges of conducting or contributing to multicenter research collaborations. We present our experiences in conducting multicenter investigations to provide insight into this demanding and rewarding frontier of research.BACKGROUND Some orthopaedic procedures exhibit volume-outcome relationships that suggest benefits associated with a triage and treatment by higher volume surgeons and hospitals. The purpose of this study was to determine whether this association is present for open reduction internal fixation (ORIF) of tibial plateau fractures regarding the outcome of conversion to total knee arthroplasty (TKA). METHODS The Florida State Inpatient Database was queried to identify patients who underwent ORIF of a tibial plateau fracture between 2006 and 2009. The annual volumes of surgeons and hospitals were determined. The outcome of interest was any subsequent hospitalization for TKA within 5 years. Comparing the rates of this outcome, cut points were established to define high and low volume. Survival analysis, including Cox proportional hazards modeling, was used to estimate the effect of volume on rates of TKA while controlling for patient factors and injury characteristics. RESULTS In this cohort of 3,921 patients, 172 patients (4.4%) underwent TKA within 5 years of ORIF of the tibial plateau. This included 5.0% of patients treated by low-volume surgeons versus 2.1% treated by high-volume surgeons and 4.8% treated at low-volume hospitals versus 2.0% treated at high-volume hospitals. High-volume surgeons and hospitals were defined by annual volumes greater than or equal to 7 and 29, respectively. After adjustment, treatment at a low-volume hospital was associated with a larger hazard of conversion to TKA (hazard ratio = 2.05; 95% confidence interval = 1.11 to 3.80). Treatment by a low-volume surgeon was also associated with a larger hazard of conversion to TKA (hazard ratio = 2.17; 95% confidence interval = 1.31 to 3.59). DISCUSSION High-volume treatment of tibial plateau fractures is associated with a lower rate of conversion to TKA, suggesting that the regionalization of care for these injuries may improve outcomes. LEVEL OF EVIDENCE Level III.INTRODUCTION The purpose of this study was to compare the short- to mid-term outcomes of patients who underwent reverse total shoulder arthroplasty (RTSA) for severe glenohumeral osteoarthritis (GHOA) with an intact rotator cuff (RC) to a matched rotator cuff arthropathy (RCA) cohort. METHODS Between 2004 and 2014, all patients who underwent RTSA for severe GHOA with a minimum 2-year follow-up were identified. Demographic and baseline variables were extracted from the medical records. Subjects were matched in the ratio of 12 to RTSA subjects with RCA, while controlling for the demographic and intraoperative variables. Postoperative active forward elevation (AFE), active external rotation, American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Scale (VAS), and Simple Shoulder Test were recorded. Complications and revision surgery rates were noted. Comparative multivariate analysis was performed. Preoperative Walch classification for each subject was obtained through radiograph review, and the impact of GHOA defined by the Walch classification did not impact the outcomes at the 2-year follow-up. LEVEL OF EVIDENCE Level III Therapeutic Study.