Kuhnesbensen6877

Further exploration into factors that may attain a restraint-free environment is warranted.

This study reports the processes implemented to reduce restraint use through enhanced communication and increased documentation. Further exploration into factors that may attain a restraint-free environment is warranted.With the evolution from single healthcare entities to health systems, the role of the system chief nurse executive (SCNE) has evolved. The SCNE leads at the highest executive level in the system and has continuum of care accountability. To effectively support the scope and breadth of the SCNE role, the organizational structure must contain key elements to ensure success. click here This article outlines the key elements of a system nursing organization and serves to aid in the development, improvement, and sustainability of successful system nursing structures.The COVID pandemic generated unparalleled operational disruption. C-suites and chief nurse executives responded to create capacity and clinical readiness despite enormous uncertainty. Innovations were put in place to combat the care crisis; however, is there merit in continuing these innovations as the pandemic subsides? Examining highly impactful operational innovations that were rapidly implemented during the pandemic should be prioritized as organizations seek to establish their new normal.The Magnet Recognition Program® has a dedicated team of RNs and non-RNs who are committed to advancing nursing and supporting healthcare organizations on their Magnet® journeys. Healthcare organizations who are either Magnet-designated or applicants for Magnet designation regularly communicate with the various members of the Magnet program office team. This perspective will highlight the roles of the senior Magnet program analysts and the assistant director of Magnet program operations.This past year brought the deadliest pandemic of our time and a huge social awakening and movement for racial justice. It became clear to me in late spring that I needed to learn more about structural racism, White supremacy, racial healthcare disparities, unconscious bias, and my own prejudices that govern my attitudes, values, behaviors, and decisions as a nurse leader, faculty member, board member, and a human being. To that end, I began to read, watch, and listen to both scholarly and lay journals and media that provide historical and current empirical accounts and studies of how racism and White supremacy have dominated our society, organizations, and communities in the United States for hundreds of years.

To determine outcomes of radial head replacement (RHR) for acute fractures using 3 different implant designs with or without cement fixation.

Retrospective.

Tertiary referral hospital.

One hundred fourteen elbows underwent RHR for an acute radial head fracture using either (1) a nonanatomic design and smooth stem (n = 60), (2) a nonanatomic design with a grit-blasted, ingrowth, curved stem (n = 21), or (3) an anatomic design with a grit-blasted ingrowth straight stem (n = 33). Cemented (25%) or uncemented (75%) fixation was used at the discretion of the treating surgeon.

RHR.

The primary outcome was implant survivorship free of revision or removal for any reason. All elbows were evaluated clinically (the Mayo Elbow Performance Score and reoperations/complications) and radiographically.

Fourteen implants (12%) were revised. Of elbows with a minimum 2-year clinical follow-up, the average Mayo Elbow Performance Score was 88. The rate of survivorship free from revision was 92% [95% confidence interv levels of evidence.

(1) Evaluate intentional temporary limb deformation for closure of soft-tissue defects as a reconstruction strategy in open tibia fractures and (2) analyze the deformity parameters required for such reconstruction.

Multicenter retrospective cohort.

Level I trauma center.

Nineteen patients 18 years of age and older at the time of initial trauma, with a Gustilo-Anderson type IIIB or IIIC open tibia fracture treated with hexapod external fixation and intentional bony deformity created to facilitate soft-tissue closure.

Intentional limb deformation for soft-tissue closure, followed by gradual correction with a hexapod external fixator.

Radiographic healing, radiographic assessment of limb alignment, and functional and bony Application of the Method of Ilizarov Group score.

The average age was 45.3 (20-70), and 79% of patients were men. The most common mechanism of injury was motor vehicle accidents. The distal 1 of 5 of the tibia was the most common fracture location, with 37% of these involving the articular surface at the plafond. After wound closure, deformity correction was initiated after 30 days on average. Varus and apex posterior were the most common initial deformity required for primary soft-tissue closure. Bony and functional Application of the Method of Ilizarov Group outcomes were good or excellent in 94% of patients.

Intentional deformation followed by a gradual correction can be an effective strategy to obtain bone union and soft-tissue coverage in certain open fractures. This technique, in essence, converts these injuries from type IIIB to IIIA. This strategy obviates the need for flap coverage and results in satisfactory outcomes.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cutaneous metastasis may be the initial sign of internal malignancy but more often represents a late manifestation of widely disseminated disease. Breast carcinoma is the most common malignancy to metastasize to the skin. Although several studies have detailed the histopathologic patterns of cutaneous metastasis from internal malignancies, very little has been published regarding metastases of breast carcinoma to the skin. Furthermore, the histopathologic and clinical features observed in the cases of breast carcinoma with local skin involvement as opposed to cases exhibiting distant cutaneous metastases have not been adequately investigated. We have reviewed 232 cases of breast carcinoma with cutaneous metastases from 2 large institutions. All cases of carcinoma of the breast with involvement of the skin of the anterior chest wall were compared with those with distant cutaneous metastases. Two hundred thirty-two cases in 199 patients were included, of which 126 had skin involvement exclusively involving the ipsilateral anterior chest, and 106 had biopsy-proven distant cutaneous metastases.