Bachmannryberg0832

Purpose To report a case of von Hippel-Lindau (VHL) syndrome in a monocular patient with progressive vision loss due to Juxtapapillary Capillary Retinal Angioma and epiretinal membrane (ERM). Patient We describe a 37-year-old white male patient with von Hippel-Lindau (VHL) syndrome who presented for retinal evaluation. The right eye was blind with NLP vision. The left eye had a best-corrected visual acuity of 20/30 and exhibited a peripheral capillary hemangioblastoma (CH) at 12 o'clock and a juxtapapillary capillary hemangioma with an epiretinal membrane (ERM) covering the fovea. The patient underwent two sessions of Fluorescein Potentiated Argon Laser treatment to the peripheral CH with initial stabilization of vision. After 18 months of follow up, the ERM contracted causing decline in vision to 20/50. Intravitreal injection of bevacizumab was performed without improvement in vision or distortion. 25g pars plana vitrectomy with epiretinal membrane (ERM) peeling and internal limiting membrane (ILM) removal was performed with immediate improvement in vision and distortion. Conclusions This case suggests that pars plana vitrectomy is a reasonable treatment option for vision loss due to Juxtapapillary Capillary Retinal Angioma and epiretinal membrane (ERM) formation.Background Small fonts on vaccine labels make manually recording vaccine data in patient records time-consuming and challenging. Vaccine 2-dimensional (2D) barcode scanning is a promising alternative to manually recording these data. Problem While vaccine 2D barcode scanning assists in data entry, adoption of scanning technology is still low. Approach Pilot sites (n = 27) within a health system scanned 2D barcodes to record vaccine data for 6 months. The time to record through scanning and nonscanning methods was measured for 13 vaccinators at 9 sites. A survey was administered to participants across all sites about their experience. Outcomes On average, 22 seconds were saved per vaccine scanned versus entered manually (7 vs 29 seconds, respectively). Participants reported preference for scanning over other vaccine entry options and identified benefits of scanning. Conclusion Expanded use of 2D barcode scanning can meaningfully improve clinical practices by improving efficiency and staff satisfaction during vaccine data entry.Background The effectiveness of the dose verification features of the electronic medication administration record (eMAR) and complementary systems in the hospital setting is not well understood. Purpose The authors completed a narrative synthesis of literature findings on the effectiveness of eMAR-based systems in the hospital setting. Methods A literature review was carried out across 5 bibliographic databases to evaluate the safety features of current eMAR-based systems in preventing dosing errors and design issues that impede their usability. Results While eMAR-based systems are beneficial to reducing order and drug cross-checking errors, safe dose verification features are sporadically available for targeted tasks. Overall, the eMAR had little impact on preventing low to moderate dosing errors. Dosing errors may occur because of error-prone activities that result from system design and work process issues during medication administration.Background Unsuccessful discharge planning (DP) may lead to undesirable health consequences among patients after discharge from the hospital. Purpose The aims of this study were to assess nurses' knowledge, perception, and practice of DP in acute care settings and identify significant predictors for nurses' practice toward DP. Methods The study had a descriptive correlational cross-sectional design. Three questionnaires about knowledge, perception, and nurses' activities toward DP were used. selleck inhibitor Nurses (n = 117) were recruited from 3 Jordanian hospitals. Results The level of nurses' knowledge toward DP was very low to low. Slightly more than half (52.1%) of nurses had a negative perception toward DP and about 50% had poor practices related to DP. Nurse-to-patient ratio and perception of nurses were significant predictors for nurses' practice toward DP. Conclusion The reinforcement of a positive perception toward DP among nurses working in acute care settings may lead to better health outcomes among patients after discharge from hospital.Background Six Sigma is a quality improvement (QI) method used in hospitals, but not typically in nursing homes (NHs), to reduce service variability and expenditures. Local problem The existing QI process for functional maintenance program (FMP) charting/auditing in an urban NH allowed variability and lost revenue. Methods A single-group pre/posttest design with analysis of variance and t-test analysis was used to implement Six Sigma for the FMP process. Intervention Phases of Define, Measure, Analyze, Improve, and Control addressed performance objectives of FMP capacity; staff retention; congruence between prescribed, performed, and charted FMPs; and month-end summaries of resident status on FMPs. Results With the existing staff, capability was increased by 17 residents ($200 000 revenue) and 90% to 100% charting congruence was achieved. Limited success was attributed to lack of skill diffusion, team communication, manager availability, and project prioritization. Conclusions Six Sigma was moderately successful when applied in a single NH for QI.Background The literature includes multiple descriptions of successful nurse-led interventions, but the effects of nurse-led education on nurse and patient satisfaction in an executive health program are unknown. Local problem Nursing staff desire to practice more fully within their scope of licensure. Increased practice demands raised questions about whether nurse-led education would improve staff and patient satisfaction. Methods/interventions A structured quality improvement process was used to design a nurse-led patient education program. Pilot measures included 5-point Likert scale patient and staff satisfaction surveys. Nurse burnout was also measured before and after the pilot. Results Patient satisfaction was high; 96% reported favorable satisfaction during the pilot, with sustained results over the following 3 years. Nurses' sense of achievement improved by 12 percentage points, and perception of making good use of skills and abilities increased by 39 percentage points. Conclusions A nurse-led patient education intervention contributed to improved staff satisfaction while sustaining a positive patient experience.