The added value of the advanced practice provider in paediatric acute care cardiology

2020 ◽  
pp. 1-4
Author(s):  
Amanda J. Willis ◽  
Amanda Hoerst ◽  
Stephen A. Hart ◽  
Diana Holbein ◽  
Kristyn Lowery ◽  
...  
Keyword(s):  
Acute Care ◽  
Correlation Coefficients ◽  
Added Value ◽  
Patient Specific ◽  
Advanced Practice ◽  
Surgical Volume ◽  
Multinomial Regression ◽  
Multinomial Regression Model ◽  
Case Mix Adjustment ◽  
Care Demands

Abstract Objectives: Advanced practice providers (APPs) are being employed at increasing rates in order to meet new in-hospital care demands. Utilising the Paediatric Acute Care Cardiology Collaborative (PAC3) hospital survey, we evaluated variations in staffing models regarding first-line providers and assessed associations with programme volume, acuity of care, and post-operative length of stay (LOS). Study design: The PAC3 hospital survey defined staffing models and resource availability across member institutions. A resource acuity score was derived for each participating acute care cardiology unit. Surgical volume was obtained from The Society of Thoracic Surgeons database. Pearson’s correlation coefficients were used to evaluate the relationship between staffing models and centre volume as well as unit acuity. A previously developed case-mix adjustment model for total post-operative LOS was utilised in a multinomial regression model to evaluate the association of APP patient coverage with observed-to-expected post-operative LOS. Results: Surveys were completed by 31 (91%) PAC3 centres in 2017. Nearly all centres (94%) employ APPs, with a mean of 1.7 (range 0–5) APPs present on weekday rounds. The number of APPs present has a positive correlation with surgical volume (r = 0.49, p < 0.01) and increased acuity (r = 0.39, p = 0.03). In the multivariate model, as coverage by APPs increased from low to moderate or high, there was greater likelihood of having a shorter-than-expected post-operative LOS (p < 0.001). Conclusions: The incorporation of paediatric acute care cardiology APPs is associated with reduced post-operative LOS. Future studies are necessary to understand how APPs impact these patient-specific outcomes.

scholarly journals Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

2020 ◽  
Vol 41 (S1) ◽  
pp. s343-s344
Author(s):  
Margaret A. Dudeck ◽  
Katherine Allen-Bridson ◽  
Jonathan R. Edwards
Keyword(s):  
Acute Care ◽  
National Level ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
Central Line ◽  
Patient Specific ◽  
Healthcare Associated Infections ◽  
Healthcare Associated ◽  
Repeat Infection ◽  
Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

scholarly journals Modal verbs of strong obligation in Scottish Standard English

2021 ◽  
pp. 1-27
Author(s):  
OLE SCHÜTZLER ◽  
JENNY HERZKY
Keyword(s):  
General Pattern ◽  
Standard English ◽  
Multinomial Regression ◽  
Internal Factors ◽  
Mixed Effect ◽  
Modal Verbs ◽  
Grammatical Subject ◽  
Multinomial Regression Model ◽  
Third Person ◽  
Mode Of Production

This article investigates differences between Scottish Standard English (SSE) and Southern British Standard English (SBSE) in the semantic domain of strong obligation. Focusing on the modal verbs must, have to, need to and (have) got to, we use new corpus material from nineteen written and spoken genres in the Scottish component of the International Corpus of English (ICE-SCO) and corresponding texts from ICE-GB. Data are analysed using a mixed-effect multinomial regression model to predict the choice of verb. Language-internal factors include mode of production (written/spoken), grammatical subject (first/second/third person) and source of obligation (objective/subjective). Our results show that, as previous research suggests, SSE is much more likely to employ need to for the expression of strong obligation, and less likely to employ must and (have) got to. This general pattern remains essentially unaffected by language-internal factors. To account for our findings, we draw on the sociologically motivated process of democratisation and the language-internal process of grammaticalisation.

Customised hybrid CT-MRI 3D-printed model for grade V spondylolisthesis in an adolescent

2021 ◽  
Vol 14 (3) ◽  
pp. e239192
Author(s):  
Jayanthi Parthasarathy ◽  
Eric A Sribnick ◽  
Mai-Lan Ho ◽  
Allan Beebe
Keyword(s):  
Potential Benefit ◽  
High Spatial Resolution ◽  
Composite Model ◽  
Added Value ◽  
Patient Specific ◽  
Team Approach ◽  
Multidisciplinary Team Approach ◽  
3D Printed ◽  
Ct Data ◽  
Ct And Mri

3D-printed patient-specific models provide added value for initial clinical diagnosis, preoperative surgical and implant planning and patient and trainee education. 3D spine models are usually designed using CT data, due to the ability to rapidly image osseous structures with high spatial resolution. Combining CT and MRI to derive a composite model of bony and neurological anatomy can potentially provide even more useful information for complex cases. We describe such a case involving an adolescent with a grade V spondylolisthesis in which a composite model was manufactured for preoperative and intraoperative evaluation and guidance. We provide a detailed workflow for creating such models and outline their potential benefit in guiding a multidisciplinary team approach.

scholarly journals Using airborne HIAPER Pole-to-Pole Observations (HIPPO) to evaluate model and remote sensing estimates of atmospheric carbon dioxide

2016 ◽  
Author(s):  
C. Frankenberg ◽  
S. S. Kulawik ◽  
S. Wofsy ◽  
F. Chevallier ◽  
B. Daube ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Atmospheric Carbon Dioxide ◽  
Correlation Coefficients ◽  
Added Value ◽  
Total Carbon ◽  
Accuracy And Precision ◽  
Atmospheric Carbon ◽  
Carbon Dioxide Co2 ◽  
Global Carbon ◽  
Comparable Quality

Abstract. In recent years, space-borne observations of atmospheric carbon-dioxide (CO2) have become increasingly used in global carbon-cycle studies. In order to obtain added value from space-borne measurements, they have to suffice stringent accuracy and precision requirements, with the latter being less crucial as it can be reduced by just enhanced sample size. Validation of CO2 column averaged dry air mole fractions (XCO2) heavily relies on measurements of the Total Carbon Column Observing Network TCCON. Owing to the sparseness of the network and the requirements imposed on space-based measurements, independent additional validation is highly valuable. Here, we use observations from the HIAPER Pole-to-Pole Observations (HIPPO) flights from January 2009 through September 2011 to validate CO2 measurements from satellites (GOSAT, TES, AIRS) and atmospheric inversion models (CarbonTracker CT2013B, MACC v13r1). We find that the atmospheric models capture the XCO2 variability observed in HIPPO flights very well, with correlation coefficients (r2) of 0.93 and 0.95 for CT2013B and MACC, respectively. Some larger discrepancies can be observed in profile comparisons at higher latitudes, esp. at 300 hPa during the peaks of either carbon uptake or release. These deviations can be up to 4 ppm and hint at misrepresentation of vertical transport. Comparisons with the GOSAT satellite are of comparable quality, with an r2 of 0.85, a mean bias μ of −0.06 ppm and a standard deviation σ of 0.45 ppm. TES exhibits an r2 of 0.75, μ of 0.34 ppm and σ of 1.13 ppm. For AIRS, we find an r2 of 0.37, μ of 1.11 ppm and σ of 1.46 ppm, with latitude-dependent biases. For these comparisons at least 6, 20 and 50 atmospheric soundings have been averaged for GOSAT, TES and AIRS, respectively. Overall, we find that GOSAT soundings over the remote pacific ocean mostly meet the stringent accuracy requirements of about 0.5 ppm for space-based CO2 observations.

scholarly journals Application of Multinomial Regression Model to Identify Parameters Impacting Traffic Barrier Crash Severity

2019 ◽  
Vol 13 (1) ◽  
pp. 57-64
Author(s):  
Mahdi Rezapour ◽  
Amirarsalan Mehrara Molan ◽  
Khaled Ksaibati
Keyword(s):  
Regression Model ◽  
Multinomial Logistic Regression ◽  
Crash Severity ◽  
Multinomial Regression ◽  
Interstate Highways ◽  
The Road ◽  
Run Off ◽  
Multinomial Regression Model ◽  
Proportional Odds Assumption ◽  
And Performance

Background: Run Off The Road (ROTR) crashes are some of the most severe crashes that could occur on roadways. The main countermeasure that can be taken to address this type of crashe is traffic barrier installation. Although ROTR crashes can be mitigated significantly by traffic barriers, still traffic barrier crashes resulted in considerable amount of severe crashes. Besides, the types of traffic barriers, driver actions and performance play an important role in the severity of these crashes. Methods: This study was conducted by incorporating only traffic barrier crashes in Wyoming. Based on the literature review there are unique contributory factors in different crash types. Therefore, in addition to focusing on traffic barrier crashes, crashes were divided into two different highway classes: interstate and non-interstate highways. Results: The result of proportional odds assumption was an indication that multinomial logistic regression model is appropriate for both non-interstate and interstates crashes involved with traffic barriers. The results indicated that road surface conditions, age, driver restraint and negotiating a curve were some of the factors that impact the severity of traffic barrier crashes on non-interstate highways. On the other hand, the results of interstate barrier crashes indicated that besides types of barriers, driver condition, citation record, speed limit compliance were some of the factors that impacted the interstate traffic barrier crash severity. Conclusion: The results of this study would provide the policymakers with the directions to take appropriate countermeasures to alleviate the severity of traffic barrier crashes.

Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical-Care Nurses Study of Practice

2006 ◽  
Vol 15 (2) ◽  
pp. 130-148 ◽  
Author(s):  
Deborah Becker ◽  
Roberta Kaplow ◽  
Patricia M. Muenzen ◽  
Carol Hartigan
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Clinical Judgment ◽  
American Association ◽  
Critical Care Nurses ◽  
Advanced Practice ◽  
Clinical Nurse ◽  
Care Nurse ◽  
Clinical Nurse Specialists

• Background Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. • Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners. • Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners. • Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment. • Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

A collaborative program for advanced practice in trauma/critical care nursing

1996 ◽  
Vol 16 (2) ◽  
pp. 120-127 ◽  
Author(s):  
V Keough ◽  
J Jennrich ◽  
K Holm ◽  
W Marshall
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Practice Nurse ◽  
Tertiary Care ◽  
Standards Of Care ◽  
Advanced Practice ◽  
Advanced Practice Nurse ◽  
Care Nurse

The students and faculty enrolled in the first TNP class have set a standard for future TNPs: a rigorous course of education with advanced practice and scholarship within an advanced practice collaborative model. Because of the increasingly number of trauma victims and the highly specialized care they require, nurses must come forward and provide quality care. The TNPs and their faculty must promote further recognition of the TNP role, become leaders in the field of acute care, and continue to develop and maintain collaborative relationship with physicians in support of advanced practice nursing in many areas of tertiary care. The first three graduates of the trauma/critical care practitioner class are now employed in advanced practice roles and are applying their education within trauma/critical care settings. Two of the students are trauma nurse practitioners in a community hospital, and one is a critical care nurse practitioner in a university hospital. Currently, there is an acute care nurse practitioner certification examination that is appropriate for nurses in the field of trauma/critical care. Co-sponsored by the AACN Certification Corporation and the American Nurses Credentialing Center, this examination is offered twice a year, in June and October. AACN is active in supporting and promoting the TNP role and, in conjunction with the American Nurses Association, has developed new standards of care and scope of practice to include this expanded role for the advanced practice nurse. The future for this exciting and demanding role looks bright for the advanced practice nurse interested in the care of the acutely ill patient. The time is right for this collaboration between nurses and physicians.

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