Balanced Literacy through the Use of a Progressive Daily Message in a Kindergarten Classroom

The focus of this project was to review available literature on using a daily message within the framework of a balanced literacy program, and create specific lessons and activities to use in a kindergarten classroom that help students become successful readers and writers. Throughout this project the students will be experiencing powerful communication between teacher and students, and student to student, practicing various literacy skills, responding to print daily, and interacting with text and other students. These activities will help foster their attitude and ability to read independently

Development of an Implementation Guide for Literature Circles from Teacher Led to Student Led in an Upper Elementary Classroom

The focus of this project was to review the available literature on the topic of literature circles from the framework of a balanced literacy program and to create materials to be used by intem1ediate elementary teachers for implementing student led literature circles into their reading curriculum. The results of the research show that through specific teacher guidance, children are empowered with choices and are provided with opportunities to dialog with classmates in a context of creating connections. The project includes an instrnctional framework to establish literature circles, a progression of teacher led to student led applications, and intermediate literature book selections for use with literature circles

Hospital Performance Trends on National Quality Measures and the Association With Joint Commission Accreditation

BackgroundEvaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS).ObjectivesTo examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases.Design, setting, and patientsPerformance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data.MeasurementsChanges in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores.ResultsHospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores.ConclusionsWhile Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458-465. © 2011 Society of Hospital Medicine

Incidence of Fractures Requiring Orthopedic Operative Intervention Following Electric Scooter Injuries

Introduction: Standing electric scooters became widely popular and increasingly available as an inexpensive and easy mode of transportation in the United States in September 2017. Regulation and safety guidelines established by electric scooter companies and government agencies vary greatly, and serious injuries have subsequently followed the rise in use of these devices. Objective: The objective of this study is to determine the incidence, severity, and outcome of orthopedic injuries related to standing electric scooter usage. Materials and Methods: This study is a case series of all patients sustaining injuries attributed to electric scooter usage requiring orthopedic consultation at George Washington University Hospital between January 1, 2018 and December 31, 2018. The main outcomes include the type and severity of these injuries, definitive treatment, and the estimated cost to the health system. Results: 10 patients were identified as sustaining injuries directly relating to electric scooter usage that required orthopedic consultation at GWUH between January 1, 2018 to December 31, 2018. Eight patients underwent operative fixation; three patients sustained upper extremity fractures and five sustained lower extremity fractures. Those injuries included two distal radii fractures, one humeral shaft fracture, one ankle fracture, one ankle fracture with dislocation, one tibial plateau fracture, and one tibia/fibular shaft fracture. Two patients were treated definitively without surgical treatment. Two patients were kept inpatient for their injuries and underwent fixation in the acute setting. Six patients were stabilized at the time of injury and discharged with scheduled follow up for outpatient surgical fixation. Two patients did not require surgical treatment and were treated definitively prior to discharge and follow up. Conclusion: Orthopedic injuries secondary to electric scooter usage are increasing in prevalence as the devices become more available and popular. The severity of orthopedic injuries varies from definitive care in the emergency department to requiring operative fixation and inpatient admission at the hospital. These findings may contribute to more standard regulation and safety guidelines for safe electric scooter usage

High Number of Negative Radiographs for Suspected Tibial Shaft Fracture Adds Expense and Increases Patient Throughput Time in the Emergency Department

Purpose: Tibial shaft fractures (OTA 42A-C) are the most common long bone fracture in adults, and the diagnosis is commonly made by emergency department (ED) providers prior to orthopedic consultation. Due to the subcutaneous anatomy of the tibia, a comprehensive history and physical examination are often sufficient for fracture diagnosis, with radiographs serving as a secondary aid in confirming the diagnosis and planning treatment. Although it is expected that some of these radiographic studies will be negative despite clinical suspicion for fracture, a high rate of negative X-Rays increases cost and inefficiency in the ED. This study aims to define the rate at which tibial radiographs are negative for fracture at a Level I trauma center. Secondary objectives include assessment of cost, resource allocation, and radiation exposure associated with these negative X-Rays. Finally, we present diagnostic criteria to guide the clinician in efficiently obtaining tibial radiographs. Methods: At a Level I trauma center, a prospective database was retrospectively evaluated for ED radiographs taken from 2014 to 2017. The number of radiographs taken for suspected trauma to the tibial diaphysis in the absence of concomitant periarticular injury was recorded. From this group, the percentage of X-rays positive for tibia fracture was determined. The increased cost, ED throughput time, resource utilization, and radiation exposure was analyzed. Results: During the three year study period, 734 tibia radiographs were performed in the ED for diagnosis of tibial shaft fracture. Of these, 565 (76.9%) were negative for tibial shaft fracture. Patient charges were increased from these negative radiographs through both higher radiology charges ($598 per tibia radiographic series) and higher professional charges. The average time to obtain a tibia X-ray series in the ED was 28 minutes (range: 13-74 minutes). The radiation exposure from a tibia radiographic series was found to be 15 millirems. Conclusion: At this institution, a large proportion of the radiographs obtained for suspected tibial shaft fracture are negative. The resources and time spent acquiring these radiographs places higher demands on physicians and staff and increases charges and radiation exposure to the patient. In addition, these negative radiographs add throughput time in the ED, thereby potentially contributing to ED overcrowding. Given the subcutaneous nature of the tibia, diagnosis of tibial shaft fracture is often reliably made through history and physical examination. We propose a systematic approach to maximize the diagnostic efficiency of tibia radiographs and subsequently improve resource allocation in the ED

Missed obturator hip dislocation in a 19-year-old man.

Traumatic obturator hip dislocations are rare injuries that are typically diagnosed and managed acutely. We encountered a patient who presented with a painful hip 2 months after sustaining an undiagnosed traumatic obturator hip dislocation. After failed closed treatment, the hip was reduced with open reduction, utilizing a Kocher approach and a trochanteric osteotomy. At 15 months postoperatively, the patient maintained a functional range of motion without clinical or radiographic signs of posttraumatic arthritis or avascular necrosis

The impact of trauma centre accreditation on patient outcome

Trauma centre accreditation originated as a North American initiative in the 1970\u27s with the aim of standardising and improving care for injured patients. This system of grading a hospital\u27s ability to receive serious trauma has subsequently spread, most notably to Australasia. Many studies have focussed on determing whether this accreditation results in improved patient outcomes. We review the evidence to date, which suggests significant mortality reductions albeit from mainly Class III studies and reflect on the future sustainability of this initiative given mounting financial pressures. © 2006