Factors That Lead To Hospital Readmissions and Interventions that Reduce Them: Moving Toward a Faith Community Nursing Intervention

Abstract Hospital readmissions affect over 80 percent of all Medicare enrollees. Hospitals have a responsibility to their Medicare patients to keep them safe after discharge in their homes and communities. With changes in the Medicare reimbursement model, hospitals are examining efficient methods of decreasing avoidable re-admissions. A Faith Community Nurse Transitional Care Program may be just the answer to improve patient’s discharge experience, ensure post-discharge support and reduce re-hospitalization. Methods In preparations for testing a Faith Community Nurse Transitional Care Program Model, a systematic integrative review was needed. Using PRISMA, a search was done, inclusion criteria identified, and articles retrieved. Sixty-two articles were collected, compared, and combined using a descriptive matrix template. Results Chronic diseases such as heart failure, COPD, diabetes mellitus, cancer, stroke and/or psychosis, depression, and lower mental health status have the highest risks. Patient variables include Medicare and Medicaid payer status, markers of frailty and elderly with complex medical, social and financial needs. Lack of caregiver or social support, poor health literacy, inability to navigate the health care system, are non-clinical needs leading to readmissions. Methods or interventions leading to decreased readmissions are early discharge planning, case management, self-management skills enhanced, medication education, and standardized tools. Conclusions A systematic integrative review process identified factors that increase and reduce hospital readmissions. The key findings revealed that certain disease, patient, and non-clinical variables can predict patient’s risks for readmission. Interventions done before discharge and after discharge can impact hospital readmissions. A new Faith Community Nurse Transition Care Program meets many of the criteria for decreasing readmission as identified in the literature. In addition, Faith Community Nurses can provide whole health care, which includes care of the physical, psychological, social, and spiritual dimensions of the person

Exploring Standardized Nursing Languages: Moving Toward a Faith Community Nursing Intervention

There are many benefits when a specialty is able to translate nursing interventions into a standardized language. One of the benefits is that nurses from different specialties, geographic areas, or countries are able to understand terminologies and concepts. The aim of this paper is to examine three standardized nursing languages and their use in describing faith community nursing through an integrative literature review. General descriptions, recognitions, populations, translations, reliability/validation/utility, and components of the Omaha System, the Nursing Intervention Classification, and the International Classification for Nursing Practice were presented. The author did not find literature to support the use of one standardized language over another in Faith Community Nursing. The lack of research using the Omaha System and the International Classification in this specialty may suggest a gap with exploratory potential. The presence of Faith Community Nursing research successfully using the Nursing Intervention Classification may suggest familiarity with this taxonomy and its ability to describe interventions unique to the practice

Remote access for NAS: Supercomputing in a university environment

The experiment was designed to assist the Numerical Aerodynamic Simulation (NAS) Project Office in the testing and evaluation of long haul communications for remote users. The objectives of this work were to: (1) use foreign workstations to remotely access the NAS system; (2) provide NAS with a link to a large university-based computing facility which can serve as a model for a regional node of the Long-Haul Communications Subsystem (LHCS); and (3) provide a tail circuit to the University of Colorado a Boulder thereby simulating the complete communications path from NAS through a regional node to an end-user

Computational fluid dynamics combustion analysis evaluation

This study involves the development of numerical modelling in spray combustion. These modelling efforts are mainly motivated to improve the computational efficiency in the stochastic particle tracking method as well as to incorporate the physical submodels of turbulence, combustion, vaporization, and dense spray effects. The present mathematical formulation and numerical methodologies can be casted in any time-marching pressure correction methodologies (PCM) such as FDNS code and MAST code. A sequence of validation cases involving steady burning sprays and transient evaporating sprays will be included

On the stability of very massive primordial stars

The stability of metal-free very massive stars ($Z$ = 0; M = 120 - 500 \msol) is analyzed and compared with metal-enriched stars. Such zero-metal stars are unstable to nuclear-powered radial pulsations on the main sequence, but the growth time scale for these instabilities is much longer than for their metal-rich counterparts. Since they stabilize quickly after evolving off the ZAMS, the pulsation may not have sufficient time to drive appreciable mass loss in Z = 0 stars. For reasonable assumptions regarding the efficiency of converting pulsational energy into mass loss, we find that, even for the larger masses considered, the star may die without losing a large fraction of its mass. We find a transition between the $\epsilon$- and $\kappa$-mechanisms for pulsational instability at Z\sim 2\E{-4} - 2\E{-3}. For the most metal-rich stars, the $\kappa$-mechanism yields much shorter $e$-folding times, indicating the presence of a strong instability. We thus stress the fundamental difference of the stability and late stages of evolution between very massive stars born in the early universe and those that might be born today.Comment: 7 pages, 5 figures. Minor changes, more results given in Table 1, accepted for publication in Ap

Adsorption of Multi-block and Random Copolymer on a Solid Surface: Critical Behavior and Phase Diagram

The adsorption of a single multi-block $AB$-copolymer on a solid planar substrate is investigated by means of computer simulations and scaling analysis. It is shown that the problem can be mapped onto an effective homopolymer adsorption problem. In particular we discuss how the critical adsorption energy and the fraction of adsorbed monomers depend on the block length $M$ of sticking monomers $A$, and on the total length $N$ of the polymer chains. Also the adsorption of the random copolymers is considered and found to be well described within the framework of the annealed approximation. For a better test of our theoretical prediction, two different Monte Carlo (MC) simulation methods were employed: a) off-lattice dynamic bead-spring model, based on the standard Metropolis algorithm (MA), and b) coarse-grained lattice model using the Pruned-enriched Rosenbluth method (PERM) which enables tests for very long chains. The findings of both methods are fully consistent and in good agreement with theoretical predictions.Comment: 27 pages, 12 figure

Patient-reported outcomes of periacetabular osteotomy from the prospective ANCHOR cohort study

BACKGROUND: Current literature describing the periacetabular osteotomy (PAO) is mostly limited to retrospective case series. Larger, prospective cohort studies are needed to provide better clinical evidence regarding this procedure. The goals of the current study were to (1) report minimum 2-year patient-reported outcomes (pain, hip function, activity, overall health, and quality of life), (2) investigate preoperative clinical and disease characteristics as predictors of clinical outcomes, and (3) report the rate of early failures and reoperations in patients undergoing contemporary PAO surgery. METHODS: A large, prospective, multicenter cohort of PAO procedures was established, and outcomes at a minimum of 2 years were analyzed. A total of 391 hips were included for analysis (79% of the patients were female, and the average patient age was 25.4 years). Patient-reported outcomes, conversion to total hip replacement, reoperations, and major complications were documented. Variables with a p value of ≤0.10 in the univariate linear regressions were included in the multivariate linear regression. The backward stepwise selection method was used to determine the final risk factors of clinical outcomes. RESULTS: Clinical outcome analysis demonstrated major clinically important improvements in pain, function, quality of life, overall health, and activity level. Increasing age and a body mass index status of overweight or obese were predictive of improved results for certain outcome metrics. Male sex and mild acetabular dysplasia were predictive of lesser improvements in certain outcome measures. Three (0.8%) of the hips underwent early conversion to total hip arthroplasty, 12 (3%) required reoperation, and 26 (7%) experienced a major complication. CONCLUSIONS: This large, prospective cohort study demonstrated the clinical success of contemporary PAO surgery for the treatment of symptomatic acetabular dysplasia. Patient and disease characteristics demonstrated predictive value that should be considered in surgical decision-making. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Porous Silicon Nanoparticles Embedded in Poly(lactic‐ co ‐glycolic acid) Nanofiber Scaffolds Deliver Neurotrophic Payloads to Enhance Neuronal Growth

Scaffolds made from biocompatible polymers provide physical cues to direct the extension of neurites and to encourage repair of damaged nerves. The inclusion of neurotrophic payloads in these scaffolds can substantially enhance regrowth and repair processes. However, many promising neurotrophic candidates are excluded from this approach due to incompatibilities with the polymer or with the polymer processing conditions. This work provides one solution to this problem by incorporating porous silicon nanoparticles (pSiNPs) that are pre-loaded with the therapeutic into a polymer scaffold during fabrication. The nanoparticle-drug-polymer hybrids are prepared in the form of oriented poly(lactic-co-glycolic acid) nanofiber scaffolds. We test three different therapeutic payloads: bpV(HOpic), a small molecule inhibitor of phosphatase and tensin homolog (PTEN); an RNA aptamer specific to tropomyosin-related kinase receptor type B (TrkB); and the protein nerve growth factor (NGF). Each therapeutic is loaded using a loading chemistry that is optimized to slow the rate of release of these water-soluble payloads. The drug-loaded pSiNP-nanofiber hybrids release approximately half of their TrkB aptamer, bpV(HOpic), or NGF payload in 2, 10, and >40 days, respectively. The nanofiber hybrids increase neurite extension relative to drug-free control nanofibers in a dorsal root ganglion explant assay

PolymiRTS Database 2.0: linking polymorphisms in microRNA target sites with human diseases and complex traits

The polymorphism in microRNA target site (PolymiRTS) database aims to identify single-nucleotide polymorphisms (SNPs) that affect miRNA targeting in human and mouse. These polymorphisms can disrupt the regulation of gene expression by miRNAs and are candidate genetic variants responsible for transcriptional and phenotypic variation. The database is therefore organized to provide links between SNPs in miRNA target sites, cis-acting expression quantitative trait loci (eQTLs), and the results of genome-wide association studies (GWAS) of human diseases. Here, we describe new features that have been integrated in the PolymiRTS database, including: (i) polymiRTSs in genes associated with human diseases and traits in GWAS, (ii) polymorphisms in target sites that have been supported by a variety of experimental methods and (iii) polymorphisms in miRNA seed regions. A large number of newly identified microRNAs and SNPs, recently published mouse phenotypes, and human and mouse eQTLs have also been integrated into the database. The PolymiRTS database is available at http://compbio.uthsc.edu/miRSNP/