Economics of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients.

BACKGROUND: The obective of this study was to perform a cost-effectiveness analysis comparing intermittent with continuous renal replacement therapy (IRRT versus CRRT) as initial therapy for acute kidney injury (AKI) in the intensive care unit (ICU). METHODS: Assuming some patients would potentially be eligible for either modality, we modeled life year gained, the quality-adjusted life years (QALYs) and healthcare costs for a cohort of 1000 IRRT patients and a cohort of 1000 CRRT patients. We used a 1-year, 5-year and a lifetime horizon. A Markov model with two health states for AKI survivors was designed: dialysis dependence and dialysis independence. We applied Weibull regression from published estimates to fit survival curves for CRRT and IRRT patients and to fit the proportion of dialysis dependence among CRRT and IRRT survivors. We then applied a risk ratio reported in a large retrospective cohort study to the fitted CRRT estimates in order to determine the proportion of dialysis dependence for IRRT survivors. We conducted sensitivity analyses based on a range of differences for daily implementation cost between CRRT and IRRT (base case: CRRT day $632 more expensive than IRRT day; range from $200 to $1000) and a range of risk ratios for dialysis dependence for CRRT as compared with IRRT (from 0.65 to 0.95; base case: 0.80). RESULTS: Continuous renal replacement therapy was associated with a marginally greater gain in QALY as compared with IRRT (1.093 versus 1.078). Despite higher upfront costs for CRRT in the ICU ($4046 for CRRT versus $1423 for IRRT in average), the 5-year total cost including the cost of dialysis dependence was lower for CRRT ($37 780 for CRRT versus $39 448 for IRRT on average). The base case incremental cost-effectiveness analysis showed that CRRT dominated IRRT. This dominance was confirmed by extensive sensitivity analysis. CONCLUSIONS: Initial CRRT is cost-effective compared with initial IRRT by reducing the rate of long-term dialysis dependence among critically ill AKI survivors.

Nursing Facility Accountability Measure Work group Membership List, March 19, 2009

Recognize facilities that provide quality of life and appropriate access to medical assistance program beneficiaries in a cost-effective manner. Each measure is intended to represent nursing facility characteristics in each of the four domains.

Iowa Board of Nursing Annual Report, July 1, 2011-June 30, 2012

The annual report of the Iowa Board of Nursing includes information on legislation, administrative rules, nursing education, nursing practice, continuing education, licensing, enforcement, administration, financial report, statistics and general nursing demographics.

The Economics of Dead Zones: Linking Externalities from the Land to their Consequences in the Sea, October 2012,

The purpose of this review and analysis is to provide a basic understanding of the issues related to worldwide hypoxic zones and the range of economic questions sorely in need of answers. We begin by describing the causes and extent of hypoxic zones worldwide, followed by a review of the evidence concerning ecological effects of the condition and impacts on ecosystem services. We describe what is known about abatement options and cost effective policy design before turning to an analysis of the large, seasonally recurring hypoxic zone in the Gulf of Mexico. We advance the understanding of this major ecological issue by estimating the relationship between pollutants (nutrients) and the areal extent of the hypoxic zone. This “production function” relationship suggests that both instantaneous and legacy contributions of nutrients contribute to annual predictions of the size of the zone, highlighting concerns that ecologists have raised about lags in the recovery of the system and affirms the importance of multiple nutrients as target pollutants. We conclude with a discussion of critical research needs to provide input to policy formation.

Delirium upon admission to Swiss nursing homes: a cross-sectional study.

QUESTIONS UNDER STUDY: We wished to investigate the prevalence of delirium in patients upon admission to nursing homes and whether or not the previous place of residence predicts delirium. METHODS: The Resident Assessment Instrument Minimum Data Set (RAI-MDS) and the Nursing Home Confusion Assessment Method (NHCAM) were used to determine whether the previous place of residence (community, nursing home, acute care, psychiatric, rehabilitation hospital) predicted the prevalence of sub-syndromal or full delirium in nursing home residents in three Swiss cantons (n = 11745). RESULTS: 39.7% had sub-syndromal and 6.5% had full delirium. Lower cognitive performance and increased depressive symptoms were significant predictors of higher NHCAM values independent of previous residence. Age, civil status, continence, newly introduced drugs, and basic activities of daily living were predictors in some resident groups. The variance of NHCAM scores explained varied between 25.1% and 32.3% depending on previous residence. CONCLUSIONS: Sub-syndromal and full delirium are common upon nursing home admission. Increased dependence and depression are consistently associated with higher NHCAM scores. Patients from psychiatric settings have an increased risk of delirium. Although factors associated with delirium depend on a patient's previous residence, all patients must be carefully screened for sub-syndromal and full delirium.

Iowa Board of Nursing Annual Report, July 1, 2012-June 30, 2013

The annual report of the Iowa Board of Nursing includes information on legislation, administrative rules, nursing education, nursing practice, continuing education, licensing, enforcement, administration, financial report, statistics and general nursing demographics.

Iowa Board of Nursing Annual Report, July 1, 2012-June 30, 2013

The annual report of the Iowa Board of Nursing includes information on legislation, administrative rules, nursing education, nursing practice, continuing education, licensing, enforcement, administration, financial report, statistics and general nursing demographics.

The construction process of pedagogical knowledge among nursing professors

Didactic knowledge about contents is constructed through an idiosyncratic synthesis between knowledge about the subject area, students' general pedagogical knowledge and the teacher's biography. This study aimed to understand the construction process and the sources of Pedagogical Content Knowledge, as well as to analyze its manifestations and variations in interactive teaching by teachers whom the students considered competent. Data collection involved teachers from an undergraduate nursing program in the South of Brazil, through non-participant observation and semistructured interviews. Data analysis was submitted to the constant comparison method. The results disclose the need for initial education to cover pedagogical aspects for nurses; to assume permanent education as fundamental in view of the complexity of contents and teaching; to use mentoring/monitoring and the value learning with experienced teachers with a view to the development of quality teaching.

The emergence of forensic nursing and advanced nursing practice in Switzerland: an innovative case study consultation.

BACKGROUND AND METHODS: The objectives of this article were to systematically describe and examine the novel roles and responsibilities assumed by nurses in a forensic consultation for victims of violence at a University Hospital in French-speaking Switzerland. Utilizing a case study methodology, information was collected from two main sources: (a) discussion groups with nurses and forensic pathologists and (b) a review of procedures and protocols. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined by Hamric, Spross, and Hanson (2009). RESULTS: Advanced nursing practice competencies noted in the analysis included "direct clinical practice," "coaching and guidance," and "collaboration." The role of the nurse in terms of "consultation," "leadership," "ethics," and "research" was less evident in the analysis. DISCUSSION AND CONCLUSION: New forms of nursing are indeed practiced in the forensic clinical setting, and our findings suggest that nursing practice in this domain is following the footprints of an advanced nursing practice model. Further reflections are required to determine whether the role of the forensic nurse in Switzerland should be developed as a clinical nurse specialist or that of a nurse practitioner.

Is the ATIC terminology oriented to nursing phenomena?

The main goal of this observational and descriptive study is to evaluate whether the diagnosis axis of a nursing interface terminology meets the content validity criterion of being nursing-phenomena oriented. Nursing diagnosis concepts were analyzed in terms of presence in the nursing literature, type of articles published and areas of disciplinary interest. The search strategy was conducted in three databases with limits in relation to period and languages. The final analysis included 287 nursing diagnosis concepts. The results showed that most of the concepts were identified in the scientific literature, with a homogeneous distribution of types of designs. Most of these concepts (87.7%) were studied from two or more areas of disciplinary interest. Validity studies on disciplinary controlled vocabularies may contribute to demonstrate the nursing influence on patients" outcomes.

The Economics of Reducing the County Road System: Three Case Studies in Iowa - Executive Summary, HR-242, 1986

This Executive Summary presents a brief summary of the main research report, "The Economics of Reducing the County Road System: Three Case Studies in Iowa" (DOT/OST/P-34/86-035). The case studies are described, as well as the analytic methodology and research findings.