Spatial event cluster detection using an approximate normal distribution

Background  

In geographic surveillance of disease, areas with large numbers of disease cases are to be identified so that investigations of the causes of high disease rates can be pursued. Areas with high rates are called disease clusters and statistical cluster detection tests are used to identify geographic areas with higher disease rates than expected by chance alone. Typically cluster detection tests are applied to incident or prevalent cases of disease, but surveillance of disease-related events, where an individual may have multiple events, may also be of interest. Previously, a compound Poisson approach that detects clusters of events by testing individual areas that may be combined with their neighbours has been proposed. However, the relevant probabilities from the compound Poisson distribution are obtained from a recursion relation that can be cumbersome if the number of events are large or analyses by strata are performed. We propose a simpler approach that uses an approximate normal distribution. This method is very easy to implement and is applicable to situations where the population sizes are large and the population distribution by important strata may differ by area. We demonstrate the approach on pediatric self-inflicted injury presentations to emergency departments and compare the results for probabilities based on the recursion and the normal approach. We also implement a Monte Carlo simulation to study the performance of the proposed approach.     

Social Work Admission Assessment Tool for identifying patients in need of comprehensive social work evaluation

Early identification of patients who need a social work evaluation is integral to effective discharge planning. This article describes the development and application of the Social Work Admission Assessment Tool (SWAAT), a six-item scale that identifies patients with complicated discharge needs who require a social work evaluation. It addresses ambulation, mental status, living situation, current social services, self-perceived need for additional services, and need for assistance in going home. Based on their scores, patients are categorized as having low, intermediate, or high need. A greater proportion of high-need patients were discharged with services and had prolonged hospitalizations (p = .0001). The SWAAT is a comprehensive needs assessment tool that may facilitate discharge planning and improve quality of care.     

Nursing considerations for optimal outpatient management of adult patients with leukemia treated with clofarabine

Despite improvements in treatment, the outcome for some adult patients with acute or chronic leukemias remains poor. Clofarabine, a second-generation purine nucleoside analog, received U.S. Food and Drug Administration approval in 2004 for the treatment of pediatric patients with relapsed or refractory acute lymphocytic leukemia after at least two previous regimens. In addition, clinical studies have shown encouraging safety and efficacy results with clofarabine in the treatment of adult patients with various hematologic malignancies. Although most adult patients with leukemia receive the first course of clofarabine while hospitalized, many can be subsequently treated as outpatients with proper monitoring, support, and education. The most frequent side effects associated with clofarabine are gastrointestinal-related, myelosuppression, hepatotoxicity, renal dysfunction, and anorexia. Careful patient monitoring is essential to ensure early identification and prompt intervention. Younger patients and those of any age with no comorbid health issues, good performance status, and an adequate support network are more likely to tolerate outpatient clofarabine administration. Early identification and proactive pharmacologic and nonpharmacologic interventions may reduce the severity of these toxicities and prevent their progression. Patient education about strategies for prevention and management of symptoms also is essential.     

Best practices in creating a culture of certification

Certification is the criterion standard of professional practice, distinguishing excellence in nursing care, mastery of knowledge, skills, and abilities beyond the scope of professional licensure. It is the validation of an individual nurse's qualifications for practice in a defined area. Becoming certified is a personal and professional commitment that demonstrates the value that the individual nurse places on higher standards of practice and lifelong learning. The American Association of Critical-Care Nurses (AACN) Beacon Award for Excellence, Magnet Recognition Program, and Malcolm Baldrige National Quality Award all recognize certification as a key component of nursing excellence in specialty practice. Both the general public and nurse professionals increasingly recognize the need for practice on the basis of evidence to provide safe, quality patient care. In today's rapidly changing and complex health care delivery system, certification is becoming the standard by which bedside practice and the impact of nursing care on patient outcomes are measured. This article will provide a review of current best practices in creating a culture of certification, including the journey of 3 hospitals selected as the 2010 Best Practice Roundtable presentations at the AACN National Teaching Institute.