Executive competencies of nurses in the Veterans Health Administration

This study identifies competencies and accompanying skills, knowledge, and abilities (SKAs) required by the Veterans Health Administration (VHA) nurse executives. Using the Delphi decision-making method, 144 VHA directors of nursing identified five top competencies necessary for nurse executives. An expert panel sorted competencies into the eight core domains of the VHA high-performance development model. Next, nurse executives rated SKAs by using a 7-point importance scale. Response rates were 34% and 48.2% for Delphi rounds 1 and 2, respectively. Round 1 generated 245 unique nurse executive competencies. In round 2, the highest rated SKAs involved ethical conduct, decision-making, abilities to continuously learn and lead, staffing, and conflict-resolution skills. Competency list outcomes are expected to be useful for executive self-assessment, professional development, and identification of continuing education needs. Specific SKAs can provide a means for development of job requirements and career performance criteria.     

Computer-assisted quantification of interstitial lung disease associated with rheumatoid arthritis: preliminary technical validation

Purpose

To validate a threshold-based prototype software application (MeVis PULMO 3D) for quantification of chronic interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) using variable threshold settings for segmentation of diseased lung areas.

Methods

Twenty-two patients with rheumatoid arthritis were included and underwent thin-section CT (4 × 1.25 mm collimation). CT scans were assessed by two observers for extent of ILD (EoILD), and twice by MeVis PULMO 3D for each protocol. MeVis PULMO 3D used four segmentation threshold (ST) settings (ST = −740, −780, −800 and −840 HU). Pulmonary function tests were obtained in all patients. Statistical evaluation used 95% limits of agreement (LoA) and linear regression analysis.

Results

There was total concordance between the software measurements. Interobserver agreement was good (LoA = −28.36 to 17.58%). EoILD by readers correlated strongly with DL_CO (r = −0.702, p < 0.0001) and moderately with FVC (r = −0.523, p = 0.018). There was close correlation between readers and MeVis PULMO 3D with best results for ST <780 HU (EoILD vs. MeVis PULMO 3D: r = 0.650 for ST = −800 and −840 HU, respectively; p = 0.002). MeVis PULMO 3D correlated best with DL_CO at ST of −800 HU (r = −0.44, −0.49, −0.58 and −0.57 for ST = −740, −780, −800 and −840, respectively; p = 0.007-0.05) and moderately with FVC (r = −0.44, −0.51, −0.59 and −0.45 for ST = −740, −780, −800 and −840), respectively; p = 0.007-0.05).

Conclusion

The MeVis PULMO 3D system used holds promise to become a valuable instrument for quantification of chronic ILD in patients with RA when using the threshold value of −800 HU, with evidence of the closest correlations, both with human observers and physiologic impairment.     

Spread of ampicillin/vancomycin-resistant Enterococcus faecium of the epidemic-virulent clonal complex-17 carrying the genes esp and hyl in German hospitals

The incidence of vancomycin-resistant Enterococcus faecium isolation was low (≤5%) in German hospitals before 2003. Within the second half of 2003 and the first half of 2004, however, increasing frequencies of up to 14% were noticed in several hospitals in southwestern Germany. This increase was attributed mainly to the occurrence and spread of epidemic-virulent ampicillin/vancomycin-resistant, vanA- and vanB-positive E. faecium clones, most of which exhibited the virulence factors enterococcal surface protein (esp) and bacteriocin activity and some which exhibited hyaluronidase (hyl). E. faecium possessing hyaluronidase was initially found in U.S. hospitals and recently detected in several European hospitals and, subsequently, in German hospitals as well. Ampicillin/vancomycin-resistant E. faecium clones originating mainly from southwestern German hospitals were characterized by multilocus sequence typing since different sequence types (STs) belonging to the clonal complex-17 are currently disseminated worldwide. Multilocus sequence typing revealed that, in 1998 and 1999, ampicillin/vancomycin-resistant E. faecium clone ST-117 was prevalent in various German hospitals, while in 2003 and 2004, clone ST-203 dominated in several hospitals located in southwestern Germany. Both sequence types display single-locus variants of ST-78, which was frequently recorded in various Italian hospitals between 2000 and 2003, and all of these STs belong to the clonal complex-17. Expression of linezolid resistance was observed in ampicillin/glycopeptide-resistant E. faecium strains (VanA type) from two tertiary hospitals in southwestern Germany due to mutations in domain V of the 23S rDNA (G2576T). While in one hospital the resistance emerged during linezolid therapy, in the other hospital resistance was caused by transfer of an identical linezolid/ampicillin/glycopeptide-resistant E. faecium strain. In conclusion, it is very important to monitor the occurrence of epidemic-virulent clonal complex-17 strains of E. faecium to prevent their spread in hospitals, especially if they are resistant to glycopeptides and linezolid.     

Molecular epidemiology of hospital-acquired vancomycin-resistant enterococci

Vancomycin-resistant Enterococcus faecium strains are a significant cause of nosocomial infections in predisposed patients. Multiple-locus variable-number tandem repeat analysis (MLVA) has been validated recently by use of a global strain collection. In this report, we applied MLVA together with multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) to type 14 isolates from three clusters of patients colonized or infected with vancomycin-resistant Enterococcus faecium and another 10 epidemiologically unrelated isolates from the same hospital. The clusters could be distinguished by all three typing methods, which proved to be concordant. PFGE patterns provided the highest resolution. We observed seven sequence types (ST), six MLVA types (MT), and nine distinct ST/MT combinations. The combination of MLST and MLVA may be an alternative to PFGE in hospital epidemiology, providing the benefits of high accuracy, reproducibility, and portability.     

Co-expressed genes enhance precision of receptor status identification in breast cancer patients

Purpose

Radial scar’s stellate appearance may mimic carcinoma mammographically and histologically. Management of radial scar (RS) found on breast core needle biopsies (CNB) ranges from excision to clinical observation due to the variation in reported upgrades to malignancy at surgical excision. We examined the upgrade rate in patients with RS detected on CNB at our institution and reviewed the current literature.

Methods

A retrospective study was conducted of all cases with RS diagnosed on CNB between December 2006 and March 2017 at our institution. Inclusion criteria were patients with “pure” RS and RS associated with high-risk lesions (HRL). Upgrade was defined as invasive or non-invasive cancer in the excisional biopsy.

Results

157 cases were identified with RS on CNB, and 122 cases met inclusion criteria. Of these 122 cases, 91 (75%) had pure RS on CNB while 31 (25%) had associated atypia or HRL. 81 (66%) of patients proceeded to excisional biopsy and 41 (34%) did not. Two patients (1.6% of total) were found to have a low-grade invasive ductal carcinoma (0.6 and 0.8 cm) upon surgical excision. None of the remaining 120 patients developed an ipsilateral breast cancer with a mean of 32.3-month follow-up.

Conclusions

We found a very low upgrade rate to breast cancer when RS was found on CNB with or without associated HRL. Our results are consistent with other reported series. Our data do not support surgical excision for RS but rather close clinical follow-up for patients with RS on CNB.