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The increase in nurse practitioners (NPs) in ambulatory medical and surgical specialty settings has prompted inquiry into their role and contribution to patient care. We explored the role and contribution of NPs in ambulatory specialty care through their activities outside of direct care and billable visits (referred to as service value activities), and how NPs perceive these activities enhance quality and efficiency of care, for both patients and the health care institution. This qualitative thematic analysis examined interviews from 16 NPs at a large academic medical center about their role and contribution to patient care quality and departmental efficiency beyond billable visits. Five categories of NP contribution were identified: promoting patient care continuity, promoting departmental continuity, promoting institutional historical and insider knowledge, addressing time-sensitive issues, and participating in leadership and quality improvement activities. As the role of NPs in specialty care grows and health care systems emphasize quality of care, it is appropriate to explore the quality- and efficiency-enhancing activities NPs perform in specialty care beyond direct patient care.

Our multi-institutional university consortium implemented a gastroschisis pathway in 2015 to standardize and improve care by promoting avoidance of routine intubation and paralysis during silo placement, expeditious abdominal wall closure, discontinuation of antibiotics/narcotics within 48 h of closure, and early initiation/advancement of feeds.Adherence to the gastroschisis pathway was prospectively monitored. Outcomes for the contemporary cohort (2015-2018) were compared with a historical cohort (2007-2012).Good adherence to the pathway was observed for 70 cases of inborn uncomplicated gastroschisis. The contemporary cohort had significantly lower median mechanical ventilator days (2 versus 5; p 0.01) and antibiotic days (5.5 versus 9; p 0.01) as well as earlier days to initiation of feeds (12 versus 15; p 0.01). However, no differences were observed in length of stay (28 versus 29 days; p = 0.70). A skin closure technique was performed in 66% of the patients, of which 46% were performed at bedside without intubation, the assistance of an operating-room team, or general anesthesia.In this study, adherence to a clinical pathway for gastroschisis across different facilities was feasible and led to reduction in exposure to mechanical ventilation and antibiotics. The adoption of a bedside skin closure technique appears to facilitate compliance with the pathway.Level II/III TYPE OF STUDY: Prospective comparative study with historical cohort.

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.

statement The mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes through increasing the use of the Cochrane Library and supporting Cochrane's role by providing an evidence base for nurses and healthcare professionals who deliver, lead or research nursing care. The CNCF produces Cochrane Corner columns, summaries of recent nursing-care-relevant Cochrane Reviews that are regularly published in collaborating nursing-related journals. Information on the processes CNCF has developed can be accessed at: cncf.cochrane.org/evidence-transfer-program-review-summaries. This is a Cochrane review summary of: Stevens B, Yamada J, Ohlsson A et al ( 2016 ) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews. Issue 7. CD001069. doi: 10.1002/14651858. CD001069.pub5.

Background Type 1 diabetes is a common childhood pediatric disease characterized by autoimmune destruction of insulin producing βeta-cells in the pancreas.1 Effective measurement and control of blood glucose levels is critical for the health and wellbeing of adolescents with type 1 diabetes. Adolescents using continuous subcutaneous insulin pumps are able to perform continuous glucose monitoring. However, evidence is unclear if this improves effectiveness when compared to self-glucose monitoring alone. This review aims to establish the optimal care of an adolescent with type 1 diabetes mellitus to maintain glycemic control and to avoid hypoglycemia. Objectives The review question is: are metabolic outcomes improved in outpatient adolescents with type 1 diabetes on a continuous subcutaneous insulin infusion pump when continuous glucose monitoring is used, compared to self-glucose monitoring alone? Inclusion criteria Types of participants This review included studies of adolescent patients, aged 12 to 18 years, in the outpatient setting with type 1 diabetes mellitus utilizing a continuous subcutaneous insulin infusion pump. Type of intervention This review included studies which evaluated continuous glucose monitoring, as compared to self-glucose monitoring alone, in adolescents utilizing a continuous subcutaneous insulin infusion pump. Types of outcomes This review included studies examining the following outcome measures: number of hypoglycemic episodes (glucose < 70mg/dL) and hemoglobin A1C level. Types of studies This review included randomized controlled trials, quasi-experimental studies were considered only in the absence of randomized controlled trials. Search strategy The search strategy included studies published between 2002 and 2012 in, or translated into, English. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity utilizing standardized critical appraisal instrument from the Joanna Briggs Institute. Data extraction Data was extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data synthesis Quantitative papers were pooled by statistical meta-analysis using JBI-MAStARI. A fixed effect model for continuous data was utilized to express weighted mean differences and 95% confidence intervals were calculated. Heterogeneity was assessed statistically using the standard Chi-square. Results There is no statistical or clinically significant difference in levels of hemoglobin A1C in adolescents on continuous subcutaneous insulin infusion pumps utilizing continuous glucose monitoring devices as compared to those utilizing self-glucose monitoring alone. Conclusions From the findings of this review, the utilization of a continuous glucose-monitoring device in conjunction with an insulin pump does not improve hemoglobin A1C levels when compared with self-glucose monitoring in adolescent patients with type 1 diabetes.

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library.