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Introduction: In the United States, deep vein thrombosis (DVT) and pulmonary embolism (PE) ranked high in terms of possibly preventable hospital deaths. Victims of trauma were at a higher risk of developing thromboembolic complications, and thus various agents were used for prophylaxis. Multiple studies recommended holding these agents in the perioperative period to decrease the potential complications of additional bleeding, wound issues, hematoma etc. However, the data regarding the timing and duration of withholding these agents was not consistent and at times surgeon specific. The aim of this study was to compare the incidence of DVT/PE in trauma patients before and after a June 2022 policy intervention to operate through prophylactic anticoagulation at an academic trauma center., Methods: We compared DVT/PE rates in trauma patients requiring surgery prior to and following policy change at our institution. The query included charts from January 1, 2018, through December 31, 2023. Clinical information relating to trauma date, surgery date, injury type, anticoagulant administration, DVT/PE development, and death, if applicable, was obtained from patient charts. We conducted a chi-square post hoc analysis to evaluate the incidence of DVT or PE before and after a policy change. The analysis focused on two categories: the presence or absence of DVT/PE., Results: DVT/PE development was 14.553 times more likely pre-policy change when anticoagulation was held prior to surgery compared to post-policy change when anticoagulation was administered before surgery (X 2 (3, N = 374) =14.553, p=.002). Mortality related to DVT/PE showed no significant difference between pre-policy and post-policy groups (X 2 (1, N = 374) = 0.130, p = .718). After excluding patients over age 65, analysis of MVA blunt trauma charts showed no statistical difference in blood transfusions pre policy v. post policy (X 2 (1, N = 174) = 0.2198, p = .639)., Conclusion: Findings suggested that DVT/PE rates have significantly decreased post policy change without a significant increase in mortality and bleeding risk., Competing Interests: Declaration of competing interest None., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background: Clinical education provides important learning opportunities for students. Finding clinical sites and faculty can be a challenge. Exploring the relationship between the number of clinical practice hours and NCLEX-RN success may be helpful for curriculum development and revision., Purpose: The purpose of this study was to provide descriptive information about clinical education in RN programs and determine if a relationship existed between the number of clinical hours and NCLEX-RN pass rate., Method: A descriptive research design using a survey was sent to over 1000 accredited nursing programs in the United States., Results: One hundred and fourteen surveys were completed. When comparing 2021 NCLEX-RN pass rates with clinical hours, there was a statistically significant difference at the 500 clinical hour interval., Conclusion: Nursing programs can ensure fiduciary responsibility while supporting clinical judgment development and licensure success by reviewing their curriculum and reconsidering the number of clinical hours in their programs., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The strategic nursing plan for a large Midwestern health care system includes achievement of the American Nurses Credentialing Center's Magnet ® recognition for all their hospitals. This study explored the barriers to and perceived value of certification among nurses employed by the same health care system across eight facilities in a metropolitan region. One of these facilities holds Magnet ® recognition., Method: Subjects were recruited by direct email to collect demographic data and complete a barrier to certification survey and the Perceived Value of Certification Tool-12., Results: There were statistically significant differences in the perception that lack of institutional support is a barrier to certification both in aggregate and when comparing the Magnet ® hospital with the others., Conclusion: As an initial exploration into barriers and perceived value, this study provides data for this health care system to plan strategies to promote certification. This study also serves as an exemplar for other organizations considering evaluation of certification barriers and value among their nursing staff. [ J Contin Educ Nurs. 2023;54(12):567-573.] .

Background: Hospital violence intervention programs (HVIPs) have recently been initiated in trauma centers across the United States. However, violence-related injuries have unique factors and issues that should be addressed in the health care provided in emergency departments., Purpose: This study aimed to characterize the patient population presenting at a level 1 ACS verified trauma center, with a chief complaint of violent trauma, and identify characteristics of patients most at risk for violence-related trauma., Methods: The cross-sectional retrospective study examined patients' electronic health records, at least 18 years, with a diagnosis of blunt or penetrating injury treated by the emergency and trauma team at level 1 ACS verified trauma center in the Midwest., Results: Assault injuries accounted for most of the mechanisms that required treatment at the hospital and disposed to home. Nearly 80% of the population had no documentation of the relationship of the assailant. The average age of the patients was 33 years and black males. Eleven patients were treated in the emergency department twice for a trauma-related injury during the six-month data collection., Conclusion: Injuries from violence require comprehensive care from various healthcare disciplines, similar to managing acute and chronic illnesses. The American College of Surgeons (ACS) guidelines support the development of an HVIP to identify risk factors and treatment plans for any patient exposed to violence. This research demonstrates that HVIPs should provide standardized screening and follow-up care while in the emergency department or immediately following the hospital to reduce the cyclical events.

Background: Nursing programs in the United States primarily use multiple-choice questions to prepare students for the NCLEX., Background: Nursing programs in the United States primarily use multiple-choice questions to prepare students for the NCLEX. Currently, the optional next-generation NCLEX is testing the validity and reliability of situational case studies., Purpose: The purpose of this study was to investigate the preparedness and confidence of nurse educators in writing NCLEX-style questions., Methods: A descriptive survey design with snowball sampling was used to collect the data and was sent to 1550 deans/directors/coordinators of publicly available email addresses of accredited schools of nursing., Results: A total of 300 participants completed the survey from 44 states. When asked about confidence in writing NCLEX-style items, those who received formal education or training reported being somewhat confident (51%), whereas those who did not reported ambivalent or not confident (49%)., Conclusion: Surveyed nurse educators lack confidence in writing questions and feel unprepared for the new question types instituted by the NCSBN in 2023. Nurse educators need continued education to develop and review NCLEX-style items and examinations., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: According to Bandura's theory, understanding the relationship of traits and leader self-efficacy in the various roles of nursing can aid in leader development and the growth of the profession., Purpose: The purpose of this study was to explore the perceptions of leader self-efficacy of academic nursing professionals to determine if traits and participation in certain activities was predictive of leader self-efficacy., Method: A validated survey tool, the Leader Efficacy Questionnaire (LEQ) was administered to nursing professionals using snowball sampling from publicly available email addresses., Findings: Statistical significance was found between the academic degrees and the 4 scores of the LEQ. Overall, the participants reported moderate to high leader self-efficacy with an LEQ overall score (LSME) of 70 or greater., Discussion: The dynamic challenges of health care require an understanding of nursing professionals' leader self-efficacy in light of their academic preparation and activities to grow the profession., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: The research purpose was to determine whether exposure to residential diabetes camps affects attitudes toward diabetes care and management in nursing students., Background: Summer camp for children with type 1 diabetes mellitus (T1D) provides a unique and engaging clinical environment for nursing students to learn about evolving diabetes care and to help children develop diabetes management skills., Methods: This prospective, pretest/posttest study assessed student nurses' attitudes about diabetes, who attended one of four residential summer camps in the United States, using the Diabetes Attitude Survey 3 (DAS3). The survey was administered before and after clinical experience designed to fulfill experiential curricula requirements from various nursing programs., Results: After attending diabetes camp, nursing students (N = 73) had a positive change in their attitudes regarding the need for special training and the psychosocial impact of diabetes., Discussion: The diabetes camp clinical experience impacted nursing students' attitudes. Diabetes camps are a unique clinical setting that uses learned clinical knowledge and judgment to promote health and prevent disease and disability, supporting the integration of primary care and public health nursing., (© 2021 Wiley Periodicals LLC.)

Background: No data evaluate the impact that an applicant's residency program reputation has on the outcome of the American Association of Hip and Knee Surgeons (AAHKS) fellowship match. This study sought to determine if an applicant's residency program ranking was associated with where the applicant matched on their rank list., Methods: We included all the US applicants from the "San Francisco Match" regarding AAHKS applicant data and match results from 2014 to 2018. Residency programs were divided into 5 tiers based on 2018 Doximity ranking of Orthopedic Residency Programs. Statistical analysis consisted of descriptive statistics, chi-squared tests, and analysis of variance., Results: In total, 656 applicants met inclusion criteria (620 males; 36 females). Tier 1 applicants applied to an average of 10 fewer programs than applicants from all other tiers. Eighteen percent of applicants from tier 1 residencies were offered interviews at 80%+ of their applied programs compared to 5% or less of the applicants from all other tiers. Applicants from top tier residencies matched at a significantly higher place on their rank list than other tiers (P < .05) and ranked into one of their first 2 choices 72% of the time. The mean fellowship rank position for tier 1 applicants was 5.96 compared to 7.04, 7.85, 7.78, and 8.10 for subsequent tiers, respectively (P < .05)., Conclusion: The fellowship match process represents a high-stakes and expensive process. This study found that applicants from more prestigious residency programs apply to fewer programs, gain more interviews, and match higher on their rank list than applicants from other residency programs., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The primary goal of the present study was to determine if applicants from higher-ranking U.S. orthopaedic surgery residency programs match at a more desired position on their fellowship match-rank list compared with those applicants from lower-ranked residency programs., Methods: San Francisco Match provided results regarding applicant data and match results from 2014 to 2018 for all orthopaedic subspecialties except the hand and the shoulder and elbow. Unmatched applicants and international medical graduates were excluded. Residency programs were divided into 5 tiers (with tier 1 being the highest-ranked residency programs and tier 5 being the lowest-ranked programs) on the basis of 2018 Doximity rankings of orthopaedic residency programs. Statistical analysis consisted of descriptive statistics, chi-square tests, and analysis of variance., Results: Two thousand eight hundred and eleven applicants met inclusion criteria. Applicants from residency programs in tiers 1 and 2 applied to significantly fewer programs than those from tiers 3, 4, or 5 (p < 0.0001). Applicants from each tier were significantly more likely to attain interviews than applicants from all tiers below them (p < 0.01). Applicants from tier-1 residency programs matched at a significantly higher position on their rank list (p < 0.001) and were more desirably ranked by fellowship programs (p = 0.003) compared with all other tiers., Conclusions: Applicants from the highest-ranking residency programs apply to fewer programs, interview at a greater percentage of these programs, and are more likely to match to 1 of their top-ranking programs than applicants from lower-ranking programs. However, the association of the applicant match position with the program ranking appears to be most pronounced when it comes to fellowships selecting which applicants to interview. These findings may help future applicants when determining which programs to apply to during the match.

Purpose: To identify common perceptions and ideas about preparation and planning for retirement of chairs of academic departments of ophthalmology, determining areas of particular stress and proposing ways to better prepare for retirement., Design: Cross-sectional study., Participants: One-hundred sixteen chairs of academic departments of ophthalmology in the United States., Methods: A confidential online survey emailed to ophthalmology chairs., Main Outcome Measures: Surveys assessed demographics; current work schedule; perceptions, preparation, and planning for retirement; and retirement training for faculty and residents., Results: Ninety-six department chairs responded to the survey (82% response rate). Most chairs anticipate retiring around age 70. Significantly, only 9% are looking forward to retirement. Reasons for delaying retirement include keeping active (37%), income/insurance/benefits (20%), and maintaining lifestyle (17%). The most common concern is financing retirement (46%). Forty percent anticipate their reason for retirement will be because of age or health, whereas 20% anticipate fatigue or burnout. Nearly half of the respondents have no specific plan upon retirement. Most respondents anticipate pursuing other interests (43%); 32% intend to spend time with family, vacationing, and travelling. Younger respondents are more concerned with the financial aspects of retirement while more senior respondents appear to delay retirement to keep active or because they enjoy their work., Conclusions: Retirement is a source of stress for many ophthalmology department chairs and many indicate financial preparation is their major concern. Despite this, the major reason for putting off retirement is a desire to keep active. Developing a retirement plan eases stress and engenders a feeling of confidence about the future., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

This report evaluates long-term safety data from 3189 human immunodeficiency virus type 1 (HIV-1) uninfected, healthy volunteers who were enrolled into 51 National Institute of Allergy and Infectious Diseases (NIAID)-sponsored Phase I and II multicentred, randomized, double-blind trials of recombinant HIV-1 subunit vaccines (23 studies), synthetic peptide vaccines (7 studies), live vaccinia-vector recombinant envelope vaccines (7 studies), canarypox vector recombinant vaccines (13 studies), a DNA vaccine (1 study), and a Salmonella-vector vaccine (1 study). During the 12,340 person-years of follow-up, participants were monitored for adverse events including immune dysfunction/autoimmunity, anaphylaxis, cancer, death, and vaccine allergy. The analysis provides evidence that a preparation of a C4-V3 polypeptide vaccine emulsified in incomplete Freund's caused serious toxicity, but otherwise no safety problems considered serious were identified for any of the vaccines and adjuvants studied. These data serve to solidify the growing safety base of current vaccine technologies utilized in candidate vaccines for HIV-1 infection.

Participants in preventive HIV vaccine trials may experience negative social consequences of trial participation, including problems related to a vaccine-induced positive HIV antibody test, yet few vaccine studies have reported on this issue. From October 1995 through November 1998, 1516 AIDS Vaccine Evaluation Group (AVEG) volunteers were assessed for reports of trial-related discrimination (TRD). Ninety TRD events were reported by 76 (5%) of 1516 volunteers. The most commonly reported incidents (n = 52, 57.8%) were negative reactions of friends, family, and co-workers to the volunteer. Few incidents (approximately 10%) were reported as linked to HIV testing. The majority of events (n = 47, 52%) were described by volunteers as "resolved" at the time of reporting, 36 (40%) as "not resolved," and for 7 (8%) events volunteers did not report resolution status. Reported incidents were analyzed by logistic regression to determine their association with the volunteer's age, sex, race, sexual orientation, and HIV risk category. There was no association between volunteer characteristics and TRD. Logistic regression and analysis of variance (ANOVA) were used to analyze association of trial sites with the number of TRD events reported. After controlling for site variation in data collection and reporting, no significant differences were found between the sites in terms of the number or type of TRD reported. Fears that TRD would be widespread and severe have not been borne out by this analysis. While the results of this study are reassuring, they should be interpreted with caution, as it is unclear whether these results may be extended to phase III trials enrolling large numbers of individuals at higher risk of HIV acquisition.

Pulmonary disease caused by Mycobacterium avium complex usually occurs in patients with chronic lung disease or deficient cellular immunity, and its prevalence is increasing. We describe 21 patients (mean age, 66 years) with such infection without the usual predisposing factors, representing 18 percent of the 119 patients surveyed. Seventeen women and 4 men were given a diagnosis of M. avium complex from 1978 to 1987, with a stable incidence over the decade, on the basis of pulmonary symptoms, abnormalities on chest films, positive cultures, and in 14, biopsy evidence of invasive disease. Most of the patients (86 percent) presented with persistent cough and purulent sputum, usually without fever or weight loss. The cough was present for a mean of 25 weeks before the correct diagnosis was made. Radiographic patterns of slowly progressive nodular opacities predominated (71 percent); only five patients had cavitary disease at presentation. All patients responded initially to antimycobacterial therapy, but eight eventually relapsed when it was stopped. Four patients died of progressive pulmonary infection caused by M. avium complex. The extent of the initial pulmonary involvement was greater in patients with progressive disease than in those whose condition improved. We conclude that pulmonary disease caused by the M. avium complex can affect persons without predisposing conditions, particularly elderly women, and that recognition of this disease is often delayed because of its indolent nature.