869 Chapters
Medium 9781937554873

2 Stumbling into Leadership: Does Gender Matter?

Christopher Lance Coleman Sigma Theta Tau International ePub

Kevin Daugherty Hook, MA, MSN, CRNP
Adult and Gerontologic Nurse Practitioner, CNO
LIFE UPenn, University of Pennsylvania School of Nursing

Like many men, nursing was a second career for me (actually a third). My professional nursing career followed a stint as a high school English teacher, a graduate degree in religious studies and ethics, and a few years with a large entertainment corporation. I had long desired a career in nursing, but for many reasons had not pursued one. Shortly after I started work as a bedside nurse in the intensive care unit / critical care unit (ICU/CCU), a hospital chaplain remarked that what made older people coming into the nursing profession interesting was that our work identities were not “formed in the crucible of the hospital.” Since then, I have pondered that remark and wondered in what ways nurses such as I might be doing things differently. Although I have several observations on this topic, the most germane to leadership is that those of us who came to nursing later and now find ourselves in leadership roles bring an outsider’s view to nursing in general and to health care organizations in particular. To what degree this hinders or hampers our professionalization as nurses is another topic. I have concluded, however, that in terms of leadership, it is a good thing.

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24 Formulary Management and Economic Considerations: Bridging the Gap between Quality Care and Cost

LaPlante. K.; Cunha, C.; Morrill, H. CABI PDF

24

Formulary Management and Economic

Considerations: Bridging the Gap between Quality Care and Cost

Dayna McManus,1 Michael A. Ruggero,2 and Jeffrey E.

Topal3*

1

Inova Fairfax Hospital, Falls Church, Virginia, US; 2Hospital of the University of

Pennsylvania, Philadelphia, Pennsylvania, US; 3Yale School of Medicine and

Yale New Haven Hospital, New Haven, Connecticut, US

Introduction

Traditionally, a driver for the formation of antimicrobial stewardship teams in the inpatient setting has been the aggregate cost reduction of antimicrobial therapy. However, one of the most important aims should be the optimization of patient care outcomes and prevention of the development of antimicrobial resistance (Fishman, 2006; Rybak, 2007).

Unfortunately, these quality metrics are much more difficult to quantify than antibiotic expenditures, but they need to be studied and quantified in order to continue the growth and success of stewardship efforts. Often, there is much initial enthusiasm for antimicrobial stewardship efforts and a significant reduction of overall antibiotic expenditures can be demonstrated in the first year or two of such a program. Thereafter, and once the antibiotic prescribing process proper checks and balances have been implemented, reductions in antimicrobial expenditures are often more modest in nature (Fishman, 2006;

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8: Eden’s Garden of South America

Webber, R. CABI PDF

Eden’s Garden of South

America

8

The Peopling of America

The biggest controversy in archaeology is over the time when humans first

­entered the Americas. Established work in North America decided this was about 15,000–17,000 years ago, based on the Clovis culture, for which there are dated artefacts up to 13,000 bp (years before present). Furthermore,

80% of the present North American populations have genetic links to the

Clovis people. However, sites in Chile at Cueva Fell and Monte Verde suggest that people migrated into South America at a much earlier date. There have been remarkable findings at Pedra Furada (now called the Serra da

Capivara National Park), where remains have been dated to 17,000–32,000 bp.

Not only do these dates considerably antedate those of the Clovis culture, but Serra da Capivara is in Brazil, inland from Recife, on the east side of

South America, thus suggesting that ancient peoples travelled into what is now the Amazon, as well as ­following down the Pacific coast, as had always been presumed.

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2 Parasites of the Gastrointestinal System

Elsheikha, H.M.; Wright, I.; McGarry, J. CABI PDF

2

Parasites of the

Gastrointestinal

System

Ascariasis of Dogs and Cats

What is ascariasis of cats and dogs?

Ascarid infections of dogs and cats are cosmopolitan. Adult worms live in the small intestine of dogs (Toxocara canis (Fig. 2.1a) and Toxascaris leonina) or cats (Toxocara cati (Fig. 2.1b) and Toxascaris leonina). Fertilized females produce eggs that become infective in the environment after being passed in faeces. Infections are well tolerated in cats and dogs but can lead to ill thrift and respiratory signs in heavily infected individuals, typically puppies and kittens. Pathology associated with ascarid infections in dogs and cats involves inflammatory and pathological alterations in the intestinal mucosa (caused by adults) and hepatopulmonary tissues (caused by migrating larvae).

What happens after a dog ingests T. canis eggs?

After a dog eats viable, embryonated eggs (Fig. 2.2) from the environment, the eggs hatch and escaped larvae enter the wall of the small intestine. The larvae migrate through the circulatory system and go to either the respiratory system or other organs/tissues in the body. If they enter body tissues, they encyst, especially in older dogs and pregnant bitches. In very young puppies, larvae move from the circulation to the respiratory system, are coughed up and swallowed and mature into adult worms in the small intestine. These adult worms lay eggs, which pass out of the animal in the faeces

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12 The Role of New Diagnostics to Enhance Antibiotic Stewardship Efforts

LaPlante. K.; Cunha, C.; Morrill, H. CABI PDF

12

The Role of New Diagnostics to

Enhance Antibiotic Stewardship Efforts

Kimberle C. Chapin and April M. Bobenchik*

The Warren Alpert School of Medicine of Brown University, Providence,

Rhode Island, US

Introduction

Clinical diagnostics performed in the clinical microbiology laboratory for the purposes of identifying infectious diseases or antibiotic susceptibility has changed significantly in the past 20 years. The transitions have come on three major fronts: less culturebased to more rapid technologies and molecular based assays; less subjective interpretive reporting to an increase in automation and objective results; and finally, how implementation of new technologies into the laboratory and clinical practice achieves success. The drivers for rapid diagnostic implementation are as likely to be initiated from outside the laboratory as from within the lab itself, and often stem from initiatives to support other hospital or healthcare goals, including: rapid PCR testing for

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