Sandra C. Garmon Bibb

Evaluating the Joint Theater Trauma Registry as a data source to benchmark casualty care

Just as data from civilian trauma registries have been used to benchmark and evaluate civilian trauma care, data contained within the Joint Theater Trauma Registry (JTTR) present a unique opportunity to benchmark combat care. Using the iterative steps of the benchmarking process, we evaluated data in the JTTR for suitability and established benchmarks for 24-hour mortality in casualties with polytrauma and a moderate or severe blunt traumatic brain injury (TBI). Mortality at 24 hours was greatest in those with polytrauma and a severe blunt TBI. No mortality was seen in casualties with polytrauma and a moderate blunt TBI. Secondary insults after TBI, especially hypothermia and hypoxemia, increased the odds of 24-hour mortality. Data contained in the JTTR were found to be suitable for establishing benchmarks. JTTR data may be useful in establishing benchmarks for other outcomes and types of combat injuries.

Concept analysis: malpractice and modern-day nursing practice.

TOPIC The concept of malpractice can mean different things depending upon the context in which the term is used. This can lead to confusion about the standard of care required for nurses engaged in modern-day nursing practice. PURPOSE This paper examines the attributes and characteristics of the concept of malpractice using Walker and Avants (2005) eight-step methodology. SOURCES OF INFORMATION CINAHL, PubMed, and PsychINFO. CONCLUSIONS Exposure to malpractice liability is an unfortunate consequence of modern-day nursing practice. An understanding of malpractice will assist nurses in identifying situations that may expose them to legal liability and hopefully lead to improved patient care.

A framework for guiding health literacy research in populations with universal access to healthcare.

At least one third of the US population suffers from limited health literacy, which has been linked to poorer health status, higher costs, and individuals who are socioeconomically disadvantaged. However, research and the development of theoretical frameworks to study health literacy have only recently begun to occur. The purpose of this article is to describe theoretical frameworks that have either been used or may be used to guide health literacy research and to identify implications for nursing research and practice related to an adaptation of a health literacy framework developed specifically for conducting research in populations with universal access to healthcare.

Moderators of access and utilization of clinical preventive services in older adults

AIM This paper reports a study exploring the relationships between potential moderators of access and utilization of clinical preventive services in a homogeneous sample of older adults with near universal health coverage. BACKGROUND Advancements have occurred in eliminating financial and structural barriers to utilization of clinical preventive services (primary, secondary and tertiary prevention) in most developed countries, but variations in utilization continue. These variations may be attributed to non-social determinants of health moderators that impact utilization in older adults. METHODS Theorized relationships were explored using questions from the United States Behavioral Risk Factor Surveillance System Survey and a homogenous convenience sample of 202 older adults (mean age 84; sd 5·23) with near universal health coverage. Data collected across a 2 year period (2007-2009) were analysed using Chi-square, Mann-Whitney U and Hierarchical Logistic Regression. FINDINGS Several logistic regression models of personal access (advised to lose weight, high blood pressure, high cholesterol); moderators (gender, perceived health status, BMI ≥ 30 kg/m(2)); and clinical preventive services utilization (check-up in last 12 months; ever had colonoscopy/sigmoidoscopy) showed statistically significant (P < 0·05) improvement in model fit by adding interaction terms (access X moderator). CONCLUSION Exploring the impact of moderators on utilization may yield more insight into variations than could be explained by measurement of the direct affect of having near universal health coverage alone.

Health Literacy Rates in a Sample of Active Duty Military Personnel

The results reported in this article are from a larger descriptive study examining the health literacy rates in active duty military personnel receiving health care within a culture of universal access. The purpose of this article is to describe the health literacy skills among a sample of active duty military personnel with comparison to the national population. Data were collected using the shortened version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM) in a convenience sample of 155 active duty subjects at a major military hospital from January 2007 through May 2007. Results indicate that military personnel have adequate health literacy skills although variations were noted on the basis of health training and race/ethnicity. Although the S-TOFHLA was found to be a practical tool for assessing health literacy in a high-tempo health care setting, additional reliability and validity testing is needed.