Aim To evaluate literature on the importance of good communication between managers and nurses, and its influence on nurses and patient care. Background In the nursing scenario, concepts such as engagement and job satisfaction are tied to manager communication and influence the care provided (Kunie et al., 2017). It is crucial to recognize the importance of manager communication on the nurses and patient care. The evaluation was guided by this question: in the review of post‐2014 quantitative studies, is there evidence that nurse managers with high communication competence have better patient/staff outcomes than those with lower competencies? Evaluation We evaluated current research through an evidence review on the day‐to‐day influence of nurse manager communication. We conducted our search using common health databases. Since the American Organization for Nurse Leadership developed nurse manager competencies in 2014, we only included articles published after that year. Further inclusion criteria included primary, quantitative and peer‐reviewed research. Key Issues Thirty articles remained after the application of inclusion/exclusion criteria with five themes emerging: patient safety and quality, job satisfaction, leadership styles, innovative practice and general management skills. Conclusion Research associates positive patient and staff outcomes with a leader who exhibits communication competences. Implications for Nursing Management Assessment of current competence levels in communication in nurse managers is needed. Education for improving communication skills is also needed.

Overall, patient reporting provides information similar to medical record abstraction without significant differences by patient race or educational level. Use of patient reports, which are less costly than medical record audits, is a reasonable approach for observational comparative effectiveness research.

Ultrasound tissue characterization (UTC) is an imaging tool used to quantify tendon structural integrity. UTC has quantified Achilles tendon (AT) acute response to load in athletes; however, AT response to cumulative load over a season is unknown. The purpose of this study was to evaluate AT response across a four-month competitive season in collegiate cross-country (XC) runners. Participants (n=21; male=9, female=12; age=19.8±1.2 years; height=171.9±8.9 cm; weight=60.2±8.5 kg) were imaged using the UTC device with a 10-MHz linear-array transducer mounted in a tracking device. The device captures images at 0.2 mm intervals along the AT. UTC algorithms quantified the stability of pixel brightness over every 17 contiguous transverse images into four echo types (I-IV). A total of 168 scans (n=21, bilateral limbs) were performed monthly across the four-month season (Aug=M1, Sep=M2, Oct=M3, Nov=M4). Echo-type percentages (%) were calculated from each scan. Generalized estimating equations (GEE) linear regression models evaluated echo-type % change (β) over the season (M1=reference). Type I increased from M1 to M4 (β=9.10, P<.01; 95%CI: 7.01, 11.21) and Type II decreased from M1 to M3 (β=-2.71, P=.018; 95%CI: -4.96, -0.47) and M1 to M4 (β=-10.19, P<.01; 95%CI: -12.22, -8.17). Type III increased from M1 to M3 (β=0.42, P=.003; 95%CI: 0.19, 0.65) and M1 to M4 (β=0.49, P=.002; 95%CI: 0.18, 0.81), Type IV increased from M1 to M4 (β=0.57, P<.01; 95%CI: 0.29, 0.84). A positive adaptation in AT structural integrity was observed over the XC season, with a ~10% shift from Type II to Type I UTC echo types, suggesting AT resilience to a competitive season of repetitive loading in highly trained runners.

Ultrasound Tissue Characterization (UTC) is a modality that can be utilized to characterize tendon tissue structure using ultrasonographic imaging paired with a computer algorithm to distinguish echo‐types. Several studies have demonstrated UTCs ability to distinguish Achilles tendon morphology changes, but no study has established normative data of the Achilles tendon in the general population. The aim of this study was to determine UTC echo‐type distribution in the Achilles tendon in an asymptomatic population. UTC scans were completed and analyzed on 508 participants without Achilles tendinopathy. Dedicated UTC‐algorithms were used to distinguish and calculate echo‐type percentages and the fiber type distribution was compared. The overall sample echo‐type percentages demonstrated greater levels of Type I and II echo‐types, 65.73% and 32.00%, respectively, and lower levels of Type III and IV echo‐types, 1.74% and 0.57%, respectively. In addition, females had lower levels of Echo‐type I compared to men and greater levels of echo‐type II (p < 0.001). We also found that African‐Americans had significantly greater amounts of echo‐type I and lesser amounts of echo‐type II when compared to Caucasians (p < 0.05). The results of this study create a normative data set for future UTC studies to utilize as a baseline for the evaluation of Achilles tendons. In addition, it demonstrated tendon type differences between sexes and races that need to be accounted for in future studies.

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