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Background: Retention of newly graduated nurses is becoming a costly challenge regardless of efforts such as orientation and residency programs. Satisfaction with the preceptorship relationship is important if the preceptor is to remain committed to fulfilling the role and if the preceptee is to complete the experience and then exhibit satisfactory clinical performance. Most studies have focused on describing either preceptor or preceptee perspectives regardless of the fact that both parties impact the outcomes. The purpose of this study was to describe what factors are associated with preceptors' commitment to, and satisfaction with, the preceptor role; with preceptees' satisfaction with the preceptorship experience and with their nursing performance; and with preceptors' and preceptees' job satisfaction. Methods:This study used a descriptive correlational design with a convenience sample of preceptors (n = 85) and preceptees (n = 85) from a tertiary medical center in the north-eastern U.S. Subjects were surveyed within six months of a preceptorship experience. Data were analysed for associations between preceptors' experience and perceptions of the preceptorship role; and with multiple regression for predictive models of the preceptorship relationship.Results: Total job satisfaction was rated "high" or "quite high" by 99% of preceptors and 97% of preceptees, with intrinsic factors rated higher than extrinsic factors. Preceptors ranked "assisting new staff to integrate into the unit" and "teaching and sharing knowledge" as the greatest benefits to the preceptorship program. Preceptees ranked interpersonal relationships, communication, and professional development as their strongest skills, and teaching and collaboration and critical care as their least strong skill set. Positive correlations were found between the preceptors' perceptions of benefits and rewards and their perceptions of support (r = .448, p < .01) and commitment to the role (r = .652, p < .01). The preceptors' perceptions of support predicted extrinsic, intrinsic and total job satisfaction; and explained 36%, 48%, and 50% of the variability in the outcome, respectively. The total score on the preceptee satisfaction scale was the only variable predicting extrinsic, intrinsic, and total job satisfaction; with 45%, 39%, and 20% explained by the model. Conclusions:Our findings suggest that systems should be established so that preceptors perceive that their preceptorship role is rewarded and supported. Preceptee satisfaction with the preceptorship experience was correlated with favorable evaluation of the relationship between the preceptee and preceptor. Beyond experience and competence, precepting requires considerable teaching skill. Experience is a necessary, but not sufficient, condition for a good preceptor. These findings indicate that when preceptors and preceptees have the benefit of formal preceptorship programs that are well supported, and when the preceptors' efforts are rewarded, satisfaction is enhanced for both participants, pr...

BackgroundAcute ischemic stroke (AIS) and ST‐segment elevation myocardial infarction (STEMI) are ischemic emergencies. Guidelines recommend care delivery within formally regionalized systems of care at designated centers, with bypass of nearby centers of lesser or no designation. We review the evidence of the effectiveness of regionalized systems in AIS and STEMI.MethodsLiterature was searched using terms corresponding to designation of AIS and STEMI systems and from 2010 to the present. Inclusion criteria included report of an outcome on any dependent variable mentioned in the rationale for regionalization in the guidelines and an independent variable comparing care to a non‐ or pre‐regionalized system. Designation was defined in the AIS case as certification by the Joint Commission as either a primary (PSC) or comprehensive (CSC) stroke center. In the STEMI case, the search was conducted linking “regionalization” and “myocardial infarction” or citation as a model system by any American Heart Association statement.ResultsFor AIS, 17 publications met these criteria and were selected for review. In the STEMI case, four publications met these criteria; the search was therefore expanded by relaxing the criteria to include any historical or anecdotal comparison to a pre‐ or nonregionalized state. The final yield was nine papers from six systems.ConclusionAlthough regionalized care results in enhanced process and reduced unadjusted rates of disparity in access and adverse outcomes, these differences tend to become nonsignificant when adjusted for delayed presentation and hospital arrival by means other than emergency medical services. The benefits of regionalized care occur along with a temporal trend of improvement due to uptake of quality initiatives and guideline recommendations by all systems regardless of designation. Further research is justified with a randomized registry or cluster randomized design to support or refute recommendations that regionalization should be the standard of care.

BackgroundMobile stroke units (MSUs) performance dependability and diagnostic yield of 16-slice, ultra-fast CT with auto-injection angiography (CTA) of the aortic arch/neck/circle of Willis has not been previously reported.MethodsWe performed a prospective observational study of the first-of-its kind MSU equipped with high resolution, 16-slice CT with multiphasic CTA. Field CT/CTA was performed on all suspected stroke patients regardless of symptom severity or resolution. Performance dependability, efficiency and diagnostic yield over 365 days was quantified.Results1031 MSU emergency activations occurred; of these, 629 (61%) were disregarded with unrelated diagnoses, and 402 patients transported: 245 (61%) ischemic or hemorrhagic stroke, 17 (4%) transient ischemic attack, 140 (35%) other neurologic emergencies. Total time from non-contrast CT/CTA start to images ready for viewing was 4.0 (IQR 3.5–4.5) min. Hemorrhagic stroke totaled 24 (10%): aneurysmal subarachnoid hemorrhage 3, hemorrhagic infarct 1, and 20 intraparenchymal hemorrhages (median intracerebral hemorrhage score was 2 (IQR 1–3), 4 (20%) spot sign positive). In 221 patients with ischemic stroke, 73 (33%) received alteplase with 31.5% treated within 60 min of onset. CTA revealed large vessel occlusion in 66 patients (30%) of which 9 (14%) were extracranial; 27 (41%) underwent thrombectomy with onset to puncture time averaging 141±90 min (median 112 (IQR 90–139) min) with full emergency department (ED) bypass. No imaging needed to be repeated for image quality; all patients were triaged correctly with no inter-hospital transfer required.ConclusionsMSU use of advanced imaging including multiphasic head/neck CTA is feasible, offers high LVO yield and enables full ED bypass.

Background: Timely treatment of acute ischemic stroke is crucial to optimize outcomes. Mobile stroke units (MSU) have demonstrated ultrafast treatment compared to standard emergency care. Geospatial analysis of the distribution of MSU cases to optimize service delivery has not been reported. Methods: We aggregated all first-year MSU dispatch occurrences and all cases classified by clinical teams as true stroke by zip code and calculated dispatch and true stroke incidence rates. We mapped dispatch and stroke cases and symbolized incidence rates by standard deviation. We confirmed visual impressions of clusters from map inspection by local Moran’s I, boxplot inspection, and t test. We calculated service areas using drive times to meet dispatch and true stroke need. Results: A significant cluster of high dispatch incident rate was confirmed around our MSU base in urban Memphis within a 5-min driving area supporting the initial placement of the MSU based on 911 activation. A significant cluster of high true stroke rate was confirmed to the east of our MSU base in suburban Memphis within a 10-min driving area. Mean incident longitude of cases of true stroke versus disregarded status was significantly eastward (p = 0.001785). Conclusion: Our findings will facilitate determination of socio-spatial antecedents of neighborhood overutilization of 911 and MSU services in our urban neighborhoods and service delivery optimization to reach neighborhoods with true stroke burden.

Background: Both Glasgow Coma Scale (GCS) and NIH Stroke Scale (NIHSS) are commonly used as serial assessment tools in ICH, however, the NIHSS lacks formal validation in this population. Methods: We prospectively collected ICH assessments, imaging, and outcome data. Direct comparisons of discrimination were made using GCS and NIHSS on prediction of 24-hour poor functional outcome (mRS-3-6) and hematoma volume >30cm 3 using ROC analysis; c statistics were calculated and compared with DeLong test. Results: 672 ICH patients (mean age 62±14 years; 56% men; median ICH score = 1, IQR 0-2; median ICH volume 7cm 3 , IQR 2-19) were included in the analysis. Median NIHSS and GCS were 8 (IQR 3-18) and 15 (IQR 7-15) respectively. NIHSS correlated strongly to GCS (r -0.773; p<0.001). NIHSS (c statistic: 0.91; 95%CI: 0.89-0.93) discriminated better than GCS (c statistic: 0.78; 95%CI: 0.75-0.81) for 24-hour poor functional outcome (DeLong p<0.001; Figure 1A). NIHSS (c statistic: 0.82; 95%CI: 0.78-0.86) also discriminated better than GCS (c statistic: 0.78; 95%CI: 0.73-0.83) for large hematoma volume (DeLong p=0.029; Figure 1B). Conclusions: The NIHSS has greater discriminative power than GCS to identify patients with poor functional outcomes and large hematoma volumes.

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It is an honor to write an Editorial to this Special Issue (SI) of Sustainability [...]