BackgroundFew services are available to support rural older adults living at home with advancing chronic illness. The objective of this project was to pilot a nurse-led navigation service to provide early palliative support for rural older adults and their families living at home with advancing chronic illness.MethodsTwenty-five older adults and 11 family members living with advancing chronic illness received bi-weekly home visits by a nurse navigator over a 2-year period. Navigation services included symptom management, education, advance care planning, advocacy, mobilization of resources, and psychosocial support. The nurse navigator collected longitudinal data on older adult and family needs, and older adult quality of life and healthcare utilization.ResultsSatisfaction with the service was high. There was no attrition over the 2-year period except through death, and few cancelled visits, indicating a high degree of acceptability of the intervention. The navigator addressed complex, multi-faceted needs through connecting health, social, and informal community resources. Participants who indicated a preferred place of death were able to die in that preferred place (n = 7). Emergency room use by participants was minimal and largely unpreventable by the nurse navigator. Longitudinal health-related quality of life scores for many participants were poor, lending further support to the need for more focused attention to this upstream palliative population.ConclusionsUsing a nurse navigator to facilitate early palliative care for rural older adults living with advanced chronic illness is a promising innovation for meeting the needs of this population. Further research is required to evaluate outcomes on a larger scale.

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A chart review was conducted on all eligible patients from 2009 to 2014. 47 patients were identified, 19 of whom had two attending surgeons while 28 underwent PSF performed by a single attending surgeon assisted by a resident or PA. All patients underwent similar operative procedures with pedicle-screw only constructs. Patients in the two groups underwent identical surgical and anesthetic protocols, including use of tranexemic acid. Percent EBL was calculated as EBL divided by total estimated blood volume, which was estimated as weight in kilograms multiplied by either 75ml/kg for males or 65ml/kg for females. All patients were followed out to a minimum of one year. The Student's T-test was used to compared the three major variables of blood loss, anesthesia time, and hospital length of stay. A Chi-Square test was used to compare categorical variables between the groups. AbstractBackground and Significance: Surgical correction of AIS carries a substantial risk of complication. The literature supports improved perioperative outcomes through the two surgeon strategy in other complex orthopedic procedures. Research Question: Does the presence of 2 versus 1 attending affect the perioperative morbidity of posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS) curves greater than 70°. Methods: We reviewed the database from a large regional children's hospital of all patients with AIS curves greater than 70°who underwent PSF from 2009-2014 and divided the cohort into single versus 2-surgeon groups (28 vs. 19 cases, respectively). We analyzed cases for length of surgery, estimated blood loss, and length of stay. Results: The groups were identical when comparing age, gender, spinal levels fused, and average ASA score. However, the average Cobb angle in the single surgeon group was significantly less than in the 2 surgeon group at 78.4 vs 84.0 degrees, respectively (p=0.049). Mean operative time for single versus 2 surgeons was 238 vs 212 minutes (p=0.078). Mean percent estimated blood loss was 26% for single surgeon vs 31% for 2 surgeons (p=0.236), and mean estimated blood loss for single surgeon vs 2 surgeons was 830ml vs 1045ml (p=0.052). Mean length of stay was significantly decreased in the 2 surgeon group at 5.16 days versus the single surgeon group at 6.82 days (p=0.002). Conclusions:The use of 2 surgeons in AIS deformity correction at an experienced regional children's hospital had a variable effect on clinical outcomes; the mean length of stay was reduced in the twosurgeon group but there was no difference in operative time or blood loss. This study does not rule out the potential for positive impact with a two-surgeon strategy, and given previous supportive data in the literature, this approach should further evaluated to determine its effect on improving perioperative outcomes.

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