Background Nearly one-third of new-graduate nurse practitioners report undergoing no formal orientation process, and postcertification orientation processes vary. A validated curriculum would address the need for structured training to enhance new graduates’ practice transition. Methods A competency-based practice transition curriculum for intensive care unit nurse practitioners was created using a literature review and expert panels. Competencies were established that were based on clinical categories essential to nurse practitioner practice in the intensive care unit and adapted from existing Accreditation Council for Graduate Medical Education training, aligned with the precertification nursing curriculum. Participants recruited from academic and clinical backgrounds were asked to rank curriculum items using a 4-point Likert scale. Competencies were refined on the basis of participants’ survey feedback. Results A total of 31 participants from academic medical centers and schools of nursing throughout the United States responded to the request for competency validation; 29% of participants provided qualitative data. All 9 competency topics received a mean rating greater than 3.5 and were deemed valid. Using the combined quantitative and qualitative data, a final set of competencies for nurse practitioners in the intensive care unit was developed. Conclusions The curriculum developed and validated in this study can become the basis for practice transition for novice nurse practitioners. The curriculum is adaptable and can be used for surgical and medical intensive care units. As refined, the competencies provide a validated foundation for training of new-graduate nurse practitioners in the intensive care unit.

Background Acute allograft rejection appears to be associated with increases in QT/QTc intervals. Objectives To determine the relationship between acute allograft rejection and electrocardiogram changes in patients undergoing an orthotopic heart transplant. Methods The study population comprised 220 adult patients undergoing heart transplant and enrolled in the NEW HEART study. Electrocardiograms obtained within 72 hours of endomyocardial biopsy were analyzed; electrocardiograms obtained fewer than 10 days after transplant surgery were excluded. Repeated-measures analysis was performed with statistical models including effects for rejection severity (mild and moderate/severe) and time trends independent of rejection status. Results The 151 male and 69 female transplant recipients (mean age [SD], 54 [13] years) had 969 biopsy/electrocardiogram pairs: 677 with no rejection, 280 with mild rejection, and 12 with moderate/severe rejection. Moderate to severe organ rejection was associated with significant increases in QRS duration ( P < .001), QT ( P = .009), QTc ( P = .003), and PR interval ( P = .03), as well as increased odds of right bundle block branch ( P = .002) and fascicular block ( P = .009) occurring. Conclusions Moderate to severe acute allograft rejection was associated with electrocardiographic changes after transplant surgery. Studies are needed to assess the value of computerized electrocardiogram measurement algorithms for detecting acute allograft rejection.

Background The preferred route for providing nutrition in the pediatric intensive care unit is enteral. Placement of postpyloric feeding tubes using an electromagnetic-tipped stylet that emits a signal detected by a device held over the patient’s abdomen is effective in adult intensive care units, but has not been well studied in pediatric units. Objectives To determine the effectiveness of the electromagnetic device in reducing the numbers of radiation exposures, intrahospital transports, tubes used, and tube placement attempts in the pediatric intensive care unit. Methods Data from a historical control group were compared with data from a prospective intervention group of patients less than 18 years of age and weighing at least 3 kg who required a postpyloric feeding tube in a 23-bed pediatric intensive care unit. Primary outcome was number of radiation exposures. Independent-samples Student t tests were used to compare the 2 study groups for mean equality; Pearson χ 2 tests were used to compare categorical data. Statistical testing was 2-sided, and P less than .05 was considered statistically significant. Results Of 73 children (30 in control group, 43 in intervention group), those in the intervention group had a higher success rate at tube placement ( P = .009) and fewer radiation exposures ( P = .006), intrahospital transports ( P = .004), and tubes used ( P < .001). Conclusions Successful placement of postpyloric feeding tubes by nurse practitioners was safely enhanced using an electromagnetic device. Establishing users’ expertise with the device before studying outcomes may improve effectiveness.