In an era of rising clinical costs and shrinking federal research dollars, the survival of the academic health center may depend on its capacity to cultivate high-impact innovations in care delivery ...on an accelerated basis. Yet, the health sciences literature offers little guidance regarding the key organizational determinants most likely to facilitate such innovation. We report on the conceptualization, development, and preliminary testing of a new 21-item Accelerated Healthcare Innovation Capacity scale for addressing that knowledge gap. Instrument development followed a standardized process, including expert panel testing of the new scale's content relevance validity. A sample (N = 53) of academic health center administrators, clinicians, and faculty affiliated with a single organization volunteered to complete the Accelerated Healthcare Innovation Capacity scale in survey form. Data were analyzed to evaluate scale reliability, internal consistency, and construct validity. High-expert agreement (overall S-CVI of 0.91) was obtained on content relevance validity. Cronbach α for the scale was 0.941. Exploratory factor analysis confirmed the theoretical soundness of the scale's conceptual framework, which showed high-impact health care innovation support to be a complex, multidimensional concept involving key facilitating factors across 3 major constructs-that is, Culture, Structure, and Policy-with implications for future research and managerial practice, particularly for staff development educators engaged in evaluating quality management and organizational change strategies.
In their 2010 report on The Future of Nursing, the Institute of Medicine called for nurses to be prepared to lead in all areas of healthcare. However, the nursing profession lacks consensus on a ...framework to guide the development of nurses as leaders and has yet to define essential leader competencies. This article reviews the Army’s intentional, sequential, and progressive leader development program that is grounded in essential leader competencies. The applicability of this model to nursing is discussed, and examples of how it could be applied are highlighted. This article proposes the use of the military framework as a successful model for the intentional development of nurses as leaders to meet the triple aims of better care for patients, better health for populations, and reduced costs of care through more efficient use of resources.
During the follow-up period, six (40%) patients died, all for reasons considered unrelated to apixaban (calciphylaxis n = 1, malignancy n = 1, frailty leading to withdrawal of dialysis n = 1, ...diabetic foot infection n = 1 and ischaemic heart disease n = 2). Eight (53%) patients completed 3 months of monitoring, of whom two patients did not receive planned 1-week monitoring due to blood sampling errors. ...six (40%) patients followed the monitoring schedule and remained on apixaban for the duration of follow-up. Pharmacokinetic profiling in this analysis demonstrates there was no cumulative exposure of apixaban in dialysis patients; however 25% of the measurements fell below the 5th percentile; this may be due to dialysis reducing the area under the curve of apixaban.
Hypoglycemia Reduction Strategies in the ICU Braithwaite, Susan Shapiro; Bavda, Dharmesh B.; Idrees, Thaer ...
Current diabetes reports,
12/2017, Letnik:
17, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Purpose of Review
We reviewed the strategies associated with hypoglycemia risk reduction among critically ill non-pregnant adult patients.
Recent Findings
Hypoglycemia in the ICU has been associated ...with increased mortality in a number of studies. Insulin dosing and glucose monitoring rules, response to impending hypoglycemia, use of computerization, and attention to modifiable factors extrinsic to insulin algorithms may affect the risk for hypoglycemia. Recurring use of intravenous (IV) bolus doses of insulin in insulin-resistant cases may reduce reliance upon higher IV infusion rates.
Summary
In order to reduce the risk for hypoglycemia in the ICU, caregivers should define responses to interruption of continuous carbohydrate exposure, incorporate transitioning strategies upon initiation and interruption of IV insulin, define modifications of antihyperglycemic therapy in the presence of worsening renal function or chronic kidney disease, and anticipate the effects traceable to other medications and substances. Institutional and system-wide quality improvement efforts should assign priority to hypoglycemia prevention.
Several studies have found increased risks of thrombosis with thrombocytopenia syndrome (TTS) following the ChAdOx1 vaccination. However, case ascertainment is often incomplete in large electronic ...health record (EHR)‐based studies.
To assess for an association between clinically validated TTS and COVID‐19 vaccination.
We used the self‐controlled case series method to assess the risks of clinically validated acute TTS after a first COVID‐19 vaccine dose (BNT162b2 or ChAdOx1) or severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Case ascertainment was performed uninformed of vaccination status via a retrospective clinical review of hospital EHR systems, including active ascertainment of thrombocytopenia.
One hundred seventy individuals were admitted to the hospital for a TTS event at the study sites between January 1 and March 31, 2021. A significant increased risk (relative incidence RI, 5.67; 95% confidence interval CI, 1.02‐31.38) of TTS 4 to 27 days after ChAdOx1 was observed in the youngest age group (18‐ to 39‐year‐olds). No other period had a significant increase, although for ChAdOx1 for all ages combined the RI was >1 in the 4‐ to 27‐ and 28‐ to 41‐day periods (RI, 1.52; 95% CI, 0.88‐2.63; and (RI, 1.70; 95% CI, 0.73‐3.8, respectively). There was no significant increased risk of TTS after BNT162b2 in any period. Increased risks of TTS following a positive SARS‐CoV‐2 test occurred across all age groups and exposure periods.
We demonstrate an increased risk of TTS in the 4 to 27 days following COVID‐19 vaccination, particularly for ChAdOx1. These risks were lower than following SARS‐CoV‐2 infection. An alternative vaccine may be preferable in younger age groups in whom the risk of postvaccine TTS is greatest.
California is the first state to enact legislation mandating minimum nurse-to-patient ratios at all times in acute care hospitals. This synthesis examines 12 studies of the impact of California’s ...ratios on patient care cost, quality, and outcomes in acute care hospitals. A key finding from this synthesis is that the implementation of minimum nurse-to-patient ratios reduced the number of patients per licensed nurse and increased the number of worked nursing hours per patient day in hospitals. Another finding is that there were no significant impacts of these improved staffing measures on measures of nursing quality and patient safety indicators across hospitals. A critical observation may be that adverse outcomes did not increase despite the increasing patient severity reflected in case mix index. We cautiously posit that this finding may actually suggest an impact of ratios in preventing adverse events in the presence of increased patient risk.
Statistics for Emergency Nurses Shapiro, Susan E.; Higgins, Melinda
Journal of emergency nursing,
11/2014, Letnik:
40, Številka:
6
Journal Article
Recenzirano
Odprti dostop
...inferential statistics are actually used for us to legitimately infer that the results we obtain from our experiment (or our observations) with small samples can be generalized to the larger ...relevant population, for example, to all ED patients.
Background Although well characterised in adults, less is known about post-thrombotic syndrome in children. In this review, current knowledge regarding paediatric post-thrombotic syndrome is ...summarised, with particular emphasis on pathophysiology, aetiology, diagnosis and management. Methods A Medline literature review was performed using search terms 'post thrombotic syndrome', 'post phlebitic syndrome', paediatric and children. Relevant articles were identified and included for summation analysis. Results The incident of paediatric venous thromboembolism is rising. Deep vein thrombosis can cause venous hypertension through a combination of venous reflux, venous obstruction and impairment of the calf muscle pump, leading to development of post-thrombotic syndrome. In children, this is more likely to occur if deep vein thrombosis diagnosis and treatment are delayed, if a higher number of vessels are involved, and if factors such as D-dimer are elevated at diagnosis and throughout treatment. Post-thrombotic syndrome occurs in about 26% of paediatric deep vein thrombosis, though the results of individual studies vary widely. A number of tools exist to diagnose paediatric post-thrombotic syndrome, including the modified Villalta scale and Manco-Johnson instrument. Once post-thrombotic syndrome develops, the mainstay of treatment remains supportive, with little evidence of benefit from pharmacological measures. Conclusion Surgical or interventional treatment is not advised except in exceptional cirumstances, due to variable prognosis of PTS in paediatric populations with rising incidence of paediatric venous thromboembolism, it follows that the prevalence of post-thrombotic syndrome in children may also increase. Evidence-based venous thromboembolism prevention strategies need to be implemented for prevention of deep vein thrombosis, but when it does occur, deep vein thrombosis requires prompt and effective treatment to prevent post-thrombotic syndrome. Optimum treatment strategies for post-thrombotic syndrome require further investigation.
To evaluate two methods of rewarming newborns after the first bath: radiant rewarming and skin‐to‐skin maternal newborn contact.
A nonrandomized clinical trial in which mothers chose the rewarming ...method, with 200 participants in the skin‐to‐skin rewarming group (experimental condition), and 200 in the radiant rewarming group (control).
A teaching hospital in the Southeast United States.
Healthy, term infants after vaginal delivery.
Newborn temperatures were taken immediately prior to the bath (T1), and 30 minutes (T2) and 60 minutes (T3) after the bath. Descriptive statistics and t tests were used to determine differences between groups and between time points. Logistic regression was employed to assess risk factors for newborns with temperatures less than 36.4°C 30 minutes after the bath.
Because 96 of the first 100 mothers chose skin‐to‐skin rewarming, we concluded the study early and analyzed the data. Of the 96 mothers who chose skin‐to‐skin, 91 infants were successfully rewarmed and five required rescue rewarming under the radiant warmer. Careful review of newborns requiring rescuing showed inadequate skin‐to‐skin contact or removal of the protective covering. In this sample, African American mothers were significantly younger, had smaller newborns, and their newborns had lower temperatures than non‐African American newborns.
Given a choice, mothers overwhelmingly preferred skin‐to‐skin rewarming. Newborns can safely rewarm skin‐to‐skin if staff pay special attention to how they are positioning the newborn and recheck mother and newborn frequently. The unexpected finding of racial differences in maternal and newborn characteristics will require further investigation.
PDF
