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Alarm Fatigue: Alarm Management/Intervention Education vs. Current State
Get PDFPICOT Question: In inpatient telemetry units, how does alarm management/intervention education in comparison to current state affect a decrease in non-actionable alarms and reduce alarm fatigue?https://knowledgeconnection.mainehealth.org/nurseresidency/1061/thumbnail.jp
Assessing the Accuracy of ECG Chest Electrode Placement By EMS and Clinical Personnel Using Two Evaluation Methods
No full textBackground and purpose: A valid 12-lead electrocardiogram (ECG) depends on correct acquisition technique, particularly on the accurate location of precordial (chest) electrodes. The emergency medical services (EMS) segment of the care continuum is under-represented in previous clinically oriented studies of electrode placement. This study sought to assess the accuracy of chest electrode placement by EMS and clinical personnel in one geographic area, to identify patterns of misplacement to inform future training and continuing education, and to compare two methods of assessing electrode placement.
Methods: This prospective observational study recruited a convenience sample of EMS and clinical personnel. Participants placed simulated electrodes on a CPR-style manikin and completed a questionnaire about their training and experience. A subset also marked electrode locations on a printed diagram of the ribcage. Digitized placement data and questionnaire responses were analysed statistically.
Results: Findings from 149 participants showed misplacement patterns consistent with prior studies, with 41.6% rated as acceptable and 34.2% placing ≤ 3 electrodes acceptably. Correctness of electrode placement was comparable between EMS and clinical participants. More correct electrode placement correlated with classroom vs. on-the-job training, frequent vs. infrequent practice, and greater self-confidence. The diagram data collection method proved not equivalent to, and probably less reliable than, the hands-on manikin method for assessing placement skills.
Conclusions: Significant variation in ECG chest electrode placement by EMS personnel was comparable to that previously reported for clinical personnel, suggesting that existing concerns about placement errors by clinical personnel may apply equally to EMS personnel. More frequent practice and classroom- based initial ECG training were associated with significantly greater placement accuracy. Participants used diverse strategies to identify electrode locations. Further research is warranted to clarify optimal strategies for placing chest electrodes, especially on diverse body types. Sound initial ECG training and continuing education are necessary to reinforce high-quality ECG skills
September 18th, 2024: Updates in Concussion Care
No full textZoom Passcode: 45^GRfn7https://knowledgeconnection.mainehealth.org/medicine_gr/1031/thumbnail.jp
Prevalent Metformin Use in Adults With Diabetes and the Incidence of Long COVID: An EHR-Based Cohort Study From the RECOVER Program
No full textOBJECTIVE: Studies show metformin use before and during SARS-CoV-2 infection reduces severe COVID-19 and postacute sequelae of SARS-CoV-2 (PASC) in adults. Our objective was to describe the incidence of PASC and possible associations with prevalent metformin use in adults with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: This is a retrospective cohort analysis using the National COVID Cohort Collaborative (N3C) and Patient-Centered Clinical Research Network (PCORnet) electronic health record (EHR) databases with an active comparator design that examined metformin-exposed individuals versus nonmetformin-exposed individuals who were taking other diabetes medications. T2DM was defined by HbA1C ≥6.5 or T2DM EHR diagnosis code. The outcome was death or PASC within 6 months, defined by EHR code or computable phenotype. RESULTS: In the N3C, the hazard ratio (HR) for death or PASC with a U09.9 diagnosis code (PASC-U09.0) was 0.79 (95% CI 0.71-0.88; P \u3c 0.001), and for death or N3C computable phenotype PASC (PASC-N3C) was 0.85 (95% CI 0.78-0.92; P \u3c 0.001). In PCORnet, the HR for death or PASC-U09.9 was 0.87 (95% CI 0.66-1.14; P = 0.08), and for death or PCORnet computable phenotype PASC (PASC-PCORnet) was 1.04 (95% CI 0.97-1.11; P = 0.58). Incident PASC by diagnosis code was 1.6% metformin vs. 2.0% comparator in the N3C, and 2.1% metformin vs. 2.5% comparator in PCORnet. By computable phenotype, incidence was 4.8% metformin and 5.2% comparator in the N3C and 24.7% metformin vs. 26.1% comparator in PCORnet. CONCLUSIONS: Prevalent metformin use is associated with a slightly lower incidence of death or PASC after SARS-CoV-2 infection. PASC incidence by computable phenotype is higher than by EHR code, especially in PCORnet. These data are consistent with other observational analyses showing prevalent metformin is associated with favorable outcomes after SARS-CoV-2 infection in adults with T2DM
Socioeconomic and Urban-Rural Disparities in Genome-Matched Treatment Receipt and Survival after Genomic Tumor Testing
No full textPURPOSE: Emerging cancer treatments are often most available to socially advantaged individuals. This study examines the relationship of patient educational attainment, income level, and rurality to the receipt of genome-matched treatment (GMT) and overall survival. METHODS: Survey and clinical data were collected from patients with cancer (n = 1258) enrolled in the Maine Cancer Genomics Initiative. Logistic regression models examined whether receipt of GMT differed by patient education, income, and rurality. Kaplan-Meier curves and Cox regression were conducted to evaluate 12-month mortality. We completed additional exploratory analyses using Kaplan-Meier curves and Cox models stratified by receipt of GMT. Both logistic and Cox regression models were adjusted for age and gender. RESULTS: Educational attainment, income level, and rurality were not associated with GMT receipt. Of 1258 patients, 462 (36.7%) died within 365 days of consent. Mortality risk was associated with lower educational attainment (hazard ratio (HR): 1.30; 95% CI: 1.06 to 1.59; p = .013). No statistically significant differences in mortality risk were observed for income level or rurality. Exploratory models suggest that patients who did not receive GMT with lower educational attainment had higher mortality risk (HR = 1.36, 95% CI: 1.09 to 1.69, p = .006). For patients who did receive GMT, there was no difference in mortality risk between the education groups (HR: 1.01, 95% CI: 0.56 to 1.81, p \u3e .9). CONCLUSION: While there were no disparities in who received GMT, we found a disparity in mortality associated with education level, which was more pronounced for patients who did not receive GMT. Future research is warranted to investigate the intersectionality of social disadvantage with clinical outcomes to address survival disparities
Comprehensive Suicide Risk Screening: Depression Is Not Enough
Get PDFIntroduction: In response to increasing suicide rates among youth, further focus has been put on screening for suicide and associated risk factors across health care settings. A frequent approach has been to rely on depression as the only risk factor part of the screening process. Adolescents admitted to inpatient pediatrics have an inherently higher risk for suicide given their medical comorbidities, and available literature has shown that focusing only on depression symptoms is inadequate.
Methods: The following validated psychiatric screening tools were used: Generalized Anxiety Disorder 2-item, Patient Health Questionnaire-2, Screening to Brief Intervention, and Ask Suicide-Screening Questions. An aggregate, self-scoring tool was created for the electronic health record with an automatic best practice advisory for positive screens. All 1260 patients admitted to inpatient pediatrics, aged 12 to 17 years, were screened. The screening results and completion rates were tracked over 2 years.
Results: The screening completion rate was 90% (n = 1134). Forty-one percent of the positive screens had only symptoms of anxiety and/or a risk for severe substance use disorder. Of the positive screens, anxiety was the sole symptom category for 23%, risk for severe substance use disorder for 18%, and just 7% for depression. No patients screened positive for “acute” suicidal ideation.
Discussion: Almost half of the screens considered positive did not score positive for depression, strongly supporting this more comprehensive approach in identifying patients with greater risk for suicide. Feasibility was achieved with a 90% completion rate over the 2-year pilot period of this quality initiative.
Conclusions: Effectively screening for suicide risk in youth should not rely on targeting depression symptoms and asking directly about suicidal ideation
Resources for Reduction of Stress and Burnout in Healthcare Workers Following a Mass Casualty Event
Get PDFBackground:
Being in healthcare, employees are faced with all sorts of challenges regarding their own mental and physical health and how to prioritize it, on top of caring for patients and their families. One challenge that healthcare workers hope they never have to learn how to cope with is the stress of mass casualty events.https://knowledgeconnection.mainehealth.org/nurseresidency/1024/thumbnail.jp
The Effects of Care Handoffs and Hospital-Wide Flow
Get PDFIntroduction: Observed extended boarding of admitted patients and increased length of stay in the ED due to delay in handoff resulting in decreased ability to provide full extent of care.https://knowledgeconnection.mainehealth.org/nurseresidency/1028/thumbnail.jp
Mid-Childhood Plasma Concentrations of Per- and Polyfluoroalkyl Substances, Modifiable Lifestyle Factors, and Bone Mineral Density Through Late Adolescence
No full textThere is limited research on associations of per- and polyfluoroalkyl substances (PFAS) with areal bone mineral density (aBMD) through adolescence and whether bone-strengthening factors ameliorate effects. In the Project Viva cohort (N = 484; 50% female), we used sex-stratified linear regression and quantile g-computation mixture models to examine associations of mid-childhood (median: 7.8 years; 2007-2010) plasma PFAS concentrations with a dual-energy X-ray absorptiometry total-body aBMD Z-score in early and late adolescence (median: 12.9 and 17.6 years, respectively). We explored stratum-specific estimates by parent/self-reported physical activity and dairy intake. Using linear mixed models, we evaluated associations with aBMD accrual from mid-childhood through late adolescence. Females with higher perfluorooctanoate (PFOA) and perfluorodecanoate (PFDA) had lower early adolescent aBMD Z-score [e.g., β(95%CI)] per doubling PFOA: -0.19(-0.41, 0.03)]. Youth with higher PFOA and PFDA had lower late adolescent aBMD Z-score, but CIs were wide [e.g., PFOA: females, -0.12(-0.40, 0.16); males, -0.10(-0.42, 0.21)]. Mixture models generally corroborated single PFAS results, and in linear mixed models, females with higher PFAS concentrations, and males with higher PFOA, had slower aBMD accrual. Less active males with higher PFOA, PFDA, and the PFAS mixture had lower late adolescent aBMD Z-score. Some PFAS appeared more negatively associated with the aBMD Z-score among those who consumed less dairy, but there was not consistent evidence of effect modification. Exposure to select PFAS may affect bone accrual through adolescence, with possible resilience conferred by greater physical activity and dairy intake