Scholarly Commons @ Baystate Health
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Stickers for Sucsess: Improving Timely Removal of Emergent Central Lines
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1021/thumbnail.jp
Less Radiation, More Information: Using a Negative Pressure Indicator to Guide Chest Tube Removal
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1008/thumbnail.jp
Aortic stenosis in cirrhosis: Pathophysiology and management in the context of liver transplantation
No full textAortic stenosis (AS), a progressive disease affecting aortic valve function, is common among individuals with metabolic and degenerative conditions, and is notably challenging to manage in patients with cirrhosis. Patients with cirrhosis frequently experience exacerbated AS symptoms due to the hyperdynamic circulatory state induced by portal hypertension, which masks early AS signs, resulting in delayed diagnosis. The coexistence of AS and liver disease significantly complicates management, particularly for those awaiting liver transplantation (LT), where untreated AS can increase perioperative morbidity and mortality. This review examines the pathophysiology, clinical manifestations, and management of AS in cirrhotic patients, with a focus on implications for LT candidates. Available treatment options, including surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR), are discussed, with TAVR emerging as a preferred approach due to favorable outcomes in high-risk patients. We also explore the potential role of TAVR as a bridge to LT, with case reports showing promising, albeit anecdotal, success in restoring LT candidacy. Limitations in current perioperative risk assessment tools, which inadequately address the unique risks faced by cirrhotic patients undergoing cardiac procedures, highlight the need for multi-disciplinary care and further research to improve outcomes of patients with concomitant end-stage liver disease and AS.
Keywords: Aortic stenosis; Aortic valve replacement; Cardio-hepatology; End stage liver disease; Liver transplant
Perceived impacts of medications for opioid use disorder implementation on mental health services and substance use counseling in carceral settings: qualitative findings from 13 Massachusetts jails
No full textBackground: Although research on Medications for Opioid Use Disorder (MOUD) in carceral settings has grown, it has largely focused on the implementation of medication delivery or on substance use outcomes in the community. However, the introduction of new programs or the expansion of treatment services in criminal legal settings can have both direct and indirect consequences on other treatment programs and correctional operations within jails. Mental health and substance use disorders frequently co-occur, and their psychosocial treatment components often overlap. We examined how the implementation of MOUD in all jails across Massachusetts impacted the mental health services operating within the jails and the requirements for substance use counseling alongside MOUD.
Methods: We conducted semi-structured interviews (n = 47) and focus groups (n = 42) with staff from 13 county jails as part of an implementation of MOUD in jails study. Using deductive and inductive coding, all transcripts were double-coded and analyzed using a modified framework method.
Results: We identified five key themes about the perceived impact of MOUD on mental health and substance use counseling services. First, MOUD implementation was perceived to reduce acute mental health crises, such as risk for suicide, and the demand on mental health services at intake to the facility. Second, staff perceptions about the effectiveness of MOUD as a stand-alone treatment influenced their decisions about the need for and interpretation of substance use counseling requirements. Third, the required components of substance use counseling created a need for additional staff, which exacerbated the existing shortage of mental health staff. Fourth, infrastructure limitations and privacy needs made the delivery of substance use counseling logistically challenging in jail settings. Finally, MOUD implementation increased interdisciplinary collaboration in some jails by requiring medical, mental health, and substance use providers to work together to resolve the needs of incarcerated individuals.
Conclusions: As jails aim to meet regulatory requirements for MOUD, they will need to manage potential staffing shortages, infrastructure constraints, and shifts in the mental health and substance use counseling services. Guidelines for implementing MOUD in carceral settings should also consider the unintended consequences of MOUD on other behavioral health services.
Keywords: Carceral; Implementation; Jails; Medications for opioid use disorder; Mental health services; Qualitative; Substance use counseling
Rebuttal to Comment on: Early Post-operative ECG Changes as a Predictor of Post-pericardiotomy Syndrome Following Atrial Septal Defect Repair
No full textWe appreciate the concerns raised by Ali. As well recognized, Post-Pericardiotomy Syndrome (PPS) has been a very difficult syndrome to classify and understand in part relating to variable methodologic approaches in the literature, and any attempts to clarify and unify methodology will only aid in better understanding this entity. Below is a point-by-point response to concerns raised
Nursing News & Views - December 2024
Get PDFNursing News & Views - December 2024https://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1040/thumbnail.jp
Wake you up to put you asleep. do pharmacological combinations for obstructive sleep apnea make sense?
No full textDalbavancin Use in Persons Who Use Drugs May Increase Adherence Without Increasing Cost
No full textBackground: Dalbavancin (DAL) may obviate concerns regarding misuse of IV access in persons who use drugs (PWUD) completing treatment for infections in an outpatient setting. However, hesitancy to adopt its use exists due to the cost-prohibitive nature of DAL and perceived issues with insurance reimbursement. Our study looks to determine the financial impact of DAL use in actual, measured cost, and health care utilization, data as well as the effect on treatment completion rates. Methods: This is a retrospective cohort comparing cost information and treatment completion rates of patients who received DAL to a random sample of patients with Staphylococcus aureus bacteremia prior to the institutional availability of DAL. Results: From June 2020 to January 2022, 29 PWUD received DAL. Dalbavancin use resulted in the completion of intended duration in 19 patients (66%) compared with 11 (55%) without DAL. The contribution margin with DAL use was 6655 without; this was not statistically significant (P = 0.47). Conclusion: Dalbavancin use in PWUD may increase treatment completion, with no statistically significant difference in contribution margins.
Keywords: cost; dalbavancin; long-acting single infusion; persons who inject drugs; persons who use drugs
Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis
No full textIntroduction: Previous systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD.
Methods: An update of a previous Cochrane review was undertaken using the Cochrane Airways Review Group Specialised Register. Searches were conducted from October 2015 to August 2023 for studies that initiated pulmonary rehabilitation within 3 weeks of hospital discharge. Studies assessing the impact of solely inpatient pulmonary rehabilitation were excluded. Forest plots were generated using a generic inverse variance random effects method.
Results: Seventeen studies were included. Posthospital discharge pulmonary rehabilitation reduced hospital re-admissions (OR 0.48, 95% CI 0.30 to 0.77, I2=67%), improved exercise capacity (6 min walk test, mean difference (MD) 57 m, 95% CI 29 to 86, I2=89%; incremental shuttle walk test, MD 43 m, 95% CI 6 to 79, I2=81%), health-related quality of life (St. George\u27s Respiratory Questionnaire, MD -8.7 points, 95% CI -12.5 to -4.9, I2=59%; Chronic Respiratory Disease Questionnaire (CRQ)-emotion, MD 1.0 points, 95% CI 0.4 to 1.6, I2=74%; CRQ-fatigue, MD 0.9 points, 95% CI 0.1 to 1.6, I2=91%), and dyspnoea (CRQ-dyspnoea, MD 1.0 points, 95% CI 0.3 to 1.7, I2=87%; modified Medical Research Council Dyspnoea Scale, MD -0.3 points, 95% CI -0.5 to -0.1, I2=60%). Significant effects were not observed for CRQ-mastery, COPD assessment test, EuroQol-5 Dimension-5 Level and mortality. No intervention-related adverse events were reported.
Discussion: Pulmonary rehabilitation delivered posthospital discharge for exacerbation of COPD results in a reduction in hospital re-admissions and improvements in exercise capacity, health-related quality of life and dyspnoea in the absence of any intervention-related adverse events.
Trial registration number: CRD42023406397.
Keywords: COPD exacerbations; exercise; pulmonary rehabilitation