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Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature
No full textObjectives: Spinal motion restriction (SMR), requiring the use of a cervical collar and allowing for use of a vacuum splint or ambulance cot, and spinal immobilization, requiring the use of a backboard and a cervical collar, have long been established as the standard of care in the prehospital management of trauma. Both techniques are based on the hypothesis that post-injury movement of the spinal column may lead to the development of delayed neurological deficits. However, these techniques, which have the potential for significant patient harm, are without definitive evidence of clinical benefit. The objective of this review is to evaluate the potential pathophysiology to delayed neurological injury, and examine the potential harms and benefits of spinal immobilization and SMR.
Methods: A structured review of the literature was performed within the National Association of EMS Physicians (NAEMSP) Trauma Compendium Series. Searches were performed in PubMed, Embase, CINAHL, and Web of Science dating back to 1900 looking for manuscripts that addressed the pathophysiology of delayed neurological injury as well as the harms, and benefits, to spinal immobilization and SMR, with a focus on backboards and cervical collars.
Results: Out of 3944 manuscripts screened, 115 manuscripts were identified. Noting that some manuscripts answered multiple study questions - 14 studies addressed the pathophysiology of disease to the phenomenon of delayed neurological injury, 55 studies examined the harms of immobilization procedures, 58 studies addressed the effectiveness of immobilization procedures, and 7 studies addressed other factors. Two case series were identified hypothesizing post-injury movement as the cause of delayed neurological injury; and 8 retrospective studies, including two case control studies and three retrospective cohort studies, were identified showing an association between hypoperfusion and worsening neurological injury. There were 55 studies showing harms, and no studies showing a definitive benefit to spinal immobilization.
Conclusions: There are no data in the published literature to support spinal immobilization and spinal motion restriction as standard of care. Efforts aimed to reduce the use of cervical collars should be considered, and the use of backboards and full body vacuum splints should be limited to the point in time of active patient extrication.
Keywords: Bioethics; Emergency Medical Services; Immobilization; Patient Safety; Spinal Injuries; Traumatic Shock
2025 SCAI/HRS clinical practice guidelines on transcatheter left atrial appendage occlusion
No full textBackground: Left atrial appendage occlusion (LAAO) devices reduce the risk of atrial fibrillation-associated stroke relative to no oral anticoagulation. However, uncertainty and practice variation persist in the areas of patient selection, periprocedural imaging, adjunctive antithrombotic therapy, and management of peridevice leak (PDL) and device-related thrombus. The Society for Cardiovascular Angiography & Interventions and Heart Rhythm Society developed these evidence-based guidelines to support clinicians, patients, and other stakeholders in management decisions regarding LAAO.
Methods: The Society for Cardiovascular Angiography & Interventions and Heart Rhythm Society convened a balanced, multidisciplinary guideline panel with \u3c 50% of members reporting significant conflicts of interest with the industry. Evidence Foundation, a registered 501(c)(3) nonprofit organization, provided methodological support for guideline development. The guideline panel formulated and prioritized clinical questions following the Grading of Recommendations Assessment, Development, and Evaluation approach in a population, intervention, comparison, outcome format. A technical review team of clinical and methodological experts conducted systematic reviews of the published evidence, synthesized data, and graded the certainty of evidence across outcomes. The guideline panel then developed recommendations and supporting statements informed by the technical review and using the Grading of Recommendations Assessment, Development, and Evaluation evidence-to-decision framework.
Results: The guideline panel developed 8 evidence-based recommendations to address variations in care related to LAAO. The panel also identified 2 knowledge gaps.
Conclusions: Key recommendations address patient selection for LAAO, periprocedural imaging, adjunctive antithrombotic therapy, and management of PDL and device-related thrombus. The panel also recommended necessary future research regarding the use of single antiplatelet therapy following LAAO and regarding the management of PDL.
Keywords: anticoagulation; antiplatelet therapy; atrial fibrillation; left atrial appendage occlusion; procedural imaging; stroke
They don\u27t know what it\u27s really like: qualitative insights into inpatient cardiac nurses\u27 perceived workload
No full textBackground: Measurements of nursing workload often fail to reflect the complexity of nursing work. Nurses\u27 perceived workload is shaped by many factors, including patient characteristics, personal, social, organizational, and environmental factors. There is a demonstrated interest in developing more comprehensive nurse workload measurement strategies, but little research has employed qualitative methods to investigate the beliefs and experiences of frontline staff. The purpose of this study was to explore inpatient nurses\u27 perceptions of their workload and the factors that impact their percieved workload levels.
Methods: This was qualitative study using focus groups. Participants were recruited from the cardiac floors of an urban, academic medical center. A total of 17 nurses participated, including nurses from bedside, charge, educator, and nurse manager roles. Focus group transcripts were analyzed by a team of qualitative investigators using conventional content analysis.
Results: Inpatient nurses\u27 perceived workload is shaped by their work volume, work attributes, and their ability to complete required tasks while providing meaningful, impactful care. The volume of nursing work is comprised of patient-focused, unit-focused, and institutional-focused tasks. Important work attributes include its perceived urgency, difficulty, alignment to the nurse and unit, interference, unpredictability, and individual nursing burden. Overall, participants expressed deep concern over high workloads that compromise holistic nursing care.
Conclusion: Strategies to more comprehensively measure nurses\u27 perceived workload should account for the breadth and complexity of nursing work. Nurses should advocate for workload measurement systems that more closely reflect their subjective work experiences.
Clinical trial registration number: Not applicable.
Keywords: Inpatient; Nursing; Nursing work; Personnel staffing and scheduling; Qualitative research; Workload
Validity and Reliability of the New Innovation Culture Scale© for Use in Healthcare Settings
No full textObjective: To assess the psychometric properties of the new 10-item Innovation Culture Scale©.
Background: American healthcare is expensive with poor health outcomes as the norm. Nurses can disrupt this paradigm through innovation; however, innovation cannot flourish without a supportive organizational culture. There is a lack of scales to measure innovation culture within healthcare settings, thus supporting improvements in quality of care.
Methods: A Northeastern health system provided a convenience sample of 5658 nurses, physicians, and allied health professionals. Scale responses were obtained digitally. Item correlations, scree plot, and confirmatory factory analysis examined the scale\u27s internal structure and assessed model fit.
Results: Two hundred sixteen participants completed the scale. Item correlations were positive and significant (P \u3c 0.001). Scree plot confirmed a single factor structure. Several indices supported an acceptable model fit (comparative fit index = 0.935, Tucker-Lewis index = 0.916, standardized root mean square residual = 0.05), although root mean square error of approximation (0.119) was poor. Cronbach\u27s α was 0.94.
Conclusion: The Innovation Culture Scale is a valid and reliable measure to assess innovation culture in healthcare settings
An Atypical Case of Varicella Meningitis in a Young Immunocompetent Male Patient With a Possible Concomitant Case of Ramsay-Hunt Syndrome
No full textVaricella zoster virus (VZV) is a single-stranded enveloped RNA virus that is a common cause of chickenpox and herpes zoster. Herpes zoster (shingles) presents with a painful rash in a dermatomal distribution. Ramsay-Hunt syndrome (herpes zoster oticus) is a specific form of shingles, which occurs due to viral reactivation in the geniculate ganglion of cranial nerve VII. It can cause the triad of symptoms of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal or on the auricle. VZV is also a rare cause of aseptic meningitis, which occurs more commonly in immunodeficient rather than immunocompetent individuals. VZV meningitis can occur with or without the stereotypical rash, which may be very minimal if present. Here, we present a case of a 30-year-old immunocompetent man who presented to his local emergency department (ED) after failed treatment of otitis media and two syncopal events. ED evaluation was positive for nuchal rigidity, scalp tenderness, and an enlarged lymph node on his right posterior neck. PCR analysis was positive for VZV meningitis without overt rash. His only skin finding was erythematous patches in the right auditory canal with a bulging tympanic membrane. His auditory symptoms did not improve with adequate antibiotic treatment, meaning his symptoms were likely viral in nature. The treating infectious disease physician felt his auditory symptoms were related to his VZV infection; however, no confirmatory tests were completed. He was discharged on hospital day 4 and completed a total of 14 days of acyclovir 500mg three times a day. Additionally, we discuss the implications of intravenous acyclovir therapy in mild VZV meningitis in young immunocompetent individuals and the role oral valacyclovir therapy can play.
Keywords: benign aseptic meningitis; health care quality and cost; immunocompetent adult; ramsay-hunt syndrome; vzv meningitis
Protocol for a randomized trial of self-management support for people with chronic obstructive pulmonary disease using lay health coaches
No full textSuccessful management of chronic obstructive pulmonary disease (COPD) centers on patient self-management behaviors (SMB) such as controller medication adherence, use of action plans, smoking cessation and more. Individuals with COPD face a number of barriers to effective self-management, including medical comorbidities, cognitive and mental health disorders, and socioeconomic factors. Poor self-management contributes significantly to poor health outcomes in patients with COPD. However, prior research has demonstrated that interventions to improve SMB must be multifaceted and tailored to individual patients\u27 specific barriers to be most effective. This randomized control study will test a 6-month self-management support intervention in 300 adults with Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifications B or E. The intervention is called Supporting self-Management Behaviors in Adults with COPD (SAMBA). It uses health coaches to identify and address barriers to SMB, support home-based pulmonary rehabilitation, and promote use of as-needed antibiotics and oral corticosteroids for early treatment of acute COPD exacerbations. SAMBA will be compared to a time and attention matched control treatment consisting of general COPD education. We hypothesize that patients receiving SAMBA will have better COPD medication adherence, greater exercise capacity, more improved COPD symptoms and quality of life, and fewer hospitalizations and ED visits than control patients. CLINICAL TRIAL REGISTRATION NUMBER: NCT06634810.
Keywords: Chronic obstructive pulmonary disease (COPD); Health coaches; Randomized controlled trial; Self-management support
Count of Neonatal Morbidities Predicts Outcomes at Age 10 and 15 in Infants Born Extremely Preterm
No full textObjective: To assess if a simple count of 5 common neonatal morbidities, including bronchopulmonary dysplasia (BPD), ultrasound-identified severe brain injury (SBI), severe retinopathy of prematurity (ROP), surgical necrotizing enterocolitis (NEC) and sepsis, predict long-term neurocognitive impairment, general medical health, behavioral health, or quality of life (QOL) at age 10 and 15 years in children born extremely preterm.
Study design: Participants from the multicenter, prospective, longitudinal study Extremely Low Gestational Age Newborns (ELGANs) were followed at ages 10 and 15 and were categorized into groups with 0, 1, 2, or ≥3 neonatal morbidities (BPD, SBI, ROP, NEC or sepsis). Long-term neurocognitive outcomes were assessed using latent profiles generated from standardized tests of intelligence and executive function. General medical health, behavioral health, and QOL were assessed using standardized assessments.
Results: Of 1198 participants who survived to age 10,889 (74.2%) and 694 (57.9%) were evaluated at age 10 and 15 respectively. The number of neonatal morbidities was linearly related to the probability for moderate to severe neurocognitive impairment at age 10 and 15, and the probability of motor impairment, legal blindness, severe hearing loss, number of health disorders, ≥2 health disorders, and poor QOL at age 10.
Conclusion: Among newborns born extremely preterm who survive long-term, a simple count of neonatal morbidities (including BPD, SBI, ROP, NEC, or sepsis) is linearly related to neurocognitive impairment, poor general health, and quality of life
Cell Phone Activity and Trauma Patient Volume in New England Through the COVID-19 Pandemic: A Research Consortium of New England Centers for Trauma (ReCONECT) Study
No full textBackground: We sought to understand whether cellular telephone activity in commercial spaces as a marker for population mobility would be associated with trauma admission volumes, taking advantage of cellular telephone data made available during the COVID-19 pandemic and large swings in population activity.
Study design: Trauma registry data from six level I trauma centers (TC) in New England were used to identify the number of daily trauma admissions (TA) from January 20th 2020 to July 31st 2021. The Device Exposure Index (DEX) is a standardized measure of daily cellular telephone interactions with other cellular telephones within a county. Spearman\u27s rank correlation was calculated for the first wave of COVID-19 from March 2020 to May 2020 and for the entire study period. Center-specific Poisson models were created to control for seasonality.
Results: During the study period, daily mean TA was 42.8 (SD 10.7) and daily mean DEX was 60.6 (SD 26.8) overlapping device visits to venues per day. The daily DEX index was moderately correlated with TA from March to May of 2020 for five centers serving unique catchment areas, with Spearman\u27s rho ranging from 0.22 to 0.47 (p\u3c 0.05). The sixth center where the catchment area overlaps with those of multiple level I centers had much lower correlation r = 0.06 (p=0.59). After controlling for seasonality, DEX vs. TA relationships remained significant among the six centers.
Conclusion: County-level daily DEX scores correlated significantly with TC-specific numbers of daily TA at 5 of 6 TC during the first three months of the study period. Additional research is needed; however, use of cellular telephone activity and interactions may be a valuable adjunct for trauma system planning
Nursing News & Views - February 2025
Full text linkNursing News & Views - February 2025https://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1042/thumbnail.jp