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Supporting Onboarding & Achieving Role Readiness Education Program: Nurse Residents “SOARR” into NSI Speed Dating
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A conceptual framework for assessing implementation strategy integrity
No full textBackground: The outcomes of planned implementation efforts have been mixed, with some applications failing to achieve the desired change or impact. While reasons for mixed findings in implementation research are multifaceted (e.g., Damschroder et al., 2009, 2022), how the implementation strategy (IS) was deployed (i.e., integrity) and its impact on the implementation outcomes of evidence-based innovations (EBIs) is under-studied and warrants further clarification.
Method: This article builds on the IS fidelity and mechanisms of change literature to create the Implementation Strategy Integrity Framework (ISIF). The ISIF was developed by a set of implementation science researchers in the Justice Community Opioid Innovation Network seeking to document the role of implementation strategies in influencing EBI outcomes.
Results: The authors identified four areas of documentation and measurement to examine the role of IS integrity on EBI outcomes. (a) Implementation Strategy Rigor (i.e., adherence, dose, and quality) requires those implementing the strategy/strategies to specify them, document adherence to the planned strategies, quality of execution, and any adaptations made. (b) Target User Responsiveness documents the extent and quality of targeted users\u27 participation in IS activities and how well the target users perform their roles in conducting actions intended by the implementation strategies. (c) Target Mechanism Activation notes to what degree the implementation strategies achieved the intended impact(s) on targeted factors that facilitate EBI use. Finally, (d) these three areas are combined with selected Inner and Outer Context variables to explain IS integrity\u27s potential moderating and mediating effects on EBI outcomes.
Conclusions: A framework that can define the integrity of an IS and allow for its subsequent use as an explanatory variable in EBI outcomes is necessary for better elucidating mechanisms of action. The ISIF offers a structured approach to operationalize, measure, and evaluate the application and related impacts of implementation strategies.
Keywords: Integrity; fidelity; implementation fidelity; implementation strategy fidelity
Comment on van Gemert et al. Child Abuse, Misdiagnosed by an Expertise Center-Part II-Misuse of Bayes\u27 Theorem. Children 2023, 10, 843
No full textOptimizing Health Care Resource Allocation, Workforce Right-Sizing, and Stakeholder Collaboration
No full textDoes Gender Affect the Outcomes of Myocardial Revascularization for Left-Main Coronary Artery Disease?
No full textCurrently, gender is not considered in the choice of the revascularization strategy for patients with unprotected left main coronary artery (ULMCA) disease. This study analyzed the effect of gender on the outcomes of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with ULMCA disease. Females who had PCI (n = 328) were compared with females who had CABG (n = 132) and PCI in males (n = 894) was compared with CABG (n = 784). Females with CABG had higher overall hospital mortality and major adverse cardiovascular events (MACE) than females with PCI. Male patients with CABG had higher MACE; however, mortality did not differ between males with CABG vs PCI. In female patients, follow-up mortality was significantly higher in CABG patients, and target lesion revascularization was higher in patients with PCI. Male patients had no difference in mortality and MACE between groups; however, MI was higher with CABG, and congestive heart failure was higher with PCI. In conclusion, women with ULMCA disease treated with PCI could have better survival with lower MACE compared with CABG. These differences were not evident in males treated with either CABG or PCI. PCI could be the preferred revascularization strategy in women with ULMCA disease.
Keywords: coronary artery bypass grafting; gender risk stratification; left main disease; percutaneous coronary intervention
Nanoparticle-mediated co-delivery of inflammasome inhibitors provides protection against sepsis
No full textThe NLRP3 inflammasome, a multiprotein complex responsible for triggering the release of pro-inflammatory cytokines, plays a crucial role in inducing the inflammatory response associated with sepsis. While small molecule inhibitors of the NLRP3 inflammasome have been investigated for sepsis management, delivering NLRP3 inhibitors has been accompanied by several challenges, primarily related to the drug formulation, delivery route, stability, and toxicity. Many existing inflammasome inhibitors either show higher liver toxicity or require a high dosage to efficiently impede the inflammasome complex assembly. Moreover, the potential synergistic effects of combining multiple inflammasome inhibitors in sepsis therapy remain largely unexplored. Therefore, a rational approach is essential for presenting the potential administration of NLRP3 small molecule inhibitors to inhibit NLRP3 inflammasome activation effectively. In this context, we present a lipid nanoparticle-based dual-drug delivery system loaded with MCC 950 and disulfiram, demonstrating markedly higher efficiency compared to an equivalent amount of free-drug combinations and individual drug nanoparticles in vitro. This combination therapy substantially improved the in vivo survival rate of mice for LPS-induced septic peritonitis. Additionally, the synergistic approach illustrated a significant reduction in the expression of active caspase-1 as well as IL-1β inhibition integral components in the NLRP3 pathway. This study underscores the importance of integrating combination therapies facilitated by nanoparticle delivery to address the limitations of small molecule inflammasome inhibitors
How I Do It Applying non-invasive ventilation in treatment of acute exacerbation of chronic obstructive pulmonary disease using evidence-based interprofessional clinical practice
No full textWhen administered as first-line intervention to patients admitted with acute hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease exacerbation in conjunction with guideline recommended therapies, noninvasive ventilation (NIV) has been shown to reduce mortality and endotracheal intubation. Opportunities to increase uptake of NIV continue to exist despite inclusion of this therapy in clinical guidelines. Identifying patients appropriate for NIV, and subsequently providing close monitoring to determine an improvement in clinical condition involves a team consisting of physician, nurse and respiratory therapist in institutions that successfully implement NIV. We describe to our knowledge the first known evidence-based algorithm speaking to initiation, titration, monitoring, and weaning of NIV in treatment of acute exacerbation of chronic obstructive pulmonary disease that incorporates the necessary interprofessional collaboration among physicians, nurses and respiratory therapists caring for these patients.
Keywords: Acute exacerbation of COPD (AECOPD); chronic obstructive pulmonary disease (COPD); interprofessional team; noninvasive ventilation (NIV)
The Public Health and Economic Impact of Drug Overdose Out-of-hospital Cardiac Arrest in the United States
No full textObjective: To calculate disability-adjusted life years (DALY) and labor productivity loss due to drug overdose out-of-hospital cardiac arrest (DO-OHCA) and compare its contribution to the burden of disease and economic impact of all-cause nontraumatic out-of-hospital cardiac arrest (OHCA) in the US.
Methods: We performed a retrospective observational cohort analysis of all adult (age ≥18 years) nontraumatic emergency medical services-treated OHCA events, including those due to DO-OHCA, from the national Cardiac Arrest Registry to Enhance Survival (CARES) database from January 1, 2017 and December 31, 2020. The main outcome measures of interest were disability-adjusted life years, annual, and lifetime labor productivity loss over the 4-year study period. The findings for the study population were extrapolated to a national level using the CARES population catchment and U.S. population estimates by year.
Results: A total of 378,088 adult OHCA events, including 23,252 DO-OHCA (6.2%) met study inclusion criteria. The DO-OHCA DALY increased from 156,707 in 2017 to 265,692 in 2020. Per year, DO-OHCA contributed to 11.4%, 12.0%, 10.5%, and 11.4% of all OHCA DALY lost from 2017-2020, respectively. The mean annual and lifetime productivity losses for all OHCA were stable over time (annual: 50K in 2020; lifetime: 692K in 2020). The CARES population catchment increased by 39.8% over the study period (102.6M in 2017 to 143.4M in 2020). For DO-OHCA, the mean annual productivity loss was approximately 30% higher than non-DO-OHCA (49K in 2020, respectively). The mean lifetime productivity loss for DO-OHCA was 2.5 times higher than non-DO-OHCA (630K in 2020, respectively).
Conclusions: The DALY due to DO-OHCA has increased over time with expansion of the CARES dataset, but its relative contribution to total OHCA DALY (all non-traumatic etiologies) remained fairly stable. The DO-OHCAs represent approximately 6% of all adult non-traumatic EMS-treated OHCA events but has a disproportionately greater economic impact. Continued efforts to reduce DO-OHCA through public health initiatives are warranted to lessen the societal impact of OHCA in the U.S.
Keywords: burden of disease; disability-adjusted life years; drug overdose; economic productivity loss; out-of-hospital cardiac arrest
Nursing Perceptions of Robotic Technology in Healthcare: A Pretest-Posttest-Survey Analysis Using an Educational Video
No full textOCCUPATIONAL APPLICATIONSWe used a survey to evaluate the perceptions of nurses and nursing students on robotic technology for nursing care before and after reviewing an educational video that included examples of medical, care, and healthcare service robotic technology. We found that the perception of robotic technology was innately favorable and became more favorable after the video. It is beneficial for engineers to incorporate nurses\u27 frontline knowledge into the design process from the beginning, while functional changes can be implemented since nurses comprise the largest group of healthcare professionals in hospitals and are the end users of technological devices. Educating nurses in state-of-the-art technology specific to what designers are developing can enable them to provide relevant insight. Designers and engineers can use this insight to create user-friendly, effective technology that improves not only patient care but also nurse job satisfaction.
Keywords: Nurse perception; design process; educational video; pretest-posttest; quality of care; robotic technology. Plain language summary
Background: Interdisciplinary engineering and nursing collaborations have successfully addressed healthcare-related problems; however, findings highlight consistently that nurse input is underutilized in earlier stages of the design process.Purpose: Our purpose was to capture the differences in perceptions and highlight the insights of nursing students, faculty, and professionals, before and after learning about robotic technology for nursing care.Methods: A quasi-experimental, pretest–posttest survey was employed using an educational video. The survey related to the perception of three different categories of healthcare robotic technology (medical, care, and healthcare service), as represented by eight different subcategories: surgical; robotic diagnostic systems; companion; assistive; medication delivery and dispensing; cleaning and disinfecting; telepresence and remote monitoring; delivery. Participants rated each subcategory using a Likert-type scale with a 5-point response format with four items: impact, acceptance, environment, and use. Scores were summated to represent the overall construct of perception. Qualitative data were collected in the form of open-ended responses.Results: Data were collected from 118 participants, with a survey completion rate of 75%. Mean scores were significantly greater for each of the eight robotic technology subcategories after the educational video, supporting that the video influenced a positive perception of healthcare robotic technology. Themes from comments were categorized into (1) positive, mixed, and negative aspects of the research study, as well as improvements and concerns relating to (2) quality of care, (3) nurse work performance, and (4) nursing as a profession.Conclusion: An educational video enhanced the favorable perception of robotic technology in healthcare. Training nurses on technology fundamentals helped elucidate their potential concerns and identified appropriate applications. It is essential that engineers provide nurses with fundamental knowledge, consistent language, and context about the technology engineers want to develop so nurses can effectively communicate their needs