11210 research outputs found
Sort by
Clinical outcomes in anemic women undergoing elective percutaneous coronary intervention: A retrospective cohort analysis
No full textPurpose: Anemia is common among women undergoing elective percutaneous coronary intervention (PCI), yet remains under-addressed in contemporary ACC/AHA guidelines. We evaluated the association between baseline anemia and short- and long-term outcomes after PCI.
Methods: Using the TriNetX federated electronic health record network, we identified women undergoing first-time elective PCI and compared anemic vs. non-anemic patients. One-to-one propensity score matching yielded N = 1,153 per group, balancing demographics, comorbidities, medications, and labs. Clinical outcomes were assessed at 7 days, 30 days, 6 months, and 12 months, and included major adverse cardiovascular events (MACE), acute coronary syndrome (ACS), acute kidney injury (AKI), stroke or transient ischemic attack (TIA), major bleeding, transfusion requirements, all-cause hospitalization, in-stent restenosis, stent thrombosis, and all-cause mortality. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazards models.
Results: At 7 days post-procedure, baseline anemia was significantly associated with an increased risk of AKI (HR 2.2; 95% confidence interval [CI], 1.1-4.5; p = 0.03), major bleeding events (HR 3.2; 95% CI, 1.4-7.5; p \u3c 0.01), and transfusion requirements (HR 9.1; 95% CI, 2.1-39.2; p \u3c 0.01). Notably, all 7-day mortality events occurred in the anemic cohort (0.9% vs. 0.0%). By 30 days, patients with anemia continued to demonstrate higher rates of AKI, major bleeding, and transfusion needs. At 12 months, these risks persisted and, in some cases, widened. Anemia was independently associated with increased rates of major adverse cardiovascular events (MACE) (HR 1.4; 95% CI, 1.1-1.8; p = 0.01), AKI (HR 1.9; 95% CI, 1.5-2.5; p \u3c 0.01), all-cause hospitalization (HR 1.3; 95% CI, 1.1-1.5; p \u3c 0.01), and all-cause mortality (HR 2.3; 95% CI, 1.4-3.8; p \u3c 0.01). Differences in stroke or TIA rates were not statistically significant, and the incidence of stent thrombosis or restenosis was comparable between anemic and non-anemic groups.
Conclusions: Among women undergoing elective PCI, baseline anemia emerged as a strong predictor of adverse outcomes, spanning early kidney/bleeding complications and sustained increases in MACE, hospitalizations, and mortality over one year, without clear differences in stent-related events. These data support integrating anemia into pre-PCI risk assessment and motivate randomized trials of pre-procedural anemia optimization
Hemocompatibility outcomes with pharmacological therapy following LVAD implantation: Insights from the ARIES-HM3 trial
No full textBackground: The ARIES-HM3 (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump) trial demonstrated safety and decreased bleeding in eliminating aspirin from the antithrombotic regimen of patients implanted with a HM3 left ventricular assist device (LVAD). Whether pharmacologic therapies impact hemocompatibility-related adverse events (HRAEs) remains uncertain.
Objectives: In this trial analysis, the authors investigated associations between pharmacologic therapy and hemocompatibility outcomes.
Methods: Among 547 of 589 randomized patients who were discharged, non-inotrope-dependent, and completed 1-month of follow-up, the study explored the influence of pharmacotherapy (renin-angiotensin-aldosterone system [RAAS] inhibitors, heart failure [HF]-related and other cardiovascular drugs) on blood pressure control and on survival free of major nonsurgical HRAE (stroke, pump thrombosis, bleeding, and arterial thromboembolism) at 12 months.
Results: In 547 eligible patients, 65% received RAAS inhibitors, 89% received other HF-related therapy, and 82% received another cardiovascular drug at 1 month. No statistically significant interaction between RAAS inhibitors (P = 0.08), other HF-related therapies (P = 0.65), or other cardiovascular drugs (P = 0.92) on aspirin use and primary endpoint success was observed. Patients receiving RAAS inhibitors at 1 month had greater primary endpoint success (78.9% vs 69.3%, HR: 0.61 [95% CI: 0.37-1.01]; P = 0.14). Other HF-related therapies and cardiovascular drugs were not associated with primary event success either on or off prescription (HF-related therapy: 75.4% vs 76.7%; other cardiovascular drugs: 74.3% vs 81.3%). Pharmacologic therapy did not have a significant interaction with blood pressure control (RAAS inhibitors: P = 0.69; other HF-related therapy: P = 0.40).
Conclusions: Background pharmacologic therapy did not modify the effect of aspirin on HRAE; however, the use of a RAAS inhibitor was independently associated with a reduction in HRAE. These exploratory observations may potentially point to opportunity for enhancing hemocompatibility in patients receiving LVAD therapy. (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump [ARIES-HM3]; NCT04069156)
1920P ImmunoDriver-2: CD8 T cell and PD-L1 levels associate with first-line (1L) overall survival (OS) in immune checkpoint inhibition (ICI)-treated non-small cell lung cancer (NSCLC)
No full textAge Friendly Health Systems: Implementing a Social Modal of Care for Older Adults
No full textBackground
Age Friendly Health Systems (AFHS) is a social movement to care for older adults.
The framework of Age-Friendly care is the 4Ms: Mobility, Medication, Mentation and What Matters, each acting on and acted upon by the rest. Clinicians assess and act on the 4Ms for every older adult in their care.
Local Problem
At this hospital, 58% of inpatients are older adults. The implementation of AFHS drives care for this important demographic.
The goal is to implement AFHS 4M care on all inpatient units by 2025.
Method
With support of the AFHS Action Community, an interdisciplinary Steering Committee studied demographics and defined teammate education and workflows for the 4Ms. On the pilot unit, the aim was to assess and act on the 4Ms for 30 patients in 3 months. In the first 2 months, 21% of patients had 4M assessments and no patients received 4M care as a set
Plan-Do-Study-Act (PDSA) was used to study the process and adapt AFHS practices. The 4M assessments were built into the Epic admission process, however, the telemetry unit received patients who had been admitted or transferred from units throughout the hospital. Documentation was done by unit-based, virtual, agency and resource nurses, most who were not trained in 4M assessment. Rapid-cycle PDSA addressed the complexity of the AFHS assessments and care plans.
Results
We met the goal of 30 patients with 4M care after 5 months; 64% of patients on the pilot unit had all 4Ms assessed. All inpatient units implemented AFHS in 2024.
Implications for Practice
The prevalence and complexity of care for older adults is daunting. Hospitals can utilize the 4M framework to provide geriatric-sensitive care with what matters to the patient driving their care.
The practice of Age-Friendly care on all units allows consistency and efficiency to 4M assessment and interventions
Scan-Do Attitude
No full textBackground:
Medication scanning compliance was below the target of 95%. A team was formed to understand barriers. This team was led by two front line nurses. The team identified opportunities for improvement.
Local Problem:
In April 2024, the general pediatric unit’s medication scanning was as low as 88.7%, with the average weekly medication scan rate at 93.2% and patient ID band scan rate at 93.8%. Many teams contributed to the medication scanning non-compliance including respiratory, pharmacy, and bedside nurses. Some weeks respiratory medication scanning was as low at 7%. Bedside nurses had the largest number of fallouts, with 44% being their lowest.
Method:
The nurses led the teams through workflow optimization to reduce barriers. A dedicated computer for respiratory therapists and additional medication barcodes added to the unit’s automated dispensing system increased the compliance for respiratory team.
The team eliminated workarounds with patient ID banding by holding nurses accountable for scanning the patient band.
There were gaps in internet connectivity. The team partnered with IT to add routers.
The nurses partnered with pharmacy and supply chain to ensure convenience items ordered can be scanned.
The approach chosen was Rapid Cycle PDSA. Weekly medication compliance reports were reviewed to identify areas of opportunity.
Results/Conclusions:
After 14 weeks, the team maintained a medication scanning compliance greater than 95%. However, the unscannable convenience items issue has not yet been completely resolved.
Overall, the average patient medication scan compliance increased by 3.5% (96.7%) and the patient ID band scan rate increased by 3.5% (97.3%) between the two units.
A decrease in medication scanning events was noted, highlighting a focus on medication safety.
Implications for Practice:
This project demonstrated commitment to patient safety by assessing and addressing the front-line team\u27s barriers to medication administration. Medication administration compliance improved after implementation of the new workflow practices
Touch Up Your ROOTS: Improving Retention, Orientation, Onboarding, and Training Success
No full textBackground: A study completed by NSI Nursing Solutions (2022) reported that nurses employed less than one year have a turnover rate of 31 percent. Reasons for leaving included lack of support and resources. Illinois Masonic had a program built for peer-to-peer support for new hires through a nursing-based council. Lack of consistency was thought to be part of high turnover.
Purpose: The purpose of this project was to increase the retention rate of first year new hires nurses to Illinois Masonic via peer-to-peer engagement throughout their orientation period.
Implementation: Using a DMAIC strategy (Define, Measure, Analyze, Improve, Control), a nursing council participated in a Root Cause Analysis to improve 1 year turnover rates. Post analysis showed lack of peer-to-peer communication with new hires. Communications were changed to handwritten notes with gifts, and follow up communications with resources 1-2 months after starting orientation and again within 6 months of hire.
Outcomes: Comparison rates of new hire retention increased from 83.6% to 91.1%. Completion rates of the first check ins increased from 70.8% to 78.2%, second check ins from 64.9% to 87.6%, and final check ins from 31.1% to 58.6%. This correlated an increase in peer-to-peer communication contributes to an increase in a first-year retention rate.
Implications: Having unit-based nurses provide peer to peer engagement helps to improve retention while a nurse is in orientation/onboarding
Student Nurse Cafe: Filling Your Cup
No full textBackground
The national nursing shortage was identified as a crisis by many organizations including the American Nurses Association and the American Association of Critical-Care Nurses. Healthcare organizations must work to creatively engage and support our incoming nursing workforce by providing meaningful resources that enable recruitment and retention into the nursing profession (Swinton et al., 2024; Rosseter, 2020).
Purpose
Nursing students often run out of caffeine and feel depleted and unsupported (Burleson et al., 2023). They are often not committed to a healthcare organization outside of their clinical rotation. In alignment with the organization’s strategic goal around investing in the next-generation workforce, we wanted to connect these students with our organization.
Methods
Inspired by the success of creating supportive programming for newly hired nurses, a novel student offering was developed for students to establish pathways and partnerships to enrich their student experience and encourage students to join the organization. The Nursing Student Café offered multimodal engagement and participation opportunities. This one-hour, every semester, virtual educational offering focused on topics identified and prioritized by the nursing students. The invitation went to all nursing schools who had students within our organization.
Findings
Students attended from both Midwest states. Surveys from the pilot revealed 100% of participants strongly agreed that the cafe was helpful and would consider attending a future session. 17% of participants currently worked for the organization and planned to continue and 58% of those who didn’t expressed interest in future employment.
Conclusions
By providing student-centric offerings, the cafe increases student satisfaction and potentially recruitment, which creates a significant return on investment. The cafe is sustainable as the foundational work has been completed. By utilizing feedback from students, interest in future sessions ensures attendance and word of mouth promotion. Future considerations include expanding the cafe brand by offering in-person sessions, recorded webinars, and complementary CE offerings
Nurse Initiated Rapid Cycle ECMO Simulation in the Cath Lab
No full textIntroduction and Context: Earlier initiation of extracorporeal membrane oxygenation (ECMO) improves survival in cardiogenic shock. Patients requiring mechanical circulatory support may experience delays in care for up to an hour, as they wait for the shock team to arrive. By leveraging the catheterization (cath) lab nurse and our in-house 24/7 cardiology interdisciplinary team’s availability and expertise, we developed an evidence-based simulation that allows the entire cath lab team to function as the shock team.
Implementation Strategy: Collaborating with the organization’s simulation team, a low-fidelity percutaneous pelvic model was developed to train the team on ECMO cannulation and circuit set-up in a real-world, in-situ environment. Initial feedback led to the adoption of a rapid cycle deliberate practice approach with 3 distinct cycles: real-time feedback, increased hands-on practice, and corrective interventions. Pre-post surveys compared 5-point Likert agreement responses.
Outcomes and Impact: Twelve simulation sessions occurred (Oct-Dec 2024) with 25 nurses and 30 technologists attending, with an average of 9 years in the department. Thirty-five (18 RN, 17 Tech) completed the survey, with a positive increase in agreement from pre-post. Participants self-reported increased understanding related to activating shock team (pre: n= 26, 74%, post: n= 35, 100%). Clinical criteria for ECMO candidates improved from (pre: n= 24, 69%, post n= 34, 97%). Participants increased readiness by knowing where and how to prepare ECMO (pre: n= 28, 80%, post: n= 35, 100%) and comfort setting up ECMO machine independently improved (pre: n= 11, 31%, post: n= 34, 97%).
Insights: The project improved the nurses\u27 understanding and readiness to independently set up a patient on ECMO. Rapid cycle deliberate practice simulation prepares the team in shock roles is a tactic to decrease ECMO initiation delays. Future case study data and application of skills in practice will be evaluated.
Implications: Future case study data and application of skills in practice will be evaluated