Parkview Health Research Repository
Not a member yet
774 research outputs found
Sort by
Fasting Versus a Heart-Healthy Diet Before Cardiac Catheterization: A Randomized Controlled Trial.
No full textBACKGROUND: Patients undergoing cardiac catheterization are ordered to take nothing by mouth after midnight before their procedure with no evidence to support this practice.
OBJECTIVE: To identify best practice for fasting requirements before cardiac catheterization through comparative evaluation in a prospective randomized controlled study.
METHODS: The study included a convenience sample of 197 patients undergoing elective cardiac catheterization in a progressive inpatient cardiac unit at a regional heart institute in the midwestern United States. The patients were randomized into 2 groups. Patients in the heart-healthy diet group could eat a specified diet with low-acid options until the scheduled procedure. Patients in the fasting group were restricted to nothing by mouth after midnight except for sips of water with medications until the scheduled procedure. Outcome measures included patient-reported satisfaction and complications.
RESULTS: Compared with patients in the fasting group, those in the heart-healthy diet group had significantly more satisfaction with the preprocedural diet. Patients in the heart-healthy diet group had less thirst and hunger before and after the procedure. No patients experienced pneumonia, aspiration, intubation, or hypoglycemia after the procedure. Fatigue, glucose level, gastrointestinal issues, and loading dose of antiplatelet medication did not differ between the groups.
CONCLUSIONS: Allowing patients to eat before elective cardiac catheterization posed no safety risk and benefited patient satisfaction and overall care. The results of this study may help identify best practice for allowing patients to eat before elective procedures using conscious sedation
Issue 8: Pulmonary & Critical Care Insider
Get PDFPulmonary & Critical Care Insider Issue 8
Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.
The Pulmonary & Critical Care Insider newsletter was created by Dr. Bharat Bajantri, MD and Sarah Ellsworth, MLS in 2023 as a form of current awareness for current practice at our hospital, Parkview Health. The content resides within critical care and pulmonary related topics and this information is compiled into four main formats. Original Study Summaries: New research publications are read, reviewed, then concisely summarized for clinical interpretation with professional perspectives. Viewpoints: Editorial clinical perspective pieces on current practices. This includes mini-reviews. Snapshots: Quick reference of updated clinical practice or guidance. Contributions: Relevant submissions from other professionals.
All content in Pulmonary & Critical Care Insider is reviewed and referenced by healthcare and library professionals. Information provided is intended to disseminate new information and encourage best practices through perspective and discussion.
---------
Topics:
VIEWPOINTS- Steroids in the ICU- Septic Shock, ARDS, and Severe CAP
ORIGINAL STUDY SUMMARIES: Bronchoscopic Lung Volume Reduction (BLVR) Are we looking at the wrong outcomes?
ORIGINAL STUDY SUMMARY & PERSPECTIVE First.... Do NO HARM with PPI! Despite generally favorable safety profiles, extended PPI use has been linked to heightened risks of serious complications
Being Well While Doing Well - Distinguishing Necessary from Unnecessary Discomfort in Training (Graduate Medical Education Corner)
Key ACLS Best Practice Recommendations 2024
SNAPSHOTS: COPD- Beat it with Beets
In-hospital outcomes of patients with lung cancer with and without superior vena cava thrombosis: A nationwide analysis.
Get PDFMeeting Abstract: 2024 ASCO Annual Meeting
Background: Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. It may be caused by external compression or internal obstruction due to a thrombus or direct invasion by tumor cells. Though lung malignancy is the most common cause of SVCS, there is a lack of data on in-hospital outcomes in these patients. Methods: We queried the National Inpatient Sample 2018-2020 to identify hospitalizations with lung cancer including both small cell and non small cell lung cancer. Hospitalizations with diagnosis of acute SVC thrombosis were determined by using ICD-10 codes.Demographics and mortality rates were compared between two groups using chi square for categorical variables and t test for continuous variables. Multivariate regression analysis was further performed to study the impact of SVC thrombosis on mortality, LOS and total hospitalization cost. Results: A total of 2011620 hospitalizations with lung cancer were identified. Of these, 2855 (0.0014%) had acute SVC thrombosis. These patients were younger with a mean age of 63 years. African-Americans and Hispanics were in a higher proportion in the cohort of hospitalizations with SVC thrombus as compared to those without. (Table 1). Multivariate regression analysis revealed higher odds of mortality (OR-1.94; C.I: 1.53-2.47; P \u3c 0.001), LOS (OR 1.66; C.I:1.20- 2.31; P \u3c 0.005) and total hospitalization cost (26211.15; C.I:22183.56- 30238.74; P \u3c 0.001) in lung cancer hospitalizations. Conclusions: Our study shows that SVCT, has higher odds of mortality, length of stay and total hospital cost. Though the general recommendation is to continue anticoagulation, sometimes patients may require endovascular stent placement with/without thrombectomy. Though rare, SCVT can be life threatening and requires prompt attention
Propensity Matched In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction of Left Anterior Descending (LAD) coronary artery in Patients with & without Chronic Total Occlusion of Coronaries
Get PDFBackground Chronic total occlusion (CTO) is a near-total blockage of a coronary artery often seen during percutaneous coronary intervention for acute coronary syndrome but not directly responsible for the event. Methods The national readmission database (2016-2020) was utilized to identify hospitalizations for STEMI, with LAD as the culprit. Cohorts were stratified based on the presence of the CTO. A Propensity Score Matching (PSM) model matched CTO and non-CTO cases. Pearson’s x2 test was applied to PSM-2 matched cohorts to compare outcomes. Results Among 98,213 hospitalizations for LAD-STEMI, About 5.53% (N: 5,704) had CTO. After propensity matching (N=3,197), patients with CTO had higher mortality (10.95 vs. 7.26%, p: \u3c0.001), sudden cardiac arrest (14.29 vs. 11.57%, p\u3c0.001), cardiogenic shock (23.80 vs. 18.07%, p\u3c0.001), mechanical circulatory support use (20.39 vs. 15.57%, p\u3c0.001), and CABG rates (7.2 vs. 6.5%, p\u3c0.001), although rates of MI complications and PCI were similar in the two cohorts (p\u3e0.05). CTO patients had similar readmission rates on 30- (10.72 vs. 10.20%, p=0.52) and 90-day (18.43 vs. 17.35%, p=0.33) intervals, similar LOS (3 vs. 3 days) & higher adjusted cost of hospitalization [171,793, p\u3c0.001]. Female gender (aOR: 1.16), DM (aOR: 1.27), ESKD (aOR: 1.27) & HF (aOR:1.39) were significant predictors of readmission while rehabilitation transfer was protective against readmissions (aOR:0.31) [p\u3c0.001]. Conclusions In LAD-STEMI hospitalizations, patients with CTO have higher mortality, complications, and resource utilization, although MI complications & 90-day readmission rates were similar
Applying Efficiency to Quantify Workplace Violence Situations for Meaningful Analysis
Get PDFPresented at the 2024 Parkview Nursing Research Symposium.
Background/Problem: Standard data gathering around workplace violence has been a national gap and there is not a national recommendation on how or what data points to collect. Purpose: A process was developed that enabled automated data collection and aggregation which allowed gathering of workplace violence data. The process built moved from a manual time-consuming endeavor to an efficient process that quantified a multitude of key metrics needed for analysis that can be used to drive meaningful mitigation. Methods: A focus study was built within Midas that included most of the elements from a paper form that was initially used to identify how Behavioral Emergency Response Team (BeRT) responded to alerts activated. Multidisciplinary and interdisciplinary teams were pulled together and modified the elements. A comprehensive list of data points and consensus was received. Those data points were embedded into Midas as an electronic format and allowing the use of a pre-existing platform that end users were already familiar with. A standard report was built based on data points that could be easily exported into excel format. Results: A list of agreed upon data points from key stakeholders drove engagement and utilization of electronic data entry instead of using a paper manual process of writing down information gathered during BeRT alerts. Entering data points into Midas as an electronic platform catapulted the ability to collect, aggregate, and quantify data into meaningful analytics. Conclusion: Pulling teams together to gather a consensus of meaningful data points, leveraging current familiar electronic platforms, and utilizing pre-existing information were used to develop buy-in and develop an efficient process for workplace violence data entry. This allowed the ability to use standard data points for aggregation and analysis
Inquire, Act, Empower: Resilience Strategies for Adolescent Mental Wellness
Get PDFPresented at the 2024 Parkview Nursing Research Symposium.
Background/Problem: Adolescence is a pivotal period for mental health development, with many experiencing stressors that may contribute to the onset of mental health disorders. Research has identified key resilience factors that enhance mental well-being and mitigate the risk of these disorders. Translating this research into practical nursing interventions promotes mental wellness among adolescents.
Objectives/Aim/Purpose: This poster aims to explore evidence-based resilience factors in adolescents and present action-oriented nursing interventions that can be integrated into clinical practice to empower young individuals in maintaining mental wellness and preventing mental health disorders.
Methods: A systematic review of research was conducted to identify resilience factors relevant to adolescents, such as strong social connections, effective coping mechanisms, emotional regulation, and supportive environments. Based on these findings, a series of practical nursing interventions were developed for implementation in various clinical and community settings.
Results: The review highlights several actionable strategies for nursing practice, including:
1. Enhancing Social Support Networks: Encouraging peer and family involvement through group activities and family therapy.
2. Coping Skills Development: Implementing stress management education that teach adolescents healthy coping strategies and problem-solving techniques.
3. Fostering Emotional Regulation: Integrating mindfulness practices and emotional awareness exercises into nursing care to help adolescents better manage their feelings.
4. Building Self-Efficacy: Develop programs that help adolescents set and achieve personal goals, fostering a sense of accomplishment and control over their lives.
Conclusion: Adolescent mental health care should prioritize resilience-building interventions that are evidence-based and practical for nurses to implement. By integrating these strategies into nursing practice, nurses can play a vital role in promoting mental well-being and preventing the onset of mental health disorders in adolescents. This poster highlights the transition from resilience research to actionable interventions, offering a roadmap for nurses to advance adolescent mental health care
Evaluation of Shared Governance Perceptions at Parkview Health
Get PDFPresented at the 2024 Parkview Nursing Research Symposium.
Background: Shared governance is a structure for clinical nurses to have a voice in decisions regarding practice and the practice environment. It is imperative to have a model that is inclusive of all nurses and allows for decision-making and accountability related to nursing practice. It is essential that nurses are empowered to make decisions at the point of care related to patient care decisions. Objective: The purpose of this study was to assess current state of shared governance councils at Parkview Health. Method: Data was collected using the Index of Professional Nursing Governance (IPNG) version 3.0 and the Council Health Survey. The IPNG 3.0, is a reliable and valid tool containing 50 questions related to professional nursing governance with six subscales. The Council Health Survey instrument includes 25-items to assess council effectiveness at either the unit or system level [2]. The scale has the following three subscales: Structure, Activities, and Membership. Demographic data was also collected including current role in the organization. Descriptive statistics were calculated for all measures. Comparisons were made for IPNG 3.0 total score, IPNG 3.0 subscales and Council Health Activities and Membership subscales for current role, work location, and years in current role. For these comparisons, Kruskal-Wallis tests were conducted due to the non-parametric nature of IPNG 3.0 scores and Council Health Summary. Results: A total of 500 respondents had complete responses on the IPNG 3.0 and were retained for analyses. Nearly all respondents were female (95.2%), the modal age range was 30-39 years old, and 64.4% had a Baccalaureate Degree in Nursing. In their current role, 83.8% provided direct patient care and 66.0% worked full-time. On INPG-3, 68.3% of leaders responded with scores meeting the threshold for shared governance; whereas 60.5% of non-direct care employees and 55.6% of direct care employees met this threshold. Scores for some of the subscales showed that leaders reported more shared governance than direct care and non-direct care employees. No differences in Council Health Survey scores were found by current role. A significant difference among IPNG 3.0 scores by location was discovered. Three subscales showed significant differences as well (Influence over Resources, Participation in Committee Structures, Control over Practice). Conclusions: The findings revealed a disparity in the perception of shared governance among nursing roles and according to work location. Nursing leaders consistently reported higher levels of shared governance compared to both direct and non-direct care nurses. Additionally, employees at Ambulatory PPG reported lower shared governance compared to other work locations. These discrepancies across roles and work locations underscore the need for targeted strategies to enhance the involvement and empowerment of direct care nurses, non-direct care nurses, and Ambulatory PPG in governing activities
Evaluating Stress Relief Management Through Use of Candy on an Orthopedic Trauma Unit
Get PDFPresented at the 2024 Parkview Nursing Research Symposium.
Background : Questioned the evidence and opportunity for simple strategies to reduce in-the-moment clinical staff anxiety or stress. Came across a popular therapy trend in which sour or spicy candy is used as a form of distraction for momentary panic-level anxiety. With help from the Parkview Librarian, discovered there was not much information to support this theory, but also that it may not have been evaluated in the context of in-patient, clinical staff stress. Initiated “Stress Relief Treats” project on the Orthopedic Trauma unit in June 2024 to assess if pausing to have a piece of sour/spicy candy could positively impact staff stress levels. Objectives: The goal of the “Stress Relief Treats” project is to identify simple strategies to reduce momentary clinical staff stress/anxiety level, such as using sour or spicy candy. Methods: This quality improvement initiative included: Providing sour and spicy candy options, including War Heads and Hot Tamales, that was easily accessible for staff in the Nurse Lead office. Anonymously surveying staff who tried the candy intervention to assess self-reported stress levels before and after eating a piece of candy. Plans to evaluate common clinical stress triggers to identify specific trends. Results: Results are still in progress, but early survey responses suggest positive outcomes in reducing stress levels. Conclusion: While the “Stress Relief Treats” project is still in the early phases, clinical staff pausing to briefly distract themselves with a sour/spicy treat during stressful moments may be beneficial to reduce stress levels. As work continues on this project, the project may be adapted to include other simple stress-relief strategies such as short affirmations or aromatherapy options
When the Lights Go Out: Drill Your Way to Downtime Success
Get PDFPresented at the 2024 Parkview Nursing Research Symposium
Problem: The adoption of the electronic medical record (EMR) in healthcare facilities has significantly surged since the implementation of the Health Information Technology for Economic and Clinical Health Act in 2009. Despite advancements in electronic documentation, both planned and unplanned EMR downtimes pose substantial challenges. Such downtimes can disrupt clinical workflows, lead to delays in patient care and compromise the overall quality of services provided. Purpose: The aim of this project is to evaluate solutions for EMR downtime preparation that enhance staff confidence and minimize disruption of workflow during downtime events. Methods: A survey of scholarly sources and an evaluation of studies were reviewed. Various scenarios of both short-term and extended downtime processes were evaluated. Results: Downtime drills significantly enhance staff preparedness and response, leading to improved patient care continuity and operational resilience during EMR downtime events. By engaging in regular, structured training exercises, staff members can become more familiar with established protocols and procedures, enabling them to respond swiftly and effectively when the EMR system experiences disruptions. Conclusion: Conducting regular, structured drills, team members become more familiar with the protocols and procedures necessary to maintain continuity of care when the EMR system is unavailable. Drills provide hands-on experience, allowing nursing staff to practice their response strategies in a controlled environment, thereby reducing anxiety and uncertainty during actual downtimes
Optimizing Serum Magnesium Monitoring and Replacement in a Community Hospital.
Get PDFPresented at the ASHP Midyear Clinical Meeting. New Orleans, LA
Findings highlight the need to revise our healthcare system’s standard hematology/oncology treatment plans to better align with appropriate magnesium monitoring, with up to 93% of magnesium lab draws potentially being unnecessary, and replacement, including better utilization of oral magnesium formulations instead of IV which can lower costs