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Two Methods for Turning and Positioning and the Effect on Pressure Ulcer Development: A Comparison Cohort Study
No full textPURPOSE:
We evaluated 2 methods for patient positioning on the development of pressure ulcers; specifically, standard of care (SOC) using pillows versus a patient positioning system (PPS). The study also compared turning effectiveness as well as nursing resources related to patient positioning and nursing injuries. DESIGN:
A nonrandomized comparison design was used for the study. SUBJECTS AND SETTING:
Sixty patients from a trauma/neurointensive care unit were included in the study. Patients were randomly assigned to 1 of 2 teams per standard bed placement practices at the institution. Patients were identified for enrollment in the study if they were immobile and mechanically ventilated with anticipation of 3 days or more on mechanical ventilation. Patients were excluded if they had a preexisting pressure ulcer. METHODS:
Patients were evaluated daily for the presence of pressure ulcers. Data were collected on the number of personnel required to turn patients. Once completed, the angle of the turn was measured. The occupational health database was reviewed to determine nurse injuries. RESULTS:
The final sample size was 59 (SOC = 29; PPS = 30); there were no statistical differences between groups for age (P = .10), body mass index (P = .65), gender (P = .43), Braden Scale score (P = .46), or mobility score (P = .10). There was a statistically significant difference in the number of hospital-acquired pressure ulcers between turning methods (6 in the SOC group vs 1 in the PPS group; P = .042). The number of nurses needed for the SOC method was significantly higher than the PPS (P ≤ 0.001). The average turn angle achieved using the PPS was 31.03°, while the average turn angle achieved using SOC was 22.39°. The difference in turn angle from initial turn to 1 hour after turning in the SOC group was statistically significant (P \u3c .0001). No nurse injuries were reported for either group during the study. CONCLUSIONS:
Findings suggest that assistive devices such as a PPS can be effective in achieving proper positioning of patients to prevent development of pressure ulcers
Systematic analysis of design and stratification for phase III trials in first-line advanced non-small cell lung cancer.
No full textBACKGROUND: A recent study reviewed phase III trials of first-line advanced non-small cell lung cancer (NSCLC) conducted from 1981 to 2010, and provided trends in the study outcome. However, such trials have never been analyzed in detail for design and stratification factors.
METHODS: Phase III studies of systemic treatment for first-line advanced or metastatic NSCLC published in English literature between 1981 and 2010 were identified. Characteristics, including sample size, number of trials, region, rate of meeting accrual goal, primary endpoint, type of phase III, interim analysis, allocation method, and stratification factors, were determined for each decade.
RESULTS: A total of 162 studies met the criteria. The number of studies and sample size increased over the three decades. The primary endpoint was reported more frequently in recent decades, and non-overall survival endpoints were chosen in European and Asian studies. Interim analysis was conducted more commonly during the 2000s. Allocation method was rarely reported throughout the three decades. The number of stratification factors increased significantly from one in 1980s to three in 2000s. Performance status, stage, and institution were most frequently selected, and at least one of the three factors was used in most of the studies in the 2000s. However, there are many other stratification factors that were used infrequently.
CONCLUSIONS: Despite Consolidated Standards of Reporting Trials guidelines, allocation method has rarely been reported. The choice of stratification factor remains inconsistent across studies
Rational Design of Combinations for the Treatment of Advanced Cancer
No full textShort Communication
According to recent statistics, more than eight million people annually succumb to the disease in the world [1]. It is clear that we must work much harder in order to eliminate this disease in the next several decades.
Systemic immunotherapy for the treatment of cancer has been investigated for many decades and has struggled to become a key player in that regard.
Discovery of oncogenic drivers such as EGFR in non-small cell lung cancer revolutionized therapeutic management in several clinical settings [18]. Despite a number of clinical trials investigating combination strategy over the decade, combination therapy does not generally provide better outcome over single agent alone.
Clinical researchers need to work with scientists closely for designing rational trials
Clinical Nurse Specialist Roles in Conducting Research: Changes Over 3 Years
No full textPURPOSE:
The aim of this study is to describe clinical nurse specialists\u27 characteristics, interest, confidence, motivators, and barriers in conducting research. DESIGN:
This study was a descriptive, multicohort design. METHODS:
Clinical nurse specialists were recruited electronically through national and local organizations to complete anonymous surveys 3 times, over 3 years. Comparative analyses included χ and Kruskal-Wallis tests. RESULTS:
Of 2052 responders (initial, n = 629; 18 months, n = 465; and 3 years, n = 958), mean (SD) participant age was 50.3 (9.3) years. Overall, 41.7% of participants were involved as principal or coinvestigators in research. Interest in conducting nursing research (on a 0-100 scale) was 61.1 (38.4) and was lowest among the 18-month time point participant group (score, 39.1 [32.2]) and highest at the 3-year time point (68.3, [30.7]; P \u3c .001). Confidence in conducting research, discussion of statistics, and perceptions of motivators and barriers to conducting research did not differ across time period groups. Access to literature and mentors and research knowledge were the most prevalent barriers to conducting research. CONCLUSIONS:
Less than 42% of clinical nurse specialists conducted research and the rate did not change between different time groups. Access and knowledge barriers to conducting research were prominent. Workplace leaders need to consider resources and support of academic educational opportunities to increase research conduct by clinical nurse specialists
Effectiveness of the Rural Trauma Team Development Course for Educating Nurses and Other Health Care Providers at Rural Community Hospitals
No full textThe study evaluates (1) health care provider perception of the Rural Trauma Team Development Course (RTTDC); (2) improvement in acute trauma emergency care knowledge; and (3) early transfer of trauma patients from rural emergency departments (EDs) to a verified traumacenter. A 1-day, 8-hour RTTDC was given to 101 nurses and other health care providers from nine rural community hospitals from 2011 to 2013. RTTDC participants completed questionnaires to address objectives (1) and (2). ED and trauma registry data were queried to achieve objective (3) for assessing reduction in ED time (EDT), from patient arrival to decision to transfer and ED length of stay (LOS). The RTTDC was positively perceived by health care providers (96.3% of them completed the program). Significant improvement in 13 of the 19 knowledge items was observed in nurses. Education intervention was an independent predictor in reducing EDT by 28 minutes and 95% confidence interval (CI) [-57, -0.1] at 6 months post-RTTDC, and 29 minutes and 95% CI [-53, -6] at 12 months post-RTTDC. Similar results were observed with ED LOS. The RTTDC is well-perceived as an education program. It improves acute trauma emergency care knowledge in rural health care providers. It promotes early transfer of severely injured patients to a higher level of care
Challenges and Futures for Ethical Social Media Research
Get PDFIn AAAI Conference on Web and Social Media ICWSM Workshop:
Social media and user-generated content platforms have opened up new possibilities for communication and creativity while also providing huge amounts of information about people and their online behavior. The evolution of technology and research methods presents ongoing ethical challenges to studying people and their digital traces. These challenges are a continuing source of discussion within the research community and also a topic of public discourse as social media scholarship gains greater visibility. This workshop is aimed at exploring difficult and unanswered ethical questions, touching on issues such as consent, privacy, and responsibility, as well as developing a set of best practices for social media and big data research
A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial
No full textBACKGROUND:
Central line-associated bloodstream infections (CLABSIs) are a common life-threatening risk factor associated with central venous catheters (CVCs). Research has demonstrated benefit in reducing CLABSIs when CVCs coated with antimicrobials are inserted. The impact of chlorhexidine (CHG)-impregnated versus non-CHG peripherally inserted central catheters (PICCs) on risk of CLABSI is unknown. Venous thromboembolism (VTE) is also a complication associated with CVCs. This study compares the impact of both PICC lines on these outcomes. METHODS:
Patients in 3 high-risk units were randomly assigned to receive either a CHG-impregnated or non-CHG PICC line. Laboratory data were collected and reviewed daily on all study patients. The PICC dressing site was assessed daily. Medical record documentation was reviewed to determine presence of CLABSI or VTE. RESULTS:
There were 167 patients who completed the study. Three patients developed CLABSI (2 in the CHG group, and 1 in the non-CHG group), and 3 patients developed VTE (2 in the non-CHG group, and 1 in the CHG group). No significant relationship was noted between the type of PICC line on development of a CLABSI (P = .61) or VTE (P \u3e .99). A significant difference was noted in moderate bleeding (P ≤ .001) requiring thrombogenic dressing in the patients who had the CHG PICC line. CONCLUSIONS:
No differences were noted in the development of CLABSI and VTE between the CHG and non-CHG groups
Changing Physician Behavior by Integrating a Risk-Adjusted Database Into a Quality Improvement Program
No full textThe quality system described in this article was instituted at the beginning of 2007 in response to low STS star ratings from the previous year. Since we began this effort, our surgeons have promptly changed their practice patterns when they have been shown clear evidence of the need for change, and PHI has documented clear and consistent achievement of significantly improved outcomes. Indeed, PHI has achieved the highest rating from the STS ACSD for isolated CABG surgery in 3 of the last 6 years
An Asymptomatic Primary Renal Carcinoid Tumor: A Case Report
No full textPrimary renal carcinoid tumors are exceedingly rare, with less than 100 total cases being documented in world literature. A 32-year old male was referred to our service for a slow-growing, renal mass, which was first diagnosed 9-years prior. The patient was successfully treated with radical nephrectomy. In this article, we present our case report on an asymptomatic primary renal carcinoid tumor
Characteristics, Management, and Outcomes of Patients with Atrial Fibrillation Experiencing a Major Bleeding Event While on Rivaroxaban
No full textRivaroxaban, the first oral direct factor Xa inhibitor, was approved for stroke prevention in nonvalvular atrial fibrillation in 2011. Limited data are available regarding major bleeding in a clinical practice setting. The purpose of this study is to describe the patient characteristics, management, and outcomes of major bleeding events in patients receiving rivaroxaban for atrial fibrillation. This retrospective, single health system study identified patients with rivaroxaban having a major bleeding event between July 2011 and June 2014. Patients were identified through adverse event reporting or by cross-referencing rivaroxaban with International Classification of Diseases, Ninth Revision diagnosis codes for atrial fibrillation and hemorrhage, with and without transfusion. A total of 60 patients were identified. The mean age of patients was 80.3 ± 7.4 years. The most common bleed sites were gastrointestinal (63.3%) and intracranial (26.7%). Higher dose than recommended based on renal function was present in 35% of patients and concurrent antiplatelet therapy occurred in 70%. Activated prothrombin complex concentrate was utilized in 30% of patients and recombinant factor VIIa in 6.7%. A procedure or surgery was performed for bleed management in 10 patients. Anticoagulation was held at discharge in 76% of patients. A total of 6 patients died during hospital admission, 5 of whom experienced an intracranial hemorrhage. In conclusion, patients experiencing a rivaroxaban major bleeding event were elderly, often renally impaired, and receiving concurrent antiplatelet therapy. In-hospital mortality was 10%. The majority of patients (76%) had anticoagulation therapy held at discharge