scholarly journals Registered Nurses' Knowledge of Pneumonia Prevention Implementing Incentive Spirometry in Adult Hospitalized Postoperative Patients: A Quality Improvements

2019 ◽  
Author(s):  
Melissa Gaffney
Keyword(s):  
At Risk ◽  
Registered Nurses ◽  
The United States ◽  
Development Project ◽  
Small Sample ◽  
Postoperative Pneumonia ◽  
Model Framework ◽  
Improvement Program ◽  
Incentive Spirometry ◽  
Nurses Knowledge

In 2011, the Centers for Disease Control and Prevention (2018) estimated there were 157,500 cases of hospital-acquired pneumonia (HAP). Of those, ventilator associated pneumonia (VAP) had declined with increased efforts aimed at prevention, while nonventilator pneumonia (NV-HAP) did not have such prevention interventions and escalated, with approximately 2300 cases and 5600 respectively reported in one state (Baker&Quinn, 2018). The 2012 Healthcare Cost and Utilization Project National Inpatient Sample reported only 4 million people were at risk for VAP, while approximately 35 million more people were at risk for NV-HAP in the United States. The purpose of this project was to evaluate surgical unit registered nurses’ knowledge related to incentive spirometer (IS) in the prevention of NV-HAP postoperatively. The design of this quality improvement, program development project included a pretest, an evidence-based educational intervention specific to IS and a posttest administered to a small sample of RNs, guided by the Logic Model Framework. The results indicated that RNs’ perspectives on patients’ use of IS can be influenced following an educational session related to IS; however, the results showed a decrease in agreement reflecting the new knowledge of the nurses of the present evidence as it relates to incentive spirometry. These results also supported previous research findings and contribute to a body of knowledge validating nurses’ need for endorsed guidelines on appropriate usage of IS to prevent postoperative pneumonia. The Advanced Practice Nurse has a unique role that can directly impact the prevention of postoperative pneumonia.

scholarly journals Development of An Educational Program for Registered Nurses on Post Traumatic Stress Disorder

2021 ◽  
Author(s):  
Stephanie Connor
Keyword(s):  
Registered Nurses ◽  
Latin American ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
The United States ◽  
Post Traumatic Stress ◽  
Post Test ◽  
Post Traumatic ◽  
Nurses Knowledge

Post-traumatic stress disorder (PTSD) is highly prevalent in the United States, compared to European, Asian, and Latin American countries. Post-traumatic stress can develop through repeated occupational exposure to someone else’s trauma, hearing details of other’s trauma as well as one’s own traumatic events. Nurses are at high risk for developing secondary PTSD due to caring for patients who have suffered life-threatening illnesses or injuries. There is a complex correlation between PTSD and suicide and nurses are also at greater risk of completing suicide versus their non-nursing peers. The Betty Neuman Systems model recommends primary, secondary, and tertiary measures of prevention for health promotion and was used as the theoretical framework to guide this project. There is a paucity of research regarding nurses’ knowledge regarding PTSD, therefore the purpose of this project was to determine if there was a change in nurses’ knowledge regarding primary and secondary PTSD after an educational intervention. Participants consisted of 18 volunteers from a convenience sample of Registered Nurses at Our Lady of Fatima Hospital. A pre-test, post-test educational design was utilized to assess for an increase in nurses’ knowledge. Results indicated there was an overall increase in knowledge by 10.55%. from pre-test to post test; however, a paired t-test was conducted, and the increase was not statistically significant. Literature supports the need to increase the awareness of PTSD in nurses. It can be postulated that there will be an increase in the incidence of PTSD in nurses, post Covid-19. More research is needed to understand resilience factors and preventive treatment. Advance Practice Nurses can focus on prevention and early detection of symptoms, which help alleviate physiological changes and psychological difficulties that may accompany PTSD and mitigate suffering from secondary stress and PTSD.

A Silenced Population

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Kim Gryglewicz ◽  
Melanie Bozzay ◽  
Brittany Arthur-Jordon ◽  
Gabriela D. Romero ◽  
Melissa Witmeier ◽  
...  
Keyword(s):  
At Risk ◽  
Depressive Symptomatology ◽  
The United States ◽  
Future Research ◽  
At Risk Youth ◽  
Peer Relationship ◽  
Student Records ◽  
Cross Sectional ◽  
Increased Risk ◽  
Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

scholarly journals Identifying Foot and Ankle Patients at Risk to Fall Based on Patient Reported Outcomes Assessments

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002
Author(s):  
Judith Baumhauer ◽  
Jack Teitel ◽  
Allison McIntyre ◽  
David Mitten ◽  
Jeff Houck
Keyword(s):  
At Risk ◽  
Effect Size ◽  
Fall Risk ◽  
Patient Reported Outcomes ◽  
The United States ◽  
Foot And Ankle ◽  
Falls Risk ◽  
Orthopaedic Patients ◽  
Patient Reported ◽  
Patients At Risk

Category: Other Introduction/Purpose: Each year approximately 30-40% of people over the age of 65 fall. Approximately one half of these falls result in an injury with the estimated annual direct medical costs of $30 billion. Pain, mobility issues, neuropathy and post-operative weight bearing limitations make foot and ankle patients particularly vulnerable to falls. Current approaches to determine at risk patients are cumbersome and time consuming requiring performance testing and “hands on” clinical assessment. The efficiency of obtaining PRO, such as PROMIS, in the clinical arena has been well documented. The purpose of this study is determine if patient reported outcomes (PROMIS) can identify orthopaedic and specifically foot and ankle patients at risk to fall. Methods: Prospective patient reported outcomes (PROMIS CAT physical function, pain interference and depression and CMS fall risk assessment questions) and patient demographics were collected for all patients at each clinic visit from an academic orthopaedic multi-specialty practice between January 2015 and November 2017. Standardized yes/no validated self-reported fall risk questions include: “Have you fallen in the last year?” and “Do you feel you are at risk of falling?” Histograms, t-tests, confidence intervals and effect size were used to determine the fall risk “YES” patients were different than the “NO” for ALL orthopaedic patients and specifically foot and ankle patients. Logistic Regression was used to determine if age, gender, height, weight, and PROMIS scales predicted self-reported falls risk. Results: 94,761 orthopaedic patients comprising 315,273 visits (44% male, mean age 53.7+/-17 years) and 13,720 foot/ankle patients comprising 33,480 visits (37% male, mean age 52.7+/-16.1 years) had complete data for analysis. Table 1 provides the means/SD/p-values/effect sizes for patient self-identifying at risk to fall stratified by PROMIS PF/ PI/Dep t-scores. Although all PROMIS scores demonstrated significant impairment between patients at risk designation (yes/no), PROMIS PF had the largest effect size for ALL Ortho and FOOT AND ANKLE patients (0.8 and 0.7 respectively). Patients who are at risk to fall have PROMIS PF t-scores >1.5 lower than the United States normative population while the patients not at risk are less <1 SD. In the adjusted regression models gender and PROMIS PF had the largest coefficients. Conclusion: Falls are a major threat to quality of life and independence yet prevention/treatment strategies are difficult to implement across a health system. There is also a tremendous societal cost with orthopaedic surgeons often the recipient of these debilitated patients. PROMIS assessments are part of the AOFAS OFAR initiative to track patient recovery with treatment and can additional be used to fulfill a quality indicator requirement by CMS. This study demonstrates these assessments (PROMIS threshold values) can also be linked to self-report falls risk (yes/no) and may identify patients at risk with no face to face time required from the provider.

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

scholarly journals Food Insecurity in the United States: Identification, Treatment, and Implications

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 772-773
Author(s):  
Rose Ann DiMaria-Ghalili ◽  
Connie Bales ◽  
Julie Locher
Keyword(s):  
United States ◽  
Older Adults ◽  
At Risk ◽  
Food Insecurity ◽  
Well Being ◽  
The United States ◽  
Health Clinic ◽  
High Risk Population ◽  
Geriatric Syndrome ◽  
The Impact

Abstract Food insecurity is an under-recognized geriatric syndrome that has extensive implications in the overall health and well-being of older adults. Understanding the impact of food insecurity in older adults is a first step in identifying at-risk populations and provides a framework for potential interventions in both hospital and community-based settings. This symposium will provide an overview of current prevalence rates of food insecurity using large population-based datasets. We will present a summary indicator that expands measurement to include the functional and social support limitations (e.g., community disability, social isolation, frailty, and being homebound), which disproportionately impact older adults, and in turn their rate and experience of food insecurity and inadequate food access. We will illustrate using an example of at-risk seniors the association between sarcopenia, the age-related loss of muscle mass and function, with rates of food security in the United States. The translational aspect of the symposium will then focus on identification of psychosocial and environmental risk factors including food insecurity in older veterans preparing for surgery within the Veterans Affairs Perioperative Optimization of Senior Health clinic. Gaining insights into the importance of food insecurity will lay the foundation for an intervention for food insecurity in the deep south. Our discussant will provide an overview of the implications of these results from a public health standpoint. By highlighting the importance of food insecurity, such data can potentially become a framework to allow policy makers to expand nutritional programs as a line of defense against hunger in this high-risk population.

scholarly journals Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John P. Skendelas ◽  
Victor S. Alemany ◽  
Vincent Au ◽  
Devika Rao ◽  
John McNelis ◽  
...  
Keyword(s):  
New York ◽  
Acute Appendicitis ◽  
Incidental Finding ◽  
Population Sample ◽  
Operative Therapy ◽  
Operative Management ◽  
The United States ◽  
Improvement Program ◽  
Common Procedure ◽  
Appendiceal Neoplasms

Abstract Background Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010–2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed. Results We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years. Conclusions Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.

scholarly journals Using multiple imputation to classify potential outcomes subgroups

2021 ◽  
pp. 096228022110028
Author(s):  
Yun Li ◽  
Irina Bondarenko ◽  
Michael R Elliott ◽  
Timothy P Hofer ◽  
Jeremy MG Taylor
Keyword(s):  
Multiple Imputation ◽  
Statistical Methods ◽  
The United States ◽  
Treatment Selection ◽  
Potential Outcomes ◽  
Model Framework ◽  
Medical Tests ◽  
Gene Assay ◽  
The Impact ◽  
Test Result

With medical tests becoming increasingly available, concerns about over-testing, over-treatment and health care cost dramatically increase. Hence, it is important to understand the influence of testing on treatment selection in general practice. Most statistical methods focus on average effects of testing on treatment decisions. However, this may be ill-advised, particularly for patient subgroups that tend not to benefit from such tests. Furthermore, missing data are common, representing large and often unaddressed threats to the validity of most statistical methods. Finally, it is often desirable to conduct analyses that can be interpreted causally. Using the Rubin Causal Model framework, we propose to classify patients into four potential outcomes subgroups, defined by whether or not a patient’s treatment selection is changed by the test result and by the direction of how the test result changes treatment selection. This subgroup classification naturally captures the differential influence of medical testing on treatment selections for different patients, which can suggest targets to improve the utilization of medical tests. We can then examine patient characteristics associated with patient potential outcomes subgroup memberships. We used multiple imputation methods to simultaneously impute the missing potential outcomes as well as regular missing values. This approach can also provide estimates of many traditional causal quantities of interest. We find that explicitly incorporating causal inference assumptions into the multiple imputation process can improve the precision for some causal estimates of interest. We also find that bias can occur when the potential outcomes conditional independence assumption is violated; sensitivity analyses are proposed to assess the impact of this violation. We applied the proposed methods to examine the influence of 21-gene assay, the most commonly used genomic test in the United States, on chemotherapy selection among breast cancer patients.

Evaluating the Factor Structure and Criterion Validity of the Canadian Little DCDQ: Associations Between Motor Competence, Executive Functions, Early Numeracy Skills, and ADHD in Early Childhood

Assessment ◽  
2021 ◽  
pp. 107319112110039
Author(s):  
Kesha N. Hudson ◽  
Michael T. Willoughby
Keyword(s):  
At Risk ◽  
Factor Structure ◽  
Developmental Coordination Disorder ◽  
The United States ◽  
Parent Report ◽  
Criterion Validity ◽  
Early Numeracy ◽  
Motor Competence ◽  
Numeracy Skills ◽  
Coordination Disorder

The Canadian Little Developmental Coordination Disorder Questionnaire (Little DCDQ-CA) is a parent-report screening instrument that identifies 3- to 4-year-old children who may be at risk for Developmental Coordination Disorder (DCD). We tested the factor structure and criterion validity of the Little DCDQ-CA in a sample of preschool-aged children in the United States ( N = 233). Factor analysis indicated that the DCDQ-CA was best represented by one factor. Using cutoff scores that were proposed by the developer, 45% of the sample was identified as at-risk for DCD. Although a much larger percentage of children was identified as at-risk than would be expected based on the prevalence of formal DCD diagnoses in the population, the Little DCDQ-CA demonstrated good criterion validity. Specifically, compared with their peers, children who exceeded the at-risk criterion demonstrated worse motor competence, executive functioning skills, and early numeracy skills and were rated as having greater ADHD behaviors by their teachers, all consistent with expectations for children who are at risk for DCD. Results are discussed as they relate to future use of the Little DCDQ-CA.

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