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Clinical Relevance (clinical + relevance)
Kinds of Clinical Relevance Selected AbstractsA 1 mm Depressed Type IIC Minute Colorectal Cancer: First Reported Case and Discussion of Clinical Relevance, with Special Reference to Endoscopic DiagnosisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2003DP HURLSTONE No abstract is available for this article. [source] CLINICAL SCHOLARSHIP: Systematic Review of Educational Interventions for Improving Advance Directive CompletionJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2010Christine R. Durbin RN Abstract Purpose: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another. Design: Systematic review of literature based on Cochrane review criteria. Methods: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies. Findings: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly. Conclusions: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken. Clinical Relevance: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed. [source] HEALTH POLICY AND SYSTEMS: Critical Thinking of Nurse Managers Related to Staff RNs' Perceptions of the Practice EnvironmentJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2010NEA-BC, Susan Zori RN Abstract Background Information and Significance: Critical thinking (CT) skills and the inclination to engage in critical thinking are essential for nurse managers to function as transformational leaders capable of influencing staff to align with organizational goals. In an extensive literature review, numerous studies were found examining the concept of CT in students and no studies were found exploring CT in nurse managers. Identifying the attributes, such as CT, that lead to success in the nurse manager role is useful when preparing nurse managers to lead effectively in the current healthcare climate. Research Question: Is there a difference between nurse managers' CT dispositions and their respective staff nurses' perceptions of the practice environment? Design: A convenience sample of 12 nurse managers and a random sample of 132 of their respective staff registered nurses (RNs) participated in this descriptive study. CT in nurse managers was measured by the California Critical Thinking Disposition Inventory (CCTDI). Staff RNs' perceptions of the practice environment were measured by the Practice Environment Scale (PES). The research question was answered using a t test. Findings: Significant (p < .001) differences were found between specific nurse managers' CCTDI scores for open-mindedness, analyticity, and critical thinking confidence, and significant differences (p < .01) were found for systematicity when compared with their respective staff RNs' mean subscale and overall PES scores. Conclusions: Results of the study support the positive relationship between strength in critical thinking dispositions of nurse managers and their respective staff RNs' perceptions of the practice environment. Nurse managers with stronger CT dispositions may be better able to create positive practice environments that are conducive to job satisfaction and thus the retention of staff RNs. Inclusion of strategies to support the development and use of CT in nurse managers is recommended. CT and other leadership attributes and skills including emotional and social intelligence and management of change through an appreciative inquiry process may provide opportunities to improve leadership effectiveness in nurse managers. Clinical Relevance: Enhancing critical thinking skills and dispositions of nurse managers may help to create positive work environments for staff RNs. Staff RNs who work in an environment perceived to be positive may be in a better position to deliver high quality, safe patient care. [source] PROFESSION AND SOCIETY: Recovered Medical Error InventoryJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2010DNSc, Patricia C. Dykes RN Abstract Purpose: To describe the development and psychometric testing of the Recovered Medical Error Inventory (RMEI). Design and Methods: Content analysis of structured interviews with expert critical care registered nurses (CCRNs) was used to empirically derive a 25-item RMEI. The RMEI was pilot tested with 345 CCRNs. The data set was randomly divided to use the first half for reliability testing and the second half for validation. A principal components analysis with Varimax rotation was conducted. Cronbach's alpha values were examined. A t test and Pearson correlation were used to compare scores of the two samples. Findings: The RMEI consists of 25 items and two subscales. Evidence for initial reliability includes a total scale alpha of .9 and subscale alpha coefficients of .88 (mistake) and .75 (poor judgment). Conclusions: The RMEI subscales have satisfactory internal consistency reliability and evidence for construct validity. Additional testing is warranted. Clinical Relevance: A tool to measure CCRNs' experiences with recovering medical errors allows quantification of nurse surveillance in promoting safe care and preventing unreimbursed hospital costs for treating nosocomial events. [source] Prenatal Stretching Exercise and Autonomic Responses: Preliminary Data and a Model for Reducing PreeclampsiaJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2010SeonAe Yeo RNC Abstract Purpose: Preeclampsia is a leading cause of perinatal mortality and morbidity, and it increases maternal risk for future cardiovascular disease. The purpose of the study was to explore the relationships among stretching exercise, autonomic cardiac response, and the development of preeclampsia. Design: Secondary data analysis. Methods: Heart rate and pulse pressure were longitudinally examined in this secondary data analysis among women who engaged in stretching exercise daily from 18 weeks of gestation to the end of pregnancy compared with women who did walking exercise daily during the same time period. A total of 124 women were randomized to either stretching (n=60) or walking (n=64) in the parent study. Findings: Heart rates in the stretching group were consistently lower than those in the walking group. Conclusions: Based on the results of this secondary data analyses, a physiologic framework for possible beneficial effects of stretching exercise by enhancing autonomic responses on reducing risks for preeclampsia is proposed and discussed. Clinical Relevance: If the protective effect is established, stretching exercise can be translated into nursing intervention for prenatal care. [source] Validation of the Professional Practice Environment Scale in Australian General PracticeJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2010BN(Hons), Elizabeth J. Halcomb RN, FRCNA Abstract Purpose: To validate the Professional Practice Environment Scale (PPE) in Australian general practice. Methods: The PPE was modified slightly for appropriateness for the practice setting and administered to a sample of 342 Australian general practice nurses via an online survey tool. The factor structure of the 38-item PPE was examined using principal components analysis with Varimax rotation. Findings: An eight-factor solution accounted for 71.6% of the variance. Low factor loading (<0.3) or cross-component loadings were detected in eight items. A comparison of Cronbach's alpha values demonstrated little change in the deletion of eight items from four of the eight related components. Conclusions: Findings demonstrated that a 30-item version of the PPE was reliable and valid for use to assess the professional practice environment of nurses working in Australian general practice. Clinical Relevance: A tool to measure the professional practice environment in general practice is important as it will assist in monitoring the impact of the work environment on the recruitment, retention, and satisfaction of nurses in this setting. [source] Experiences of U.S. Military Nurses in the Iraq and Afghanistan Wars, 2003,2009JOURNAL OF NURSING SCHOLARSHIP, Issue 1 2010Elizabeth Scannell-Desch RN Abstract Purpose: The purpose of this study is to describe the lived experience of U.S. military nurses who served in Iraq or Afghanistan during the war years 2003 to 2009, and life after returning from war. Methods: Colaizzi's phenomenological method guided discovery. This method includes elements of both descriptive and interpretive phenomenology. The sample consisted of 37 military nurses who served in the Army, Navy, or Air Force in the Iraq or Afghanistan wars. Four data-generating questions guided the interview process. Most interviews were face-to-face and conducted in naturalistic settings chosen by the participants. Several interviews were conducted telephonically due to geographic constraints. Data analysis followed Colaizzi's method of analysis. Seven themes emerged from the data, including "deploying to war;""remembrance of war: most chaotic scene;""nurses in harm's way: more than I bargained for;""kinship and bonding: my military family;""my war stress: I'm a different person now;""professional growth: expanding my skills;" and "listen to me: advice to deploying nurses." Analysis continued until data saturation was achieved. Results: Results indicated that wartime deployment was a difficult challenge, lessons learned should be shared with nurses deploying in future years, homecoming was more difficult than most nurses anticipated, and reintegration after coming home takes time and effort. Conclusions: Nursing in war is a unique experience regardless of education, preparation and training. There are a myriad of variables that enter into the experience and effect outcomes, both personal and professional. Clinical Relevance: Wartime nursing is a reality in the current clinical practice arena. War takes its toll on everyone involved, including the caregivers. Nurses returning from war can provide valuable insights to those that follow. [source] Development and Validation of a Mass Casualty Conceptual ModelJOURNAL OF NURSING SCHOLARSHIP, Issue 1 2010CWOCN, Joan M. Culley RN Abstract Purpose: To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events. Design: The model was designed based on extant literature and existing theoretical models. A purposeful sample of 18 experts validated the model. Open-ended questions, as well as a 7-point Likert scale, were used to measure expert consensus on the importance of each construct and its relationship in the model and the usefulness of the model to future research. Methods: Computer-mediated applications were used to facilitate a modified Delphi technique through which a panel of experts provided validation for the conceptual model. Rounds of questions continued until consensus was reached, as measured by an interquartile range (no more than 1 scale point for each item); stability (change in the distribution of responses less than 15% between rounds); and percent agreement (70% or greater) for indicator questions. Findings: Two rounds of the Delphi process were needed to satisfy the criteria for consensus or stability related to the constructs, relationships, and indicators in the model. The panel reached consensus or sufficient stability to retain all 10 constructs, 9 relationships, and 39 of 44 indicators. Experts viewed the model as useful (mean of 5.3 on a 7-point scale). Conclusions: Validation of the model provides the first step in understanding the context in which mass casualty events take place and identifying variables that impact outcomes of care. Clinical Relevance: This study provides a foundation for understanding the complexity of mass casualty care, the roles that nurses play in mass casualty events, and factors that must be considered in designing and evaluating information-communication systems to support effective triage under these conditions. [source] Psychometric Analysis of the Brisbane Practice Environment Measure (B-PEM)JOURNAL OF NURSING SCHOLARSHIP, Issue 1 2010Anndrea Flint RN, MHSc(HSM) Abstract Purpose: To undertake rigorous psychometric testing of the newly developed contemporary work environment measure (the Brisbane Practice Environment Measure [B-PEM]) using exploratory factor analysis and confirmatory factor analysis. Methods: Content validity of the 33-item measure was established by a panel of experts. Initial testing involved 195 nursing staff using principal component factor analysis with varimax rotation (orthogonal) and Cronbach's alpha coefficients. Confirmatory factor analysis was conducted using data from a further 983 nursing staff. Results: Principal component factor analysis yielded a four-factor solution with eigenvalues greater than 1 that explained 52.53% of the variance. These factors were then verified using confirmatory factor analysis. Goodness-of-fit indices showed an acceptable fit overall with the full model, explaining 21% to 73% of the variance. Deletion of items took place throughout the evolution of the instrument, resulting in a 26-item, four-factor measure called the Brisbane Practice Environment Measure-Tested. Conclusions: The B-PEM has undergone rigorous psychometric testing, providing evidence of internal consistency and goodness-of-fit indices within acceptable ranges. The measure can be utilised as a subscale or total score reflective of a contemporary nursing work environment. Clinical Relevance: An up-to-date instrument to measure practice environment may be useful for nursing leaders to monitor the workplace and to assist in identifying areas for improvement, facilitating greater job satisfaction and retention. [source] A New Information Exchange System for Nursing Professionals to Enhance Patient Safety Across EuropeJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2009Dr. Alessandro Stievano RN Abstract Purpose: Ensuring safe healthcare services is one of today's most challenging issues, especially in light of the increasing mobility of health professionals and patients. In the last few years, nursing research has contributed to the creation of a culture of safety that is an integral part of clinical care and a cornerstone of healthcare systems. Organizing Constructs: European institutions continue to discuss methods and tools that would best contribute to ensuring safe and high-quality care, as well as ensuring access to healthcare services. According to the European Commission between 8% and 12% of patients admitted to hospitals in the European Union member states suffer from adverse events while receiving care, although some of these events are part of the intrinsic risk linked to receiving care. However, most of these adverse events are caused by such avoidable healthcare errors as, for instance, diagnosis mistakes, inability to act on the results of tests, medication errors, failures of healthcare equipment and hospital infections. Nosocomial infections alone are estimated to affect 4.1 million inpatients, that is, about 1 of every 20 inpatients, causing avoidable suffering and mortality, as well as an enormous loss of financial resources (at least ,5.48 billion a year). Conclusions: The Internal Market Information (IMI) System, developed by the European Commission, aims at contributing to patient safety by means of a timely and updated exchange of information among nursing regulatory bodies on the good standing and scope of practice of their registrants. Through the IMI System, the European Federation of Nursing Regulators will improve its electronic database on nurses to allow national nursing regulatory bodies to exchange the information needed to recognize the nurses' educational and professional qualifications and competencies. This process both facilitates the mobility of professionals and ensures high-quality nursing practice in an even and consistent way across the European Union. Clinical Relevance: On a national basis, nursing regulatory bodies play an important role in ensuring patient safety through high standards of nursing education and competence, whereas on an international basis, patient safety can assured by a better exchange of information between national regulatory bodies on the good professional standing of nurses. [source] Human Rights Barriers for Displaced Persons in Southern SudanJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2009Carol Pavlish PhD Abstract Purpose: This community-based research explores community perspectives on human rights barriers that women encounter in a postconflict setting of southern Sudan. Methods: An ethnographic design was used to guide data collection in five focus groups with community members and during in-depth interviews with nine key informants. A constant comparison method of data analysis was used. Atlas.ti data management software facilitated the inductive coding and sorting of data. Findings: Participants identified three formal and one set of informal community structures for human rights. Human rights barriers included shifting legal frameworks, doubt about human rights, weak government infrastructure, and poverty. Conclusions: The evolving government infrastructure cannot currently provide adequate human rights protection, especially for women. The nature of living in poverty without development opportunities includes human rights abuses. Good governance, protection, and human development opportunities were emphasized as priority human rights concerns. Human rights framework could serve as a powerful integrator of health and development work with community-based organizations. Clinical Relevance: Results help nurses understand the intersection between health and human rights as well as approaches to advancing rights in a culturally attuned manner. [source] Case Management Workforce in the United StatesJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2009Eun-Jun Park RN Abstract Purpose: The purpose of this study was to investigate and compare characteristics of the case management (CM) workforce in the US by age, years of experience, and original profession. Design: This study was an exploratory, descriptive secondary analysis of demographic and job characteristics of 24,085 certified case managers (CCMs). Methods: Descriptive statistics, Chi-square tests, and correlation coefficients were calculated. Findings: The majority of the case-management workforce is made up of RNs (93.3%). The CCMs were older, with a mean age of 55.0 years, than were those in their original profession and started to work as CCMs late in their careers. The educational level of RN-CCMs was lower than that of CCMs from other professions. Also, job titles and work settings of CCMs were diverse, with different focus areas depending on clients' needs. The distribution of CCMs was associated with the number of managed-care enrollees. Conclusions: Profiles of CCMs in this study are valuable for clinical practice and can assist with deployment of the CM workforce. Clinical Relevance: To develop and deploy CCMs better matched to societal healthcare needs, characteristics of CCMs should be precisely understood. Managing the CM workforce is expected to be critical because of a shortage of RN workers and aging-of-the-workforce issues in the US. [source] Nurses' Perceptions of Safety Culture in Long-Term Care SettingsJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2009Laura M. Wagner RN Abstract Purpose: To describe perceptions of workplace safety culture among nurses employed in long-term care (LTC) settings. Design: A cross-sectional survey. Respondents were licensed nurses (N=550) with membership in gerontological nursing professional organizations in the United States (n=296), Canada (n=251), and other (n=3). Methods: An anonymous, self-administered, mail-in questionnaire, which included the Hospital Survey on Patient Safety Culture as well as questions about individual and institutional characteristics. The survey included key aspects of safety culture, such as work setting, supervisor support, communication about errors, and frequency of events reported. Findings: Nurse-managers reported significantly more positive safety culture perceptions compared with licensed staff nurses. Additionally, licensed nurses employed in government-run facilities had significantly less positive safety culture perceptions compared with those working in nonprofit organizations. Conclusions: Interventions designed to improve safety culture in LTC settings should be focused on the concerns of licensed staff nurses and the improvement of communication between these nurses and their managers. Clinical Relevance: Enhancing safety culture in long-term care settings may facilitate improvements in resident safety. Assessment of workplace safety culture is the first step in identifying barriers that nurses face to provide safe resident care. [source] International Differences in Nursing Research, 2005,2006JOURNAL OF NURSING SCHOLARSHIP, Issue 1 2009Denise F. Polit PhD Abstract Purpose: To compare the characteristics of nursing research being done in different countries, using data from studies published in nonspecialty, English-language nursing journals. Design: Data for this cross-sectional analysis were retrieved from a consecutive sample of 1,072 studies published in eight leading English-language research journals in 2005 and 2006. Methods: For each study, data were extracted on the characteristics of the study participants and authors, study focus-specialty area, funding, and methodologic attributes. Studies from 15 countries or regional groupings were compared. Findings: International differences in authors, participants, and study characteristics were typically large and statistically significant. Studies that were focused on nurses were especially prevalent in Europe, Australia, and Canada, whereas patient-centered studies were most common in Asian countries and the US. Qualitative studies were predominant in Norway, Sweden, and the UK. Asian nurse researchers, by contrast, undertook mostly quantitative studies, and were especially likely to conduct intervention research. Significant country differences existed in the omission of demographic (age and sex) information about participants, with omissions most prevalent in the UK and Ireland and least prevalent in Asian countries. Research funding was reported for 62% of all studies, ranging from 13% in Turkey to over 75% in Canada and the US. Conclusions: Although this study had several limitations, especially with regard to potential biases in the sample of studies from non-English-speaking countries, this analysis of over 1,000 nursing studies indicates many important inter-country differences in the focus, methods, and authorship patterns of nursing research published in leading journals. Clinical Relevance: Because research "informs" practice, international differences that exist in the focus and methods of nursing research have implications for nursing practice in the respective countries. [source] The Legacy of Childhood Sexual Abuse and Family AdversityJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2008Donna S. Martsolf Purpose: To describe the process by which childhood adversity influences the life course of survivors of childhood sexual abuse. Design: A community-based, qualitative, grounded-theory design. Methods: In this grounded theory study, data were drawn from open-ended interviews conducted as part of a larger study of women's and men's responses to sexual violence. The current study indicates the experiences of 48 female and 40 male survivors of childhood sexual abuse and family adversity. Data were analyzed using the constant comparison method. Findings: Participants described a sense of inheriting a life of abuse and adversity. The process by which childhood adversity influences the life course of adult survivors of childhood sexual abuse is labeled Living the Family Legacy. The theory representing the process of Living the Family Legacy includes three major life patterns: (a) being stuck in the family legacy, (b) being plagued by the family legacy, and (c) rejecting the family legacy/creating a new one. Associated with these life patterns are three processes by which participants passed on a legacy to others, often their children: (a) passing on the family legacy, (b) taking a stab at passing on a new legacy, and (c) passing on a new legacy. Conclusions: The legacy of abuse and adversity has a profound effect on the lives of survivors of childhood sexual abuse. There are several trajectories by which the influence of childhood adversity unfolds in the lives of adult survivors and by which the legacy is passed on to others. Clinical Relevance: The model representing the theoretical process of Living the Family Legacy can be used by clinicians who work with survivors of childhood sexual abuse and childhood adversity, especially those who have parenting concerns. [source] Breast-Cancer-Related Lymphedema: Information, Symptoms, and Risk-Reduction BehaviorsJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2008Mei R. Fu Purpose: To explore the effect of providing lymphedema information on breast cancer survivors' symptoms and practice of risk-reduction behaviors. Design: A cross-sectional design was used to obtain data from 136 breast-cancer survivors in New York City from August 2006 to May 2007. Descriptive statistics, t tests, chi-square tests, and correlations were calculated. Methods: Data were collected using a demographic and medical information interview tool, two questions regarding status of receiving lymphedema information, the Lymphedema and Breast Cancer Questionnaire, and Lymphedema Risk-Reduction Behavior Checklist. Findings: Fifty-seven percent of the participants reported that they received lymphedema information. On average, participants had three lymphedema-related symptoms. Only 18% of participants were free of symptoms. Participants who received information reported significantly fewer symptoms (t=3.03; p<0.00) and practicing more risk-reduction behaviors (t=2.42; p=0.01). Conclusions: Providing lymphedema information has an effect on symptom reduction and more risk-reduction behaviors being practiced among breast cancer survivors. Clinical Relevance: In clinical practice, nurses and other healthcare professionals could consider taking the initiative to provide adequate and accurate information and engage breast-cancer survivors in supportive dialogues concerning lymphedema risk-reduction. [source] Development of a Self-Report Instrument to Measure Patient Safety Attitudes, Skills, and KnowledgeJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2008Rebecca Schnall Purpose: To describe the development and psychometric testing of the Patient Safety Attitudes, Skills and Knowledge Scale (PS-ASK). Methods: Content validity of a 35-item instrument was established by a panel of experts. The instrument was pilot tested on 285 nursing students. Principal components analysis (PCA) with varimax rotation was conducted, and Cronbach's alphas were examined. Paired samples t-tests were used to show responsiveness of the scales pre- and post-patient safety curriculum. Results: The final instrument consists of 26 items and three separate scales: attitudes, skills, and knowledge. The attitudes and skills scales each had a three-factor solution. The knowledge items had a one-factor solution. Both skills and knowledge were significantly increased at Time 2 (p<0.001). Conclusions: The skills and knowledge subscales had satisfactory internal consistency reliability, evidence for construct validity, and responsiveness for use as independent scales in future studies. The attitudes subscale needs further refinement before implementation. Comparison with other measures of patient safety skills (e.g., observation) and knowledge are warranted. Clinical Relevance: A tool to measure clinicians' attitudes, skills, and knowledge about patient safety might be useful to evaluate nurses and other clinicians during educational preparation and in practice. [source] The Development of Advanced Nursing Practice GloballyJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2008Barbara Sheer Purpose: To examine the development of advanced nursing practice globally. Methods: Data were collected from documentary resources available in the International Nurse Practitioners/Advanced Practice Nurse Network (INP/APNN) of the International Council of Nurses. The areas examined were guided by the "key informant survey on advanced nursing practice self-administered questionnaire." Two core members of the INP/APNN who have rich experience in global advanced nursing development analyzed the data. A total of 14 countries and three regions from five continents were included in the analyses. The development of advanced nursing practice in these areas is facilitated by a need for better access to care in a cost-containment era and the enhancement of nursing education to postgraduate level. The mechanism for regulation of practice is in place in some countries. Conclusions: Confirms the development of advanced practice in nursing is a global trend. Clinical Relevance: APNs can improve global health with points to enhanced education in nursing and regulation of advanced practice. [source] Soldiers With Musculoskeletal InjuriesJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2008Bonnie M. Jennings Purpose: To describe Soldiers' (e.g., U.S. Army personnel) perspectives of the effect of musculoskeletal injuries. Design: Data were collected in the summer of 2003 using a prospective survey design. The survey was mailed to active duty Soldiers on modified work plans because of musculoskeletal injuries. These Soldiers were assigned to one Army installation in the US. Methods: Responses to the survey questions were analyzed using descriptive statistics. The numerous handwritten comments were evaluated qualitatively. Findings: Injuries most often involved the back and knees (18% each). At least 47% of the injuries were work related. Injuries interfered with Soldiers' abilities to perform military tasks such as road marching (80%) and organized physical training (69%). Although many respondents indicated they were not experiencing pain, at least some Soldiers reported mild pain for each of 19 anatomic locations. Severe pain was reported most often for the lower back (21%). In their written comments, Soldiers expressed a sense of frustration with their injuries, the healthcare system and providers, and their unit leaders. Conclusions: Healthcare personnel are challenged to better manage Soldiers with musculoskeletal injuries and expedite their return to full duty. Unit leaders are challenged to create work environments that focus on injury prevention and allow injured Soldiers time to heal. Clinical Relevance: The Soldiers in this study were often engaged in physically challenging work or sports activities when injured. Because people outside the Army engage in similar activities (e.g., construction workers, endurance athletes), the findings from this study might be applicable to nonmilitary communities. Additionally, with the number of Reserve and National Guard Soldiers currently on active duty, civilian nurses might be caring for Soldiers with musculoskeletal injuries. [source] Effective Strategies for Implementing a Multicenter International Clinical TrialJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2008Leanne M. Aitken Purpose:International collaboration in research is essential in order to improve worldwide health. The purpose of this paper is to describe strategies used to administer an international multicenter trial to assess the effectiveness of a nursing educational intervention. Design:The study design was a two-group randomized multicenter international clinical trial conducted to determine whether a brief education and counselling intervention delivered by a nurse could reduce prehospital delay in the event of symptoms suggestive of acute coronary syndrome (ACS) in patients previously diagnosed with cardiovascular disease. Method:A flexible but well-defined project structure showed intervention consistency in five sites among three countries and included experienced project coordinators, multidimensional communication methods, strategies to optimize intervention fidelity, site-specific recruitment and retention techniques, centralized data management, and consideration of ethical and budgetary requirements. Findings:Staff at five sites enrolled 3,522 participants from three countries and achieved 80% follow-up obtained at both 12 and 24 months. Conclusion:Multidimensional approaches to maintain consistency across study sites, while allowing flexibility to meet local expectations and needs, contributed to the success of this trial. Clinical Relevance:In order to support appropriate development of an evidence base for practice, nursing interventions should be tested in multiple settings. A range of strategies is described in this paper that proved effective in conducting a multicenter international trial. [source] Predictors of Home Healthcare Nurse RetentionJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2008Carol Hall Ellenbecker Purpose:To examine the level of job satisfaction and test a theoretical model of the direct and indirect effects of job satisfaction, and individual nurse and agency characteristics, on intent to stay and retention for home healthcare nurses. Design:A descriptive correlation study of home healthcare nurses in six New England states. Methods:Home healthcare nurse job satisfaction self-report data was collected with the HHNJS survey questionnaire & Retention Survey Questionnaire. Findings:Based on a structural equation model, job tenure and job satisfaction were the strongest predictors of nurse retention. Conclusions:Understanding the variables associated with home healthcare nurse retention can help agencies retain nurses in a time of severe nurse shortages and increased patient demand. Clinical Relevance:Predicted nursing shortages and increasing demand have made the retention of experienced, qualified nursing staff essential to assure access to high-quality home healthcare services in the future. [source] The Effect of High Nursing Surveillance on Hospital CostJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2008Leah L. Shever Purpose: The purpose of this study was to determine the cost of one nursing treatment, surveillance, for older, hospitalized adults at risk for falling. Design: An observational study using information from data repositories at one Midwestern tertiary hospital. The inclusion criteria included patients age >60 years, admitted to the hospital between July 1, 1998 and June 31, 2002, at risk for falls or received the nursing treatment of fall prevention. Methods: Data came from clinical and administrative data repositories that included Nursing Interventions Classification (NIC). The nursing treatment of interest was surveillance and total hospital cost associated with surveillance was the dependent variable. Propensity-score analysis and generalized estimating equations (GEE) were used as methods to analyze the data. Independent variables related to patient characteristics, clinical conditions, nurse staffing, medical treatments, pharmaceutical treatments, and other nursing treatments were controlled for statistically. Findings: The total median cost per hospitalization was $9,274 for this sample. The median cost was different (p = 0.050) for patients who received high versus low surveillance. High surveillance delivery cost $191 more per hospitalization than did low surveillance delivery. Conclusion: Propensity scores were applied to determine the cost of surveillance among hospitalized adults at risk for falls in this observational study. The findings show the effect of high surveillance delivery on total hospital cost compared to low surveillance delivery and provides an example of a useful method of determining cost of nursing care rather than including it in the room rate. More studies are needed to determine the effects of nursing treatments on cost and other patient outcomes in order for nurses to provide cost-effective care. Propensity scores were a useful method for determining the effect of nursing surveillance on hospital cost in this observational study. Clinical Relevance: The results of this study along with possible clinical benefits would indicate that frequent nursing surveillance is important and might support the need for additional nursing staff to deliver frequent surveillance. [source] Efficacy and Pharmacokinetics of Pantoprazole in AlpacasJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2010G.W. Smith Background: Despite frequent clinical use, information about the pharmacokinetics and efficacy of pantoprazole in camelids is not available. Objectives: To examine the pharmacokinetics of both IV and SC pantoprazole and to determine whether pantoprazole administration would increase 3rd compartment pH in alpacas. Animals: Six healthy adult alpacas. Methods: Alpacas were fitted with a 3rd compartment cannula for measuring gastric pH. After recovery, alpacas received 1 mg/kg pantoprazole IV, q24h for 3 days or 2 mg/kg SC q24h for 3 days. Alpacas received both IV and SC pantoprazole, with a minimum of 3 weeks between treatments. Third compartment pH was recorded and plasma samples were taken for pharmacokinetic analysis. Results: Pantoprazole induced a slow but sustained increase in 3rd compartment pH when given by both the IV and SC routes. Third compartment pH was significantly increased as compared with baseline values (1.81 ± 0.7; mean ± SD) at 24 (2.47 ± 0.8), 48 (3.53 ± 1.0) and 72 hours (4.03 ± 1.3) after daily IV administration of pantoprazole. Third compartment pH increased from 1.73 ± 0.6 at baseline to 3.05 ± 1.1, 4.02 ± 1.4, and 3.61 ± 1.6 at 24, 48, and 72 hours after SC administration, respectively. Pharmacokinetic analysis demonstrated that pantoprazole had a short elimination half-life (0.47 + 0.06 h) and a high clearance rate (12.2 ± 2.9 mL/kg/min) after both IV and SC administration. Conclusions and Clinical Relevance: Based on the results of this study, pantoprazole represents a safe and effective drug for increasing 3rd compartment pH in camelids. Either IV or SC administration is likely to be an effective treatment for gastric ulcers. [source] Calcium and Phosphorus Homeostasis in Dogs with Spontaneous Chronic Kidney Disease at Different Stages of SeverityJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010O. Cortadellas Background: Studies in dogs with experimental chronic kidney disease (CKD) have demonstrated that abnormalities of calcium-phosphorus (Ca-P) homeostasis occur frequently and have a negative effect on kidney function and survival. However, the prevalence of these alterations in dogs with naturally occurring CKD at different stages of severity has not yet been investigated. Hypothesis: Abnormalities of Ca-P metabolism occur early in the course of CKD with an increased prevalence in more severe stages. Animals: Fifty-four dogs with CKD and 22 healthy dogs. Methods: Blood and urine samples were obtained for a CBC, biochemistry, determination of parathyroid hormone (PTH), calcitriol, and ionized calcium concentrations and urinalysis. Based on urine protein/creatinine ratio and serum creatinine concentration, dogs were grouped according to the IRIS classification for CKD. Results: Hyperparathyroidism (HPTH) (PTH , 48 pg/mL) was diagnosed in 41 (75.9%) dogs with CKD. Its prevalence increased from 36.4% (stage 1) to 100% (stage 4). Hyperphosphatemia (P > 5.5 mg/dL) was present in 37 (68.5%) dogs; increasing in prevalence from 18% (stage 1) to 100% (stage 4). Receiver-operating characteristic curve analysis showed that serum phosphorus concentration in the 4.5,5.5 mg/dL range correctly identified the presence of HPTH in most dogs. Calcitriol concentration progressively decreased in dogs with CKD and differences became statistically significant by stage 3. Conclusion and Clinical Relevance: HPTH and hyperphosphatemia occur frequently in dogs with naturally occurring CKD, even at early stages of CKD in some dogs. These findings highlight the importance of monitoring these parameters early in the course of CKD. [source] Cross-Sectional Imaging Characteristics of Pituitary Adenomas, Invasive Adenomas and Adenocarcinomas in Dogs: 33 Cases (1988,2006)JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010Rachel E. Pollard Background: Pituitary tumors in dogs can be adenomas, invasive adenomas, or adenocarcinomas. In people, invasive adenomas and pituitary adenocarcinomas carry a worse prognosis than adenomas. Hypothesis/Objective: To identify differentiating features on cross-sectional imaging in dogs with pituitary adenomas, invasive adenomas, and adenocarcinomas. Animals: Thirty-three dogs that had computed tomography (CT) or magnetic resonance imaging (MRI) performed and a necropsy diagnosis of pituitary adenoma (n= 20), invasive adenoma (n= 11), or adenocarcinoma (n= 2). Methods: Medical records were retrospectively reviewed for signalment, history, and diagnosis. CT and MR images were reviewed for characteristics of pituitary tumors. Results: Mean (± standard deviation) age for dogs with pituitary adenomas (10.6 ± 2.9 years) was greater than that of those with invasive adenomas (8.3 ± 2.7 years, P= .04). Eighteen out of 20 (90%) dogs with adenomas had contrast-enhancing masses. Thirteen out of 20 (65%) had homogeneous enhancement. Mean adenoma height was 1.2 ± 0.7 cm. Eight out of 20 (40%) adenomas were round and 8/20 (40%) compressed surrounding brain. Eleven out of 11 dogs (100%) with invasive adenomas had contrast-enhancing masses. Seven out of 11 (64%) masses were homogeneous. Mean invasive adenoma height was 1.8 ± 0.7 cm, which was significantly greater than adenomas (P= .03). Mass shape varied from round to oval to irregular. Six out of 11 (55%) masses compressed surrounding brain. Clinical and imaging features were variable for 2 dogs with adenocarcinomas. Conclusions and Clinical Relevance: Invasive adenoma should be suspected if a dog with a pituitary tumor is <7.7 years of age and has a mass >1.9 cm in vertical height. Adenocarcinomas are uncommon and metastatic lesions were not seen with imaging. [source] Congenital Cardiac Defects in Neonatal Foals: 18 Cases (1992,2007)JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010T.L. Hall Background: Literature available regarding congenital cardiac defects in foals is limited to reports of individual cases or small case series. Objective: To describe the clinical, echocardiographic, and necropsy findings and breed predilection of congenital cardiac defects in neonatal foals. Animals: Eighteen foals <15 days of age with 1 or more congenital cardiac defects. Methods: Medical records of foals diagnosed with congenital cardiac defects at the William R. Pritchard Veterinary Medical Teaching Hospital were reviewed. Data collected included history, signalment, clinical signs, laboratory data, diagnostic and necropsy results, and outcome. Results: Arabian foals represented 39% of cases with congenital cardiac defects and were significantly (P= .004) overrepresented (OR = 4.7 [CI: 1.8,12.4]) compared with the general hospital population. Ventricular septal defect (VSD) (14/18), tetralogy of Fallot (5/18), and tricuspid valve atresia (4/18) were the most common defects identified. A ,3/6 heart murmur (14/14) accompanied by tachycardia (14/17), tachypnea (17/17), and cyanosis of mucous membranes (7/16) were the most common clinical signs. Concurrent congenital defects were common (9/18). Two foals, both with VSD, survived for , 8 years after diagnosis and 1 was a successful performance horse. Conclusions and Clinical Relevance: Arabian horses appear to have a predisposition for cardiac defects. The presence of a loud murmur (, 3/6), cyanotic membranes, and tachycardia or tachypnea in a neonatal foal should warrant thorough evaluation of the heart for congenital defects. Foals with cardiac defects should be closely evaluated for concurrent congenital defects in other body systems. [source] Field Safety and Efficacy of Protamine Zinc Recombinant Human Insulin for Treatment of Diabetes Mellitus in CatsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2009R.W. Nelson Background: This study describes the efficacy of a new protamine zinc recombinant human insulin (PZIR) preparation for treating diabetic cats. Objective: To evaluate effects of PZIR on control of glycemia in cats with newly diagnosed or poorly controlled diabetes mellitus. Animals: One hundred and thirty-three diabetic cats 120 newly diagnosed and 13 previously treated. Methods: Prospective, uncontrolled clinical trial. Cats were treated with PZIR twice daily for 45 days. Control of glycemia was assessed on days 7, 14, 30, and 45 by evaluation of change in water consumption, frequency of urination, appetite, and body weight, serum fructosamine concentration, and blood glucose concentrations determined 1, 3, 5, 7, and 9 hours after administration of PZIR. Adjustments in dosage of PZIR were made as needed to control glycemia. Results: PZIR administration resulted in a significant decrease in 9-hour mean blood glucose (199 ± 114 versus 417 ± 83 mg/dL, X± SD, P < .001) and serum fructosamine (375 ± 117 versus 505 ± 96 ,mol/L, P < .001) concentration and a significant increase in mean body weight (5.9 ± 1.4 versus 5.4 ± 1.5 kg, P= .017) in 133 diabetic cats at day 45 compared with day 0, respectively. By day 45, polyuria and polydipsia had improved in 79% (105 of 133), 89% (118 of 133) had a good body condition, and 9-hour mean blood glucose concentration, serum fructosamine concentration, or both had improved in 84% (112 of 133) of the cats compared with day 0. Hypoglycemia (<80 mg/dL) was identified in 151 of 678, 9-hour serial blood glucose determinations and in 85 of 133 diabetic cats. Hypoglycemia causing clinical signs was confirmed in 2 diabetic cats. Conclusions and Clinical Relevance: PZIR is effective for controlling glycemia in diabetic cats and can be used as an initial treatment or as an alternative treatment in diabetic cats that do not respond to treatment with other insulin preparations. [source] Comparison of 2 Doses of Recombinant Human Thyrotropin for Thyroid Function Testing in Healthy and Suspected Hypothyroid DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2009F.S. Boretti Background: Various protocols using different doses of recombinant human thyrotropin (rhTSH) in TSH stimulation testing have been described. However, the influence of TSH dosage on thyroxine (T4) concentration has not yet been evaluated in suspected hypothyroid dogs. Objective: To evaluate the effectiveness of 2 doses of rhTSH. Animals: Fifteen dogs with clinical signs consistent with hypothyroidism and abnormal stimulation results with 75 ,g rhTSH and 18 clinically healthy dogs. Methods: All dogs were stimulated with 75 and 150 ,g rhTSH IV in a 1st and 2nd stimulation test, respectively. Blood samples were taken before and 6 hours after rhTSH administration for determination of total T4 concentration. Results: Using the higher dose led to a normal test interpretation in 9 of the 15 dogs, in which stimulation had been abnormal using the lower dose. Based on follow-up information, hypothyroidism was excluded in 7 of these 9 dogs. In all 6 dogs with a blunted response to the higher dose, hypothyroidism could be confirmed. Healthy dogs showed significantly higher post-TSH T4 concentrations with the higher compared with the lower dose. Post-TSH T4 concentrations after TSH stimulation were not related to dogs' body weight in either healthy or diseased dogs. Conclusions and Clinical Relevance: TSH dose significantly influenced test interpretation in suspected hypothyroid dogs. Differentiation between primary hypothyroidism and nonthyroidal disease was improved with 150 ,g rhTSH. Because this effect was independent of the dogs' body weight, the higher dose is recommended in dogs that have concurrent disease or are receiving medication. [source] Neurologic Dysfunction in Hypothyroid, Hyperlipidemic Labrador RetrieversJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2007Christina L. Vitale Background: Hypothyroidism has been associated with a variety of neurologic signs, but the mechanism for this association is not completely understood. Hypothyroidism also is associated with hyperlipidemia that predisposes to atherosclerosis, increased blood viscosity, and thromboembolic events. Objective: The objective is to characterize neurologic signs potentially associated with hyperlipidemia and atherosclerosis in canine hypothyroidism. Animals: This study used dogs referred to North Carolina State University Veterinary Teaching Hospital for evaluation of neurologic signs. Materials and Methods: A retrospective study was conducted in which medical records of dogs with neurologic signs and a diagnosis of hypothyroidism and hyperlipidemia were reviewed. Details of the history, presenting signs, results of routine blood tests, thyroid tests, cerebrospinal fluid (CSF) analysis and diagnostic imaging, and response to therapy were compiled. Results: Three Labrador Retrievers and one Labrador Retriever cross fit the inclusion criteria. All dogs were hypothyroid and severely hyperlipidemic. Neurologic signs included tetraparesis, central and peripheral vestibular signs, facial paralysis, and paraparesis. Two dogs had an acute history and rapid resolution of signs consistent with an infarct, the presence of which was confirmed in 1 of the dogs by magnetic resonance imaging. Two dogs had chronic histories of cranial neuropathies and paraparesis. One of these dogs had evidence of iliac thrombosis and atherosclerosis on ultrasound examination. All dogs improved with thyroid hormone supplementation. Clinical Relevance: Labrador Retrievers may be predisposed to the development of severe hyperlipidemia in association with hypothyroidism. One possible consequence of severe hyperlipidemia is the development of neurologic signs due to atherosclerosis and thromboembolic events. [source] Incidence and Clinical Relevance of Hyperglycemia in Critically Ill DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2007Danna M. Torre Background: Hyperglycemia associated with critical illness in nondiabetic human patients is a common occurrence in the intensive care unit (ICU), with a reported incidence as high as 71%. Hypothesis: Hyperglycemia in critically ill dogs increases the risk of morbidity and mortality. Animals: Two hundred forty-five dogs hospitalized in the ICU over a 2-month period were evaluated. Methods: Prospective observational study was conducted over a 2-month period. All dogs in the ICU had their highest daily blood glucose concentration recorded. All dogs with diabetes were excluded from the study. Hyperglycemia was defined as a blood glucose concentration >120 mg/dL. Dogs with hyperglycemia were monitored for persistence and resolution of hyperglycemia. Results: During the study period, 245 dogs were evaluated, of which 38 (16%) were hyperglycemic. Twenty-six percent (10/ 38) developed hyperglycemia during hospitalization, whereas 74% (28/38) were hyperglycemic at presentation. Length of hospitalization (LOH) was shorter in dogs that presented with hyperglycemia compared with those that developed hyperglycemia during hospitalization (P= .001). Seventy-one percent (27/38) of dogs were discharged from the hospital, whereas the remaining 29% (11/38) died or were euthanatized. Nonsurvivors had significantly higher median glucose concentration (median, 176 mg/dL; range 122,310 mg/dL) than did survivors (median, 139 mg/dL; 121,191 mg/dL; P= .021). Conclusions and Clinical Importance: The incidence of hyperglycemia in this population of dogs was 16%. Dogs that developed hyperglycemia had longer LOH and nonsurvivors had more pronounced hyperglycemia than did survivors. [source] | ||||||||||||||||||||||||||||||||||||||||