Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

Objectives To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. Design A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English‐language articles published between 1990 and April 2016. Setting Hospital or skilled nursing facility. Participants Older adults with informal caregivers discharged to a community setting. Measurements Readmission rates, length of and time to post‐discharge rehospitalizations, costs of postdischarge care. Results Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62–0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64–0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. Conclusion For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

Objectives To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. Design A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English‐language articles published between 1990 and April 2016. Setting Hospital or skilled nursing facility. Participants Older adults with informal caregivers discharged to a community setting. Measurements Readmission rates, length of and time to post‐discharge rehospitalizations, costs of postdischarge care. Results Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62–0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64–0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. Conclusion For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission

Concurrent use of prescription drugs and herbal medicinal products in older adults: A systematic review

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.The use of herbal medicinal products (HMPs) is common among older adults. However, little is known about concurrent use with prescription drugs as well as the potential interactions associated with such combinations. Objective Identify and evaluate the literature on concurrent prescription and HMPs use among older adults to assess prevalence, patterns, potential interactions and factors associated with this use. Methods Systematic searches in MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, Web of Science and Cochrane from inception to May 2017 for studies reporting concurrent use of prescription medicines with HMPs in adults (≥65 years). Quality was assessed using the Joanna Briggs Institute checklists. The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) three stage approach to mixed method research was used to synthesise data. Results Twenty-two studies were included. A definition of HMPs or what was considered HMP was frequently missing. Prevalence of concurrent use by older adults varied widely between 5.3% and 88.3%. Prescription medicines most combined with HMPs were antihypertensive drugs, beta blockers, diuretics, antihyperlipidemic agents, anticoagulants, analgesics, antihistamines, antidiabetics, antidepressants and statins. The HMPs most frequently used were: ginkgo, garlic, ginseng, St John’s wort, Echinacea, saw palmetto, evening primrose oil and ginger. Potential risks of bleeding due to use of ginkgo, garlic or ginseng with aspirin or warfarin was the most reported herb-drug interaction. Some data suggests being female, a lower household income and less than high school education were associated with concurrent use. Conclusion Prevalence of concurrent prescription drugs and HMPs use among older adults is substantial and potential interactions have been reported. Knowledge of the extent and manner in which older adults combine prescription drugs will aid healthcare professionals can appropriately identify and manage patients at risk.Peer reviewedFinal Published versio

The Influence of Redcap in Improving the Quality of Data in Sickle Cell Medical Research Program: The Case of Sickle Cell Program at Muhimbili National Hospital

The study examined the influence of REDCap in improving the quality of data in sickle cell medical research program. The study used descriptive research design whereas both qualitative and quantitative approaches were used where a cross-sectional design was employed to collect information at one time in particular point. A total of 52 questionnaires with closed-ended questions were distributed. Primary data were collected through survey and in-depth interviews. Data were analyzed by using SPSS which simplified process of data analysis; the program identified the position of the variables and multiple regression analysis. The study found that there is effectiveness of REDCap in improving the quality of data in sickle cell medical research program in the sense that REDCap has effectively facilitated the collection of all necessary variables and essential information for research purposes. The study concluded that REDCap plays a significant role in improving the overall data quality in the context of sickle cell medical research programs. The study suggests that stringent quality control procedures should be implemented to ensure the accuracy and reliability of data input into the REDCap system. This recommendation underscores the importance of maintaining high standards in data management processes to enhance the credibility and validity of research outcomes in the field of sickle cell medical research.&nbsp

Enhancing Nurses\u27 Pain Reassessment and Documentation Using Clinical Decision Support: A Quality Improvement Project in Acute Care

Purpose: The project aimed to educate medical-surgical registered nurses (RNs) on using the clinical decision support (CDS) tools to complete pain reassessment and documentation. Objectives were to increase pain reassessment compliance, identify perceived pain reassessment barriers, and change current pain reassessment and documentation behaviors. Background: Nurses are responsible for assessing, reassessing, and managing patients’ pain. Quality pain reassessment and documentation are essential to effective pain management. Methods: Participants were accrued via convenience sampling in addition to inclusion and exclusion criteria. The Plan-Do-Check-Act (PDCA) Cycle was used to guide the pilot project conducted in one medical-surgical unit. Implementation interventions: asynchronous computer-based learning module with step-by-step instruction and demonstration on how to use the CDS tools, dissemination of tip sheets to reinforce learning module content, unit rounding, and distribution of information on the importance of pain reassessment and documentation. Participants were also invited to complete an electronic questionnaire to evaluate demographics and perceived pain reassessment barriers. Results: 18 participants completed the project. The educational intervention had a small effect on the participants’ pain reassessment compliance one-week post-intervention. By the second post-intervention week, compliance dipped and regressed to baseline. The primary barriers contributing to participants’ pain reassessment compliance rates were time constraints, competing patient care priorities, heavy workload, inadequate staffing, and forgetfulness. Conclusion: The project results suggest that an educational intervention focused on CDS tools could improve nurses’ pain reassessment and documentation compliance and behaviors

Presenting a Population-based Multiple Sclerosis Registry for Iran

 Introduction: Worldwide prevalence of Multiple Sclerosis (MS) is growing, and given the huge burden on the patient, the community and the healthcare system, prevention interventions and symptom management in order to improving the quality of life of these patients are of utmost importance. One of the most important strategies in this regard is providing the existence of an MS population-based registry. Accordingly, this research was aimed at providing a population-based MS registry model.Materials and Methods: This is a qualitative study, carried out within the years 2016 and 2017. The population of the present study consisted of models of multiple sclerosis population registries. In this study, a model was provided using library resources, informational networks and information retrieval from databases of PubMed, Google Scholar, Springer, Science direct, and Wiley and also through studying the registry of developed countries. Then, this model using Delphi technique and questionnaire tool was validated and after data analysis, the final model was presented.Results: In the present study, a demographic MS registry model including the following eight main criteria was proposed: registry goals, data sources, minimum data set, data set, data processing, various types of reports, quality control measures and patient follow-up procedures. Conclusion: Considering the prevalence of MS in Iran and the need for optimal data management, it is recommended that measures be taken to establish and use a national MS population-based registry and be one of the priorities of the Ministry of Health and Medical Education. 

Science on a Shoestring: Building Nursing Knowledge With Limited Funding

Building the science for nursing practice has never been more important. However, shrunken federal and state research budgets mean that investigators must find alternative sources of financial support and develop projects that are less costly to carry out. New investigators often build beginning programs of research with limited funding. This article provides an overview of some cost-effective research approaches and gives suggestions for finding other sources of funding. Examples of more cost-effective research approaches include adding complementary questions to existing funded research projects; conducting primary analysis of electronic patient records and social media content; conducting secondary analysis of data from completed studies; reviewing and synthesizing previously completed research; implementing community-based participatory research; participating in collaborative research efforts such as inter-campus team research, practice-based research networks (PBRNs), and involving undergraduate and doctoral students in research efforts. Instead of relying on funding from the National Institutes of Health (NIH) and other government agencies, nurse researchers may be able to find support for research from local sources such as businesses, organizations, or clinical agencies. Investigators will increasingly have to rely on these and other creative approaches to fund and implement their research programs if granting agency budgets do not significantly expand