Color-Changing Device to Improve Adherence to Foley Catheter Replacement Protocols and Reduce Urinary Tract Infection Frequency

Background: Foley catheter-associated UTI’s (CAUTI’s) represent a driving cause of cystitis, bacteremia and sepsis in the hospital setting. Accordingly, the CDC has identified prolonged indwelling time as the foremost risk factor for CAUTI’s. However, the fundamental design of the Foley has remained unchanged for over eighty years. Hospital-specific protocols do currently exist for the removal of infection-prone catheters; however, in practice it remains commonplace for catheters to be ignored, increasing the risk of life-threatening infection. Our design process addressed this by creating a color-changing alarm device that would alert providers when a catheter has been left in beyond protocol, is at risk for infection, and should be assessed for removal. Methods: In-depth interviewing with the goal of collecting end-user feedback was conducted during our design process. Working with an infectious disease case manager, two physicians (urology and EM), and the CAUTI nursing chair, we targeted two primary aspects of CAUTI use: procedures currently used to determine infection risk of indwelling catheters, and potential strategies for alerting and preventing CAUTI’s. “Design Thinking” framework allowed us to incorporate stakeholder feedback, iterate ideas for, and prototype our color-changing alarm device. Results: Interviews suggest that despite current protocols, providers continue to leave catheters indwelling beyond suggested time limits. End-user feedback also indicated an urgent need for an innovative strategy to assist in the recognition of infection-prone catheters and to limit CAUTI’s. Conclusions: Currently, the color-indicator alarm system is within the prototyping phase of the iterative design process. We will incorporate end-user expert feedback (such as the five-to-eight day “critical window” suggested by our experts for catheter assessment and removal) into the product design. Future hospital trials will test whether the device improves the recognition of infectionprone catheters, effectively notifies providers of catheters left indwelling, and decreases the incidence of CAUTI’s

Medical students are accurate in interpreting the presence of pathologic interstitial edema on focused lung ultrasound compared to expert reviewers.

BACKGROUND: Over the past two decades, studies have demonstrated that lung ultrasound is useful in diagnosing alveolar interstitial syndrome, which is seen in patients with decompensated congestive heart failure (CHF). METHODS: We studied medical students performing lung ultrasound on patients admitted to the hospital with a presumed diagnosis of decompensated CHF in a prospective convenience observation study. Two ultrasound fellowship-trained emergency medicine attendings independently reviewed the lung ultrasounds at a later date, blinded to the students\u27 interpretation and other clinical information, to confirm ultrasound findings and assess for inter-rater reliability of the lung ultrasound using intraclass correlation coefficients (ICCs). RESULTS: Thirty-six patients were enrolled in the study resulting in 653 unique lung zones scanned. The zones were imaged and classified as being normal (B-lines \u3c 3) or pathologic (B-lines ≥ 3). The novice scanners\u27 interpretation was compared to expert reviews using ICCs. The ICC was 0.88, with a 95% confidence interval of 0.87 to 0.90, for all lung zones scanned. CONCLUSION: There was almost perfect agreement between novice practitioners and experts when determining the presence of pathologic B-lines in individual patients

Hypertension Outcomes Through Blood Pressure Monitoring and Evaluation by Pharmacists (HOME Study)

OBJECTIVE: To evaluate the effectiveness of a community pharmacist–based home blood pressure (BP) monitoring program. DESIGN: Trial of a high-intensity (HI) versus low-intensity (LI) intervention randomized in 12 community pharmacies. The HI intervention comprised 4 face-to-face visits with a trained pharmacist. Pharmacists provided patient-specific education about hypertension. Following the first and third visits, patients were provided with a home BP monitoring device and instructed to measure their BP at least once daily for the next month. Home BP readings were used by the pharmacists to develop treatment recommendations for the patient's physician. Recommendations were discussed with the physician and, if approved, implemented by the pharmacist. In the LI intervention, pharmacists measured patients BP in the pharmacy and referred them to their physician for evaluation. PARTICIPANTS: Patients with uncontrolled BP at baseline. MEASUREMENTS: The main outcomes were the differences in systolic and diastolic BP (SBP and DBP) from baseline to follow-up between the HI and LI patients. RESULTS: The study enrolled 125 patients, 64 in the HI and 61 in the LI group. From baseline, SBP declined 13.4 mmHg in the HI group and 9.0 mmHg in the LI group. At the final visit, the difference in SBP/DBP change between the HI and LI group was −4.5/−3.2 mmHg (P=.12 for SBP and P=.03 for DBP). CONCLUSIONS: The HI intervention achieved a lower DBP and this model could be a strategy for patients with hypertension