Evidence-Based Skin Champion Program Reduces Pressure Injuries in a Pediatric Hospital

Prevention of pressure injuries (PIs) in pediatric patients is an important nurse-sensitive quality goal. The PI rate at a large urban pediatric hospital triggered a call to action by the Chief Nursing Officer to establish a Hospital Acquired PI (HAPI) Task Force which identified the Skin Champion program as a key improvement strategy. The goals of the Skin Champion program are to lower the rate of HAPIs, empower front line care providers to implement evidence-based care bundles, achieve consistency of practice, and provide resource availability at the point of care. The implementation of the Skin Champion quality improvement program achieved an 85% reduction in severe harm and “reportable HAPI incidence, which is lower than the HAPI national average in pediatric patients (Solutions for Patient Safety, 2018), and an increase in nurse compliance with the HAPI prevention bundle. The HAPI incidence rate has remained near 0.05 per 1000 patient days

Use of a Decision Aid to Improve Decisional Comfort in College Students Treated for Respiratory Tract Infections

Decision aids have been shown to facilitate shared decision making, recognize and respect patient values, improve patient experience by designing care around those values and increase patient comfort with decisions made. The objective of the study was to determine the effectiveness of a decision aid to 1) increase decisional comfort with the appropriate use of antibiotics for respiratory tract infections and 2) maintain antibiotic prescribing rates at current levels. Participants were English-speaking college students age 18 and over diagnosed with a respiratory tract infection in the general medical clinic of a university health center from August 31, 2015-May 6, 2016. Pre- and post-intervention surveys were used to measure decisional conflict of students. Intervention included staff training in shared decision making and the use of a decision aid. Students who received routine care were 2.2 times [N=643; p

Inclusion of women in nursing research

Abstract: Background: Although the inclusion of women in research has been examined in medical publications, little is known about how federal mandates have influenced the inclusion of women in research published in nursing journals. Objective: This study aimed to examine the inclusion of women in published nursing research from 1995 to 2001, with a focus on the leading causes of mortality. Method: All the articles in each journal were reviewed, and all the research articles that focused on the top 10 causes of death were sampled to measure the inclusion of women, the characteristics of the women included, the funding source, and the topic. Results: Of the 1,149 studies reviewed, 139 met the inclusion criteria, and 117 of these studies included women. Only 15 of the studies reported the age of the women in their samples, and 10 of these included women between the ages of 35 and 64 years. The most frequently reported race was White (n = 21), followed by African American (n = 17), Hispanic (n = 6), and Asian (n = 2). There were no associations among year of publication (p = .62), federal funding (p = .30), and inclusion of women. Among the studies including women, heart disease was the most frequent topic (n = 52), followed by Alzheimer's disease (n = 21), cancer (n = 14), respiratory illness (n = 14), and diabetes (n = 8). Discussion: Although the majority of the research included women, continuing efforts must be made to include sufficient numbers of women. Article: Women's health has received increased attention over the past two decades. Statistics indicate that women have higher mortality rates than men for heart disease, stroke, diabetes, influenza and pneumonia, and nephrotic disorders (U.S. Department of Health and Human Services [DHHS], 2002). Yet, even as late as the 1980s, few studies on these topics included women. This finding initiated a cascade of events, resulting in a law requiring federally funded researchers to include women in their studies unless strong evidence supported exclusion (U.S. Public Health Service, 1985). Recently, Ramasubbu, Gurm, and Latiker (2001) examined the inclusion of women in studies published in The New England Journal of Medicine from 1994 to 1999. These authors reported that women comprised only approximately 25% of the total sample population (n = 160,801). Similarly, a review by Background Research focusing on women in the early 1970s and 1980s centered primarily on issues specific to women's biology such as menopause and childbirth. A task force on women's health found little research that included women. This lack of research resulted in a deficit of information on diseases affecting women's health

Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review

Background: Current literature supports the comprehensive health benefits of exposure to nature and green environments on human systems. The aim of this state-of-the-art review is to elucidate empirical research conducted on the physiological and psychological effects of Shinrin-Yoku (or Forest Bathing) in transcontinental Japan and China. Furthermore, we aim to encourage healthcare professionals to conduct longitudinal research in Western cultures regarding the clinically therapeutic effects of Shinrin-Yoku and, for healthcare providers/students to consider practicing Shinrin-Yoku to decrease undue stress and potential burnout. Methods: A thorough review was conducted to identify research published with an initial open date range and then narrowing the collection to include papers published from 2007 to 2017. Electronic databases (PubMed, PubMed Central, CINAHL, PsycINFO and Scopus) and snowball references were used to cull papers that evaluated the use of Shinrin-Yoku for various populations in diverse settings. Results: From the 127 papers initially culled using the Boolean phrases: “Shinrin-yoku” AND/OR “forest bathing” AND/OR “nature therapy”, 64 studies met the inclusion criteria and were included in this summary review and then divided into “physiological,” “psychological,” “sensory metrics” and “frameworks” sub-groups. Conclusions: Human health benefits associated with the immersion in nature continue to be currently researched. Longitudinal research, conducted worldwide, is needed to produce new evidence of the relationships associated with Shinrin-Yoku and clinical therapeutic effects. Nature therapy as a health-promotion method and potential universal health model is implicated for the reduction of reported modern-day “stress-state” and “technostress.”

Diagnostic Error: A Patient Safety Imperative

Objectives Develop a working definition of the term “diagnostic error” Identify system and cognitive factors that contribute to risk for diagnostic error Describe areas of opportunity for improvement to reduce the risk of diagnostic error Identify the key objectives of the Pennsylvania Patient Safety Authority’s Center of Excellence for Improving Diagnosis Summary Diagnostic errors are a complex and often overlooked problem in the field of patient safety. While various cognitive and system factors contribute to the problem, there are many opportunities for improvement. This session explores how the Pennsylvania Patient Safety Authority’s newly formed Center of Excellence will work to improve diagnosis in Pennsylvania. Presentation: 1:00:3

Reproducibility and feasibility of right ventricular strain and strain rate (SR) as determined by myocardial speckle tracking during high-intensity upright exercise: a comparison with tissue Doppler-derived strain and SR in healthy human hearts.

This study aimed to establish feasibility for myocardial speckle tracking (MST) and intra-observer reliability of both MST and tissue velocity imaging (TVI)-derived right ventricular (RV) strain (ϵ) and strain rate (SR) at rest and during upright incremental exercise. RV ϵ and SR were derived using both techniques in 19 healthy male participants. MST-derived ϵ and SR were feasible at rest (85% of segments tracked appropriately). Feasibility reduced significantly with progressive exercise intensity (3% of segments tracking appropriately at 90% maximum heart rate (HRmax)). Coefficient of variations (CoVs) of global ϵ values at rest was acceptable for both TVI and MST (7-12%), with low bias and narrow limits of agreement. Global SR data were less reliable for MST compared with TVI as demonstrated with CoV data (systolic SR=15 and 61%, early diastolic SR=16 and 17% and late diastolic SR=26 and 31% respectively). CoVs of global RV ϵ and SR obtained at 50% HRmax were acceptable using both techniques. As exercise intensity increased to 70 and 90% HRmax, reliability of ϵ and SR values reduced with larger variability in MST. We conclude that RV global and regional ϵ and SR data are feasible, comparable and reliable at rest and at 50% HRmax using both MST and TVI. Reliability was reduced during higher exercise intensities with only TVI acceptable for clinical and scientific use

Genetic Testing Reveals Germline Mutations Among Patients Undergoing Surgery for Colorectal Carcinoma in a Community Hospital Setting

Introduction: Defined germline mutations contribute to 5% to 10% of cases of colorectal carcinoma (CRC). While protocols for universal tumor screening have been adopted to detect mismatch repair (MMR) protein deficiency, widespread multigene panel testing has not been achieved. Barriers to implementing testing protocols may occur in community settings. Methods: A total of 160 patients presenting for surgical management of CRC between 2011 and 2020 were considered for retrospective analysis in a single-surgeon, single-institution, community-based cohort. The rate of multigene panel testing and prevalence of germline mutations were calculated, and patient characteristics were assessed. Results: A total of 32/160 (20%) patients underwent multigene panel testing, with 14/160 (9%) patients having germline mutations. While 88% of patients underwent panel testing after CRC diagnosis, 43% of these patients would have met testing criteria before diagnosis. Among the patients meeting criteria before diagnosis, 50% were found to carry a germline mutation. Discussion: The prevalence of germline mutations was similar to previously reported values, while the rate of multigene panel testing was higher than previously reported. These results may be unique to the study setting or result from multidisciplinary conference discussion. A significant number of patients with abnormal panel testing were not tested before CRC diagnosis, despite meeting the criteria. This finding represents a missed opportunity for risk stratification and underscores the importance of addressing testing barriers in the primary care setting. Conclusions: Primary care providers and oncologists in community hospitals must remain cognizant of changing guidelines as multigene panel testing becomes increasingly available

Impairments in reinforcement learning do not explain enhanced habit formation in cocaine use disorder.

RATIONALE: Drug addiction has been suggested to develop through drug-induced changes in learning and memory processes. Whilst the initiation of drug use is typically goal-directed and hedonically motivated, over time, drug-taking may develop into a stimulus-driven habit, characterised by persistent use of the drug irrespective of the consequences. Converging lines of evidence suggest that stimulant drugs facilitate the transition of goal-directed into habitual drug-taking, but their contribution to goal-directed learning is less clear. Computational modelling may provide an elegant means for elucidating changes during instrumental learning that may explain enhanced habit formation. OBJECTIVES: We used formal reinforcement learning algorithms to deconstruct the process of appetitive instrumental learning and to explore potential associations between goal-directed and habitual actions in patients with cocaine use disorder (CUD). METHODS: We re-analysed appetitive instrumental learning data in 55 healthy control volunteers and 70 CUD patients by applying a reinforcement learning model within a hierarchical Bayesian framework. We used a regression model to determine the influence of learning parameters and variations in brain structure on subsequent habit formation. RESULTS: Poor instrumental learning performance in CUD patients was largely determined by difficulties with learning from feedback, as reflected by a significantly reduced learning rate. Subsequent formation of habitual response patterns was partly explained by group status and individual variation in reinforcement sensitivity. White matter integrity within goal-directed networks was only associated with performance parameters in controls but not in CUD patients. CONCLUSIONS: Our data indicate that impairments in reinforcement learning are insufficient to account for enhanced habitual responding in CUD.This research was funded by the Medical Research Council (MR/J012084/1) and the NIHR Cambridge Biomedical Research Centre and was conducted at the NIHR Cambridge Clinical Research Facility. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. This research was also supported in part by a Medical Research Council (MRC) Clinical Research Infrastructure award (MR/M009041/1). R.N.C. consults for Campden Instruments and receives royalties from Cambridge Enterprise, Routledge, and Cambridge University Press. RNC’s research is supported by the UK Medical Research Council (MC_PC_17213). T.W.R. discloses consultancy with Cambridge Cognition, Lundbeck, Mundipharma and Unilever; he receives royalties for CANTAB from Cambridge Cognition and editorial honoraria from Springer Verlag and Elsevier. T.V.L., G.S. P.S.J., A.A.M. and K.D.E. declare to have no potential conflict of interest