Identification of Nurse-Controlled Predictors of Pain in Patients Undergoing a Total Hip or Total Knee Arthroplasty

Objectives: The purpose of this study was to examine relationships among nursing interventions and pain status during hospitalization in orthopedic surgical patients receiving total hip or knee arthroplasty in one of four community hospitals in San Diego, California. Background: The epidemic of opioid-related adverse events creates a need for opioid sparing approaches to pain management. Pain management practices have been studied in relation to medicine; however, the relationship between pain and opioid sparing, nurse-specific interventions is not clear. Methods: The retrospective descriptive study examined Electronic Health Record (EHR) data of patients (N = 1657) discharged after a total hip or knee arthroplasty from one of four community hospitals between March 1, 2016 and April 30, 2017. Data extracted included patients’ sociodemographic characteristics, daily morphine equivalent, average time between nursing pain assessments, actual and acceptable levels of pain, and use of adjunct therapy. Descriptive and inferential statistics were used to describe the sample and examine relationships between variables. Binomial logistic regression was utilized to identify factors that increased the likelihood of controlled pain during hospitalization for the study sample. Results: Approximately two-thirds (65.3%) of patients had their pain controlled during hospitalization; the average daily morphine equivalent day 2 post op was 1.25 mg (SD = 1.03) for the overall sample, and 1.28 mg (SD = 1.08) for those with controlled pain; slightly over one-fourth (26.8%) used aromatherapy during hospitalization. Significant group differences between patients reporting controlled vs. uncontrolled pain during hospitalization were found in patients’ age, BMI, surgeon, time between nurse pain assessments, sedation status, nerve block, aromatherapy and comfort massage use. Logistic regression indicated patients with lower BMI, longer time between nurse pain assessments on day 2 post op, received aromatherapy during hospitalization, and a nerve block were more likely to have controlled pain during hospitalization, c2(14) = 122.47, p \u3c .001. Patients whose surgeons conducted less than 60 or more than 89 surgeries during the study and patients who were not lightly drowsy or easy to arouse were more likely to experience uncontrolled pain during hospitalization. Conclusions: The daily morphine equivalent administered to patients on day two post op and during hospitalization was not significantly different for patients with controlled vs. uncontrolled pain. The results of this study show patients with controlled pain are using adjunct therapies more than those with uncontrolled pain during hospitalization; more information is needed regarding the reasons patients with uncontrolled pain are not using adjunct therapy. Pain level and lack of readily available adjunct therapies may present overwhelming barriers to patients with uncontrolled pain. Implications: Nurse-controlled variables empower nurses to improve patient care while decreasing patients’ risk for post-surgical opioid-related complications and addictions. Future research is needed to clarify patients’ and nurses’ perspectives in pain treatments and variability

Reward prospect improves inhibitory control in female university students with a history of childhood sexual and physical abuse

Background and objectives: Childhood abuse and neglect increase the risk for psychiatric disorders (e.g., depression and anxiety) during adulthood and have been associated with deficits in cognitive control. The specific mechanisms underlying these cognitive control deficits are still unknown. Methods: This study examined the expectation for reward to improve inhibitory control in young women (ages 18-35 years) with a history of childhood sexual and/or physical abuse (AG, N = 28), childhood emotional and/or physical neglect (NG, N = 30), or unaffected comparison women (HC, N = 40). They completed a previously validated rewarded (color-word) Stroop task and filled out questionnaires on depression, anxiety, and resilience. Results: Surprisingly, a significant group by reward interaction revealed larger performance benefits under reward prospect (relative to no-reward) for the AG group relative to both the NG and HC groups. Limitations: A small sample size limiting generalizability. Conclusions: These results demonstrate sensitivity of abused subjects to reward in modulating cognitive control and might aid in discussing whether using reward schedules during therapeutic interventions could be effective

Staying Strong Toolbox: co-design of a physical activity and lifestyle program for Aboriginal families with Machado-Joseph disease in the Top End of Australia

Physical activity has positive health implications for individuals living with neurodegenerative diseases. The success of physical activity programs, particularly in culturally and linguistically diverse populations, is typically dependent on their alignment with the culture, lifestyle and environmental context of those involved. Aboriginal families living in remote communities in the Top End of Australia invited researchers to collaborate with them to co-design a physical activity and lifestyle program to keep individuals with Machado-Joseph disease (MJD) walking and moving around. The knowledge of Aboriginal families living with MJD, combined with findings from worldwide MJD research, formed the foundation for the co-design. An experience-based co-design (EBCD) approach, drawing from Indigenous and Participatory methodologies, was used. An expert panel of individuals with lived experience of MJD participated in a series of co-design phases. Prearranged and spontaneous co-design meetings were led by local community researchers within each phase. Data was collected using a culturally responsive ethnographic approach and analysed thematically. Sixteen panel members worked to develop the 'Staying Strong Toolbox' to cater for individuals with MJD who are 'walking strong'; or 'wobbly'; or 'in a wheelchair'. Based on the 'Staying Strong Framework', the Toolbox was developed as a spiral bound A3 book designed to guide the user to select from a range of activities to keep them walking and moving around and to identify those activities most important to them to work on. The 'Staying Strong Toolbox' is a community driven, evidence based resource for a physical activity and lifestyle program for Aboriginal families with MJD. The Toolbox provides a guide for health professionals and support workers to deliver person-centred support to Aboriginal families with MJD, and that can be modified for use by other families with MJD or people with other forms of ataxia around the world

Exceptionally Fast Radiative Decay of a Dinuclear Platinum Complex Through Thermally Activated Delayed Fluorescence

A novel dinuclear platinum(II) complex featuring a ditopic, bis-tetradentate ligand has been prepared. The ligand offers each metal ion a planar O^N^C^N coordination environment, with the two metal ions bound to the nitrogen atoms of a bridging pyrimidine unit. The complex is brightly luminescent in the red region of the spectrum with a photoluminescence quantum yield of 83% in deoxygenated methylcyclohexane solution at ambient temperature, and shows a remarkably short excited state lifetime of 2.1 μs. These properties are the result of an unusually high radiative rate constant of around 4 × 105 s–1, a value which is comparable to that of the very best performing Ir(III) complexes. This unusual behaviour is the result of efficient thermally activated reverse intersystem crossing, promoted by a small singlet–triplet energy difference of only 69 ± 3 meV. The complex was incorporated into solution-processed OLEDs achieving EQEmax = 7.4 %. We believe this to be the first fully evidenced report of a Pt(II) complex showing thermally activated delayed fluorescence (TADF) at room temperature, and indeed of a Pt(II)-based delayed fluorescence emitter to be incorporated into an OLED

Red Light-Emitting Electrochemical Cells Employing Pyridazine-Bridged Cationic Diiridium Complexes

A rigid dinuclear Ir(III) complex showing high photoluminescence quantum yield in pure films was successfully used to fabricate light-emitting electrochemical cells with and without ionic liquid additives. The devices showed nearly instantaneous electroluminescence after biasing and maximum quantum yield approaching 1%. The lifetime of the devices was found to be limited to approximately 20 hours, which we correlated with the irreversible oxidation of the complex as seen from electrochemical measurements. This work validates the use of highly luminescent dinuclear iridium complexes in light-emitting electrochemical cells. Future studies will pursue materials with more efficient photoluminescence as well as improved electrochemical stability

Sleep disorders among Aboriginal Australians with Machado-Joseph Disease: Quantitative results from a multiple methods study to assess the experience of people living with the disease and their caregivers

Objective: To investigate frequency and characteristics of sleep disorders and their association with health-related quality of life and psychosocial wellbeing for Aboriginal Australians living with MJD. Methods: A convenience sample of MJD participants n = 24 participated in a semi-attended, ambulatory diagnostic sleep study to capture polysomnography, actigraphy and sleep diary data. Self-report measures collected were the Pittsburgh Sleep Quality Index (PSQI), STOP-BANG Questionnaire for Obstructive Sleep Apnoea (OSA), International Restless Legs Syndrome Study Group rating scale (IRLS), Kessler-5 (K5) and EuroQoL-5 Dimension (EQ5D). Caregivers (n = 22) reported EQ-5D, K5 and bed partners’ sleep behaviour (Mayo Sleep Questionnaire-Informant). Environmental factors were measured. Results: We observed Nocturia, Sleep Related Leg Cramps, OSA, REM Behaviour Disorder, and RLS, respectively in 100%, 71%, 47%, 43%, and 33% of participants with a significant positive correlation between Body mass index (BMI) and Apnoea hypopnea index (AHI). The majority of sleep was spent in non-rapid eye movement sleep (NREM)-N2 stage (77.8% (67.7, 81.6)). Overcrowding (92%) and overnight care needs (42%) interrupted sleep. MJD participants and caregivers reported high psychological distress (K5 median 12.5 IQR 7, 16.5 & 8 IQR 6, 12 respectively). Conclusion: Poor sleep quality and sleep disturbances are prevalent among this cohort. Disease manifestations and environmental factors are driving factors. Larger sample sizes are required to predict risk factors and confirm observed associations

Effects of activity-based hospital payments in Israel: A qualitative evaluation focusing on the perspectives of hospital managers and physicians

Background: Since 2010, Israel has expanded the adoption of procedure-related group (PRG) based payments for hospitals. While there is a rich quantitative literature that assesses the effects of payment reforms on efficiency or quality of care, very few qualitative studies have focused on the impacts of diagnosis-related group (DRG)-like payments on hospitals from the perspective of hospital workers as change agents. Methods: We used a qualitative, thematic analysis based on 33 semi-structured in-depth interviews with chief executive officers (CEOs), chief financial officers (CFOs), ward directors and physicians conducted in five public hospitals in Israel, sampled by maximum variation according to hospital characteristics. Results: Interviewees reported that the payment reform led to organizational changes such as increased transparency and enhanced supervision. Interviewees also reported several actions in response to the economic incentives of PRGbased payment. These included (1) shifting activities to afterhours and using operating rooms (ORs) more efficiently to enable increased surgical volumes; (2) reducing costs by shortening lengths of stay and increasing cost-consciousness in procurement; and (3) increasing revenues by improving coding and selecting procedures. Moderating factors reduced the effects of the reform. For example, organizational factors such as the public nature of hospitals or the (un)availability of healthcare resources did not always allow hospitals to increase the number of cases treated. Also, conflicting incentives such as multiple payment mechanisms or underpricing of procedures blurred the incentives of the reform. Finally, managers and physicians have many other considerations that outweigh the economic ones. Conclusion: PRG payments affected the organizational dynamics of hospitals and changed decision-making about admission and treatment policies. However, such effects were moderated by many other factors that should be considered when shaping and analyzing hospital payment reforms

Effectiveness of the Influenza Vaccine in Preventing Hospitalizations of Patients with Influenza Community-Acquired Pneumonia

Introduction: Influenza vaccination is the primary strategy for prevention of influenza infection. Influenza infection can vary from mild or even asymptomatic illness to severe community-acquired pneumonia (CAP). Although many national and international investigators and organizations report annual estimates of influenza vaccine effectiveness for prevention of influenza infection in the community, few studies report estimates for the prevention of hospitalizations due to influenza CAP, the most severe form of the infection. The objective of this study is to determine the effectiveness of the influenza vaccine for prevention of hospitalization in patients with influenza-associated CAP. Methods: This was a test-negative study using data from the first two years of the University of Louisville Pneumonia Study, a prospective, observational study of all hospitalized patients with pneumonia in Louisville, Kentucky from 6/1/2014 – 5/31/2016. Univariate and multivariate logistic models were used to evaluate the association between vaccine status and influenza-associated/non-influenza-associated CAP hospitalization. Unadjusted and adjusted vaccine effectiveness estimates were calculated. Results: A total of 1951 hospitalized patients with CAP were included in the analysis, and 831 (43%) reported having received the influenza vaccination for the influenza season by the time they were hospitalized. A total of 152 (8%) cases of influenza-CAP were confirmed in the study population, with 63 (8%) cases confirmed in vaccinated individuals. The unadjusted vaccine effectiveness was not significant, with a point estimate of 5% (95% CI: -33%, 32%). After adjusting for potential cofounders, vaccine effectiveness was also found to not be significant with a point estimate of 8% (95% CI: -30%, 35%). Conclusions: In conclusion, we found that, over the 2014/2015 and 2015/2016 influenza seasons, influenza vaccine was not effective for prevention of hospitalization with CAP due to influenza. More effective vaccines are necessary to prevent the most serious forms of influenza