Impact of Implementing the Geriatric Resource Nurse Model on Fall and Hospital Acquired Pressure Ulcer Rates, and Length of Stay in Older Adults in an Acute Care Hospital

Background.Older adults are at high risk for adverse care outcomes, such as injuries from falls, hospital acquired pressure ulcers (HAPUs), and prolonged length of stay (LOS). Available evidence suggests outcomes may improve when older adults are cared for by healthcare providers with competence in geriatrics. To improve outcomes, an acute care not-for-profit teaching hospital in Washington DC area implemented a Geriatric Resource Nurse (GRN) model that prepares registered nurses (RNs) as clinical experts on core geriatric principles on four general care wards (three medical-surgical and one cardiac). Objectives. Toexamine the effects of GRN model implementation on fall and HAPU rates, and LOS in older adults in medical-surgical and cardiac units in an acute care hospital. Methods.A retrospective chart review was conducted to measure fall and HAPU rates, and LOS before and after implementation of the GRN model. Data from 1176 charts (609 in before and 567 in after intervention group) was reviewed. Data analysis was performed in SPSS 22. Results. Total number of falls was 24 (2.0%) with 13 (2.1%) before and 11 (1.9%) after intervention group. Total number of HAPUs was 26 (2.2%) including 18 (3.0%) before and 8 (1.4%) after intervention group. LOS ranged from 1-71 days. LOS mean for total population was 5.14 (SD=5.10), with a mean of 4.88 (SD=4.71) before and a mean of 5.41 (SD=5.49) after intervention. There were no statistically significant differences in fall (x2=0.06, p=0.81) and HAPU (x2=3.24, p=0.07) rates or LOS (t=-1.78, p=0.07) before and after the intervention. Conclusions. Our findingsdid not identify significant differences in fall and HAPU rates, and LOS before and after the intervention. These findings may be a result of inconsistencies in the institutional application of a systematic approach to geriatric care

Changes in Thyroid Metabolites after Liothyronine Administration: A Secondary Analysis of Two Clinical Trials That Incorporated Pharmacokinetic Data

We examined relationships between thyroid hormone (TH) metabolites in humans by measuring 3,5-diiodothyronine (3,5-T2) and 3-iodothyronamine (3-T1AM) levels after liothyronine administration. In secondary analyses, we measured 3,5-T2 and 3-T1AM concentrations in stored samples from two clinical trials. In 12 healthy volunteers, THs and metabolites were documented for 96 h after a single dose of 50 mcg liothyronine. In 18 patients treated for hypothyroidism, levothyroxine therapy was replaced by daily dosing of 30–45 mcg liothyronine. Analytes were measured prior to the administration of liothyronine weekly for 6 weeks, and then hourly for 8 h after the last liothyronine dose of the study. In the weekly samples from the hypothyroid patients, 3,5-T2 was higher by 0.033 nmol/L with each mcg/dL increase in T4 and 0.24 nmol/L higher with each ng/dL increase in FT4 (p-values = 0.007, 0.0365). In hourly samples after the last study dose of liothyronine, patients with T3 values higher by one ng/dL had 3-T1AM values that were lower by 0.004 nmol/L (p-value = 0.0473); patients with 3,5-T2 higher by one nmol/L had 3-T1AM values higher by 2.45 nmol/L (p-value = 0.0044). The positive correlations between weekly trough levels of 3,5-T2 and T4/FT4 during liothyronine therapy may provide insight into 3,5-T2 production, possibly supporting some production of 3,5-T2 from endogenous T4, but not from exogenous liothyronine. In hourly sampling after liothyronine administration, the negative correlation between T3 levels and 3-T1AM, but positive correlation between 3,5-T2 levels and 3-T1AM could support the hypothesis that 3-T1AM production occurs via 3,5-T2 with negative regulation by T3

National survey of hospital nursing research, part 1 research requirements and outcomes

© 2016 Wolters Kluwer Health, Inc. All rights reserved. Objective: The aim of this study was to describe program requirements and scholarly outcomes for registered nurse (RN)Yled research in US hospitals. BACKGROUND: MagnetArecognitionemphasison evidence-based practice and research has stimulated thegrowthofhospital-basednursingresearchprograms. Hospital policies stipulating whether RNs can lead studies as principal investigators (PIs) varied among members of a regional nursing research consortium. METHODS: Members of the consortium conducted a nationalsurvey of hospitals regarding their requirements for RN-led research and associated scholarly outcomes. RESULTS: Most (87.1%) of the hospitals (N = 160) reported no minimum educational requirements for nurses to be PIs. Mentoring, training, and peer review/approval requirements differed between Magnet and non-Magnet hospitals. On average, hospitals reported an annual total of 4 studies initiated, 4 disseminated via podium or poster presentation, 1 published, and 2 funded. CONCLUSIONS: Findings from this study provide a prototype and benchmark information for nursing administrators planning to establish, evaluate, and/or expand nursing research programs

National survey of hospital nursing research, part 1: Research requirements and outcomes

Objective: The aim of this study was to describe program requirements and scholarly outcomes for registered nurse (RN)-led research in US hospitals. Background: Magnet recognition emphasis on evidence-based practice and research has stimulated the growth of hospital-based nursing research programs. Hospital policies stipulating whether RNs can lead studies as principal investigators (PIs) varied among members of a regional nursing research consortium. Methods: Members of the consortium conducted a national survey of hospitals regarding their requirements for RN-led research and associated scholarly outcomes. Results: Most (87.1%) of the hospitals (N = 160) reported no minimum educational requirements for nurses to be PIs. Mentoring, training, and peer review/approval requirements differed between Magnet and non-Magnet hospitals. On average, hospitals reported an annual total of 4 studies initiated, 4 disseminated via podium or poster presentation, 1 published, and 2 funded. Conclusions: Findings from this study provide a prototype and benchmark information for nursing administrators planning to establish, evaluate, and/or expand nursing research programs. © 2012 Lippincott Williams & Wilkins

Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

Abstract Background The American Board of Internal Medicine Certification Examination (ABIM-CE) is one of several methods used to assess medical knowledge, an Accreditation Council for Graduate Medical Education (ACGME) core competency for graduating internal medicine residents. With recent changes in graduate medical education program directors and internal medicine residents are seeking evidence to guide decisions regarding residency elective choices. Prior studies have shown that formalized elective curricula improve subspecialty ABIM-CE scores. The primary aim of this study was to evaluate whether the number of subspecialty elective exposures or the specific subspecialties which residents complete electives in impact ABIM-CE scores. Methods ABIM-CE scores, elective exposures and demographic characteristics were collected for MedStar Georgetown University Hospital internal medicine residents who were first-time takers of the ABIM-CE in 2006–2010 (n=152). Elective exposures were defined as a two-week period assigned to the respective subspecialty. ABIM-CE score was analyzed using the difference between the ABIM-CE score and the standardized passing score (delta-SPS). Subspecialty scores were analyzed using percentage of correct responses. Data was analyzed using GraphPad Prism version 5.00 for Windows. Results Paired elective exposure and ABIM-CE scores were available in 131 residents. There was no linear correlation between ABIM-CE mean delta-SPS and the total number of electives or the number of unique elective exposures. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures (143.4 compared to 129.7, p=0.051). Repeated electives in individual subspecialties were not associated with significant difference in mean ABIM-CE delta-SPS. Conclusions This study did not demonstrate significant positive associations between individual subspecialty elective exposures and ABIM-CE mean delta-SPS score. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures suggesting there may be an “ideal” number of elective exposures that supports improved ABIM-CE performance. Repeated elective exposures in an individual specialty did not correlate with overall or subspecialty ABIM-CE performance.</p

HIV testing in patients who are HCV positive: Compliance with CDC guidelines in a large healthcare system.

BackgroundThere are approximately 300,000 people in the United States who are co-infected with HIV and HCV. Several organizations recommend that individuals who are HCV infected, as well as persons over the age of 13, should be HIV tested. Comorbidities associated with HCV can be reduced with early identification of HIV. Our objective was to determine whether providers routinely followed HIV testing guidelines for patients who tested HCV positive (HCV+).MethodsA retrospective chart review was conducted of all patients in primary care at an academic health system from 7/2015-3/2017 who tested HCV+. As part of a primary database, HCV testing data was collected; HIV testing data was abstracted manually. We collected and described the intervals between HCV and HIV tests. To determine associations with HIV testing univariable and multivariable analyses were performed.ResultsWe identified 445 patients who tested HCV+: 56.6% were tested for HIV, the mean age was 57 ± 10.9 years, 77% were from the Birth Cohort born 1945-1965 (BC); 61% were male; and 51% were Black/AA. Patients in the BC were more likely to be HIV tested if they were: male (p = 0.019), Black/AA (pConclusionAs demonstrated, providers did not routinely follow CDC recommendations as almost half of the HCV+ patients were not correctly tested for HIV. It is important to emphasize that six persons were tested HIV positive simultaneously with their HCV+ diagnosis. If providers did not follow the CDC guidelines, then these patients may not have been identified. Improvements in EHR clinical decision support tools and provider education can help improve the HIV testing rate among individuals who are HCV+

Leveraging the electronic health record to eliminate hepatitis C: Screening in a large integrated healthcare system.

Highly efficacious and tolerable treatments that cure hepatitis C viral (HCV) infection exist today, increasing the feasibility of disease elimination. However, large healthcare systems may not be fully prepared for supporting recommended actions due to knowledge gaps, inadequate infrastructure and uninformed policy direction. Additionally, the HCV cascade of care is complex, with many embedded barriers, and a significant number of patients do not progress through the cascade and are thus not cured. The aim of this retrospective cohort study was to evaluate a large healthcare system's HCV screening rates, linkage to care efficiency, and provider testing preferences. Patients born during 1945-1965, not previously HCV positive or tested from within the Electronic Health Record (EHR), were identified given that three-quarters of HCV-infected persons in the United States are from this Birth Cohort (BC). In building this HCV testing EHR prompt, non-Birth Cohort patients were excluded as HCV-specific risk factors identifying this population were not usually captured in searchable, structured data fields. Once completed, the BC prompt was released to primary care locations. From July 2015 through December 2016, 11.5% of eligible patients (n = 9,304/80,556) were HCV antibody tested (anti-HCV), 3.8% (353/9,304) anti-HCV positive, 98.1% (n = 311/317) HCV RNA tested, 59.8% (n = 186/311) HCV RNA positive, 86.6% (161/186) referred and 76.4% (n = 123/161) seen by a specialist, and 34.1% (n = 42/123) cured of their HCV. Results from the middle stages of the cascade in this large healthcare system are encouraging; however, entry into the cascade-HCV testing-was performed for only 11% of the birth cohort, and the endpoint-HCV cure-accounted for only 22% of all infected. Action is needed to align current practice with recommendations for HCV testing and treatment given that these are significant barriers toward elimination