Infection Prevention in Patients Receiving Continuous Renal Replacement Therapy through Proper Hemodialysis Line Care

The goal was to reduce Continuous Renal Replacement Therapy (CRRT)-related Central Line-Associated Bloodstream Infection (CLABSI) rates by introducing a just-in-time re-education toolkit for proper hemodialysis (HD) line care in adult Intensive Care Units (ICU). CRRT requires specialized expertise delivered in the ICU setting with the support of HD nurses. Problem-solving when cartridges clot or clog requires ICU nurses to return the blood and notify HD to restart therapy. Current evidence supports the use of white CurosTM caps and TegoTM connectors when deaccessing lines in order to prevent CLABSIs, air emboli, and bleeding. A learning needs assessment revealed inconsistent understanding and application of these specific connectors and caps, posing potential safety risks. For this performance improvement initiative, HD nurses collaborated with the ICUs to develop an education plan addressing proper HD line care in adult ICUs. First, information about HD line care, safety concerns, and re-education on evidence-based specialty connectors and caps were presented to multiple shared governance committees and key stakeholders. Education was reinforced by placing toolkits on all adult CRRT machines; including a laminated, educational quick reference card paired with the needed specialty connectors and caps. To support practice change, weekly audits with just-in-time education have been ongoing since project initiation. CRRT-related CLABSI rates per 1,000 CRRT patient days were calculated across adult ICUs. Pre-intervention rates were at a concerning high of 4.27 in July 2018 and paralleled the initial observation of inconsistent, unsafe practice. The intervention phase began with planning (August-September 2018), followed by the implementation (October 2018-January 2019) including initial education, toolkit construction, and weekly audits with just-in-time education. Post-intervention rates fell to 0 in February and March of 2019 and continue to show the minimal incidence of CRRT-related CLABSI events with a bump to 3.26 in April 2019 and return to 0 in May 2019, indicating successful integration into practice. Data continues to be collected and analyzed as it becomes available. The partnership between adult ICUs and HD nurses resulted in improved outcomes in patients receiving CRRT. Dissemination extended beyond the adult ICUs to create positive change at the organizational level through a reduction in CLABSI rates and enhanced staff education

Assessment of Nurse Behaviors that Influence Care and Maintenance of Pediatric Oncology Central Venous Catheters

Central venous catheters (CVC) are devices necessary to medically treat pediatric patients diagnosed with conditions such as cancer. Central line associated bloodstream infection (CLABSI) is a complication associated with utilizing a central line. Nurses are responsible for maintaining and complying with strict prevention protocols. The aims of this quality improvement project are to: (a) gain an understanding of perceptions of CLABSI prevention, (b) observe adherence to the CLABSI prevention bundle, (c) measure adherence to the current CLASBI prevention bundle (post-training), (d) identify ways to improve adherence to the CLASBI bundle, and (e) ascertain potential strategies for further compliance efforts. Three sources of data included (1) medical charts, (2) online survey, and (3) observation. The survey contained questions based on the Health Belief Model including (1) Perceived Susceptibility, (2) Perceived Severity, (3) Perceived Benefits, (4) Perceived Barriers, and (5) Self-Efficacy. Charts and observational data recorded the use of CLABSI prevention bundle components. Outcomes suggested that health beliefs were strong and noncompliance was likely not a result of questionable health beliefs. Adherence to the bundle components reported though medical record review (66%) and observation (90.9%) were compared. A one sample t-test estimated that the difference in compliance reported through records versus observation were highly significant (t=11.2, p \u3c 0.001) and suggest that lack of compliance may be due to factors other than health perceptions. Adherence between patients treated was also noted. Approximately half (48%) the respondents expressed interest in becoming a “champion”. Survey responses were compared by interest groups. These findings can be used to inform the implementation of CLABSI infection prevention efforts inclusive of supporting the use of “champions” respondent suggestions such as lowering the nurse-patient ratio and increasing family engagement

Conditioned taste aversion induced by motion is prevented by selective vagotomy in the rat

The role of the vagus nerve in motion-induced conditioned taste aversion (CTA) was studied in hooded rats. Animals with complete, selective gastric vagotomy failed to form conditioned taste aversion after multiple conditioning sessions in which the conditioned stimulus (a cider vinegar solution) was drunk immediately before a 30-min exposure to vertical axis rotation at 150 deg/s. Results are discussed with reference to the use of CTA as a measure of motion-induced 'sickness' or gastrointestinal disturbance, and because motion-induced CTA requires that both the vagus nerve and the vestibular apparatus be intact, in light of the possible convergence of vegal and vestibular functions

The utility of the mannitol challenge in the assessment of chronic cough: a pilot study

There is a need for more objective outcome measures for chronic cough. In this pilot study we sought to investigate the utility of the mannitol challenge as a cough-provocation test in non-asthmatic chronic cough. We studied 16 healthy controls and 13 subjects with chronic cough. We assessed cough severity using a visual analogue score, capsaicin cough sensitivity, health status using the Leicester Cough Questionnaire and the dose of mannitol to cause 2 (C2) or 5 (C5) coughs. In all of the subjects with chronic cough and 6 of the controls we assessed the 1-week repeatability of the mannitol challenge. We found that in those subjects with chronic cough the geometric mean (logSEM) mannitol C2 and C5 was heightened compared to controls (C2: 4 (0.2) versus 16 (0.1); p = 0.04 and C5: 63 (0.1) versus 251 (0.1); p = 0.04). Cough visual analogue score, capsacin-induced cough sensitivity and health status were also altered in chronic cough compared to healthy controls, but in those subjects with chronic cough none of these outcomes was correlated with the mannitol C2 or C5. The repeatability of the mannitol challenge assessed by intraclass correlation was C2 = 0.53 and C5 = 0.59. A cut-off in the dose of mannitol of 62 mg/ml for C2 and 550 mg/ml for C5 had a sensitivity of 69 and 62% and specificity of 69 and 81% respectively to distinguish chronic coughers from healthy controls. In conclusion, the mannitol challenge my have potential as a novel cough challenge test and further work is required to extend our findings and to assess whether it has utility in different causes of chronic cough

The Holly Bough service at Liverpool Cathedral and psychological type theory : fresh expressions or inherited church?

One of the key intentions of fresh expressions of church is to reach the kind of people inherited church find it hard to reach. Psychological type profiling of church congregations has demonstrated that Anglican churches have particular difficulty in reaching those whose Jungian judging preference is for thinking rather than for feeling. Studies that have explored the psychological type profile of participants within fresh expressions suggest that they do not significantly differ from inherited congregations in terms of reaching thinking types. Two previous studies, however, have reported higher proportions of thinking types attending cathedral carol services. The present study among 441 individuals attending the Holly Bough service in Liverpool Cathedral also found a higher proportion of thinking types among the participants. These findings suggest that cathedral carol services may be functioning as fresh expressions of church in a significant way

Tackling doping in sport : a call to take action on the dopogenic environment

Widespread allegations of doping in sport consistently make front page news. The findings of an independent commission for the WADA1 underscore the importance of moving beyond a focus on individual athletes to concurrently address individual, social and environmental factors in anti-doping policy and practice (socioecological perspective)

The science of cathedral studies : exploring the demographic profile, motivational intentions, and perceived impact among those attending the Holly Bough service in Liverpool Cathedral

The Holly Bough service is a unique pre-Christmas event, combining musical excellence and theological depth, crafted by the founding dean of Liverpool Cathedral in the early twentieth century for the Fourth Sunday of Advent. Located within the developing science of cathedral studies, this paper analyses the demographic profile, motivational intention (drawing on religious orientation theory) and perceived impact on spiritual wellbeing (drawing on Fisher’s four dimensional model) among 564 participants who completed a detailed survey at the service held in 2019. The data demonstrated a mix of ages, a sense of Anglican commitment to this form of event-belonging by those who return year-on-year and invite friends to join them, and a perceived beneficial impact on all four dimensions of spiritual wellbeing