IMPROVING VENOUS THROMBOEMBOLISM PROPHYLAXIS KNOWLEDGE AMONG REGISTERED NURSES ON A MEDICAL-SURGICAL INPATIENT UNIT IN THE MIDWEST

Venous thromboembolism (VTE) is the third most common vascular disease and includes approximately 900,000 cases annually in the United States. The purpose of this quality improvement project was to enhance education regarding VTE prophylaxis for registered nurses on a medical-surgical inpatient unit at a hospital in the Midwest. This study was initiated due to one nurse’s perception that staff on this unit lacked confidence and expertise on the importance of VTE prophylaxis interventions. Participants completed a VTE knowledge pretest, followed by an educational intervention on VTE prophylaxis utilizing Health Stream. After the intervention, participants completed a VTE knowledge post-test. The study had a total of 19 participants and good variability of demographic information. Based on the results, the null hypothesis was rejected. There was a statistically significant difference between the pretest and posttest means (t= -9.795, df=18,

Improving Venous Thromboembolism Prophylaxis Knowledge Among Registered Nurses on a Medical-Surgical Inpatient Unit in the Midwest

Venous thromboembolism (VTE) is the third most common vascular disease and includes approximately 900,000 cases annually in the United States. It is commonly a problem in critical care and surgical patients, although all patients are at risk of experiencing VTE. The purpose of this quality improvement project was to enhance education regarding VTE prophylaxis for registered nurses on a medical-surgical inpatient unit at a hospital in the Midwest. This study was initiated due to one nurse’s perception that staff on a medical-surgical unit in a hospital in the Midwest lacked confidence and expertise on the importance of VTE prophylaxis interventions. Participants completed a VTE knowledge pretest, followed by an educational intervention on VTE prophylaxis utilizing Health Stream. After the intervention, participants completed a VTE knowledge posttest. The study had a total of 19 participants and good variability of demographic information. Based on the results, the null hypothesis was rejected. There was a statistically significant difference between the pretest and posttest means (t= -9.795, df=18, p\u3c.001), which was less than the alpha value (p\u3c .05). The VTE educational intervention significantly increased the nurses’ knowledge about VTE prophylaxis. The nurses gained an average of 28.316% points on the posttest after completing the educational intervention. This supports the hypothesis that the educational intervention increased the nurses’ knowledge of VTE prophylaxis. It is imperative that nurses and the health care team recognize the risk and significance of VTE. More staff education regarding VTE prophylaxis can lead to better patient outcomes

Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review

BACKGROUND: Insomnia is common in primary care, can persist after co-morbid conditions are treated, and may require long-term medication treatment. A potential alternative to medications is cognitive behavioral therapy for insomnia (CBT-I). METHODS: In accordance with PRISMA guidelines, we systematically reviewed MEDLINE, EMBASE, the Cochrane Central Register, and PsycINFO for randomized controlled trials (RCTs) comparing CBT-I to any prescription or non-prescription medication in patients with primary or comorbid insomnia. Trials had to report quantitative sleep outcomes (e.g. sleep latency) in order to be included in the analysis. Extracted results included quantitative sleep outcomes, as well as psychological outcomes and adverse effects when available. Evidence base quality was assessed using GRADE. RESULTS: Five studies met criteria for analysis. Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while very low grade evidence suggests benzodiazepines are more effective in the short term. Very low grade evidence supports use of CBT-I to improve psychological outcomes. CONCLUSIONS: CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia

Endovascular aneurysm repair: treatment of choice for abdominal aortic aneurysm coincident with horseshoe kidney? three case reports and review of literature

AbstractThere is still controversy as to which surgical method is the most suitable for repair of abdominal aortic aneurysm with concomitant horseshoe kidney (AAA-HSK). We report three cases of AAA-HSK treated with endovascular aneurysm repair. In one of these patients we sacrificed the accessory renal artery by applying coils before the operation. Renal infarction, hypertension, or elevated serum creatinine level was not observed in any of our patients. If the blood supply to the kidneys is taken into consideration, endovascular aneurysm repair is our preferred surgical method for repair of AAA-HSK when anatomic conditions are suitable for stent-graft application and kidney function is normal

AHRQ series on complex intervention systematic reviews-paper 5: advanced analytic methods.

BACKGROUND AND OBJECTIVE: Advanced analytic methods for synthesizing evidence about complex interventions continue to be developed. In this paper, we emphasize that the specific research question posed in the review should be used as a guide for choosing the appropriate analytic method. METHODS: We present advanced analytic approaches that address four common questions that guide reviews of complex interventions: (1) How effective is the intervention? (2) For whom does the intervention work and in what contexts? (3) What happens when the intervention is implemented? and (4) What decisions are possible given the results of the synthesis? CONCLUSION: The analytic approaches presented in this paper are particularly useful when each primary study differs in components, mechanisms of action, context, implementation, timing, and many other domains

Influence of extracellular rnas, released by rheumatoid arthritis synovial fibroblasts, on their adhesive and invasive properties

© 2016 by The American Association of Immunologists, Inc.Extracellular RNA (exRNA) has been characterized as a molecular alarm signal upon cellular stress or tissue injury and to exert biological functions as a proinflammatory, prothrombotic, and vessel permeability-regulating factor. In this study, we investigated the contribution of exRNA and its antagonist RNase1 in a chronic inflammatory joint disease, rheumatoid arthritis (RA). Upon immunohistochemical inspection of RA, osteoarthritis (OA), and psoriatic arthritis synovium, exRNA was detectable only in the RA synovial lining layer, whereas extracellular DNAwas detectable in various areas of synovial tissue. In vitro, exRNA (150-5000 nt) was released by RA synovial fibroblasts (RASF) under hypoxic conditions but not under normoxia or TNF-A treatment. RNase activity was increased in synovial fluid from RA and OA patients compared with psoriatic arthritis patients, whereas RNase activity of RASF and OASF cultures was not altered by hypoxia. Reduction of exRNA by RNase1 treatment decreased adhesion of RASF to cartilage, but it had no influence on their cell proliferation or adhesion to endothelial cells. In vivo, treatment with RNase1 reduced RASF invasion into coimplanted cartilage in the SCID mouse model of RA. We also analyzed the expression of neuropilins in synovial tissue and SF, as they may interact with vascular endothelial growth factor signaling and exRNA. The data support the concepts that the exRNA/RNase1 system participates in RA pathophysiology and that RASF are influenced by exRNA in a prodestructive manner. The Journal of Immunology, 2016, 197: 2589-2597