The Effects of Music Intervention on Pain and Anxiety in the Immediate Postoperative Period in Adults Undergoing Total Knee Arthroplastyand Total Hip Arthroplasty

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Introducing the Clinically Aligned Pain Assessment

Introduction: The Clinically Aligned Pain Assessment (CAPA) is an innovative way of assessing pain by engaging patients in a brief conversation about their comfort, change in comfort, pain control, functionality, and sleep. Identification of the Problem: According to the Joint Commission (TJC) and the American Society for Pain Management Nursing (ASPMN) the use of the commonly used numeric rating scale (NRS) can lead to opioid overdose and ineffective treatment. Purpose of the Study: To compare post-surgical patients’ perceptions of the effectiveness of two pain assessment tools, CAPA and NRS. Methodology: An IRB approved, prospective observational study was conducted. Patients undergoing elective spinal surgery who stayed at least one night in the hospital (n=40) were included. Nurses trained in the use of CAPA, assessed patients’ pain levels first with CAPA then NRS. Patients completed a survey on discharge comparing their perception of CAPA and NRS. Results: Patient survey results show no significant difference between the numerical scale and the CAPA tool in ease of use by patients (p\u3e.05). In addition, there was no significant difference between patients perception of nurse response between the two tools, (p\u3e.05). However, there was a statistically significant difference in patient comfort level with the two tools. (p=.018) Discussion: CAPA, compared to NRS, was similarly easy for patients to use and similar in RN response.However, patients reported more comfort with use of CAPA. Changing a nurses’ longstanding practice and asking nurses on another department to cooperate with a research study were limitations to this study. Conclusion: CAPA shows promise as an alternative to simply having patients assign a number to a complex situation, like pain. Implications for Perianesthesia Nurses and Future Research: Patients emerging from anesthesia, often find the NRS difficult to use.Pain management standards for safe and effective pain management start with CAPA conversations, giving the nurse a way of documenting it. Future research to evaluate how CAPA effects pain management and patient/nurse satisfaction. To address the limitations of this study, a similar study is being conducted in our ambulatory setting. Preliminary findings will be available for discussio

Risk Factors for Readmission in Patients with Heart Failure

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Risk Factors for Readmission in Patients with Heart Failure

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A Day in the Life: A simulated experience

An experiential learning activity titled, A Day in the Life was implemented with nineteen baccalaureate nursing students in order to achieve a holistic understanding of the challenges faced by persons living with Schizophrenia and a physical disability, such as a fracture in an upper extremity or a visual impairment. The role play simulation required that students interact with public transportation and community resources, while assuming the role of a person with Schizophrenia and a physical disability. Using a qualitative descriptive methodology, reflective journals, aesthetic expressions, and post conference discussions about A Day in the Life were reviewed and analyzed by the authors. Two major themes were identified from the journal data: Changed Person, and Eye-Opening. Exemplars illustrating each theme are provided in the manuscript. Based on the results of this study, the authors believe that the role play simulation, A Day in the Life was effective in helping students to achieve a holistic understanding of the challenges faced by persons living with Schizophrenia and a physical disability. Further use of this experiential learning activity, with multi-method evaluation, along with short and long term follow-up is recommended

Enhancing Nurse-Led Rapid Response Teams (RRT) to Save Lives

https://digitalcommons.psjhealth.org/summit_all/1022/thumbnail.jp

Variation in contrast-associated acute kidney injury prophylaxis for percutaneous coronary intervention: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) program

BACKGROUND: Contrast-Associated Acute Kidney Injury (CA-AKI) is a serious complication associated with percutaneous coronary intervention (PCI). Patients with chronic kidney disease (CKD) have an elevated risk for developing this complication. Although CA-AKI prophylactic measures are available, the supporting literature is variable and inconsistent for periprocedural hydration and N-acetylcysteine (NAC), but is stronger for contrast minimization. METHODS: We assessed the prevalence and variability of CA-AKI prophylaxis among CKD patients undergoing PCI between October 2007 and September 2015 in any cardiac catheterization laboratory in the VA Healthcare System. Prophylaxis included periprocedural hydration with normal saline or sodium bicarbonate, NAC, and contrast minimization (contrast volume to glomerular filtration rate ratio ≤ 3). Multivariable hierarchical logistic regression models quantified site-specific prophylaxis variability. As secondary analyses, we also assessed CA-AKI prophylaxis measures in all PCI patients regardless of kidney function, periprocedural hydration in patients with comorbid CHF, and temporal trends in CA-AKI prophylaxis. RESULTS: From 2007 to 2015, 15,729 patients with CKD underwent PCI. 6928 (44.0%) received periprocedural hydration (practice-level median rate 45.3%, interquartile range (IQR) 35.5-56.7), 5107 (32.5%) received NAC (practice-level median rate 28.3%, IQR 22.8-36.9), and 4656 (36.0%) received contrast minimization (practice-level median rate 34.5, IQR 22.6-53.9). After adjustment for patient characteristics, there was significant site variability with a median odds ratio (MOR) of 1.80 (CI 1.56-2.08) for periprocedural hydration, 1.95 (CI 1.66-2.29) for periprocedural hydration or NAC, and 2.68 (CI 2.23-3.15) for contrast minimization. These trends were similar among all patients (with and without CKD) undergoing PCI. Among patients with comorbid CHF (n = 5893), 2629 (44.6%) received periprocedural hydration, and overall had less variability in hydration (MOR of 1.56 (CI 1.38-1.76)) compared to patients without comorbid CHF (1.89 (CI 1.65-2.18)). Temporal trend analysis showed a significant and clinically relevant decrease in NAC use (64.1% of cases in 2008 (N = 1059), 6.2% of cases in 2015 (N = 128, p = \u3c 0.0001)) and no significant change in contrast-minimization (p = 0.3907). CONCLUSIONS: Among patients with CKD undergoing PCI, there was low utilization and significant site-level variability for periprocedural hydration and NAC independent of patient-specific risk. This low utilization and high variability, however, was also present for contrast minimization, a well-established measure. These findings suggest that a standardized approach to CA-AKI prophylaxis, along with continued development of the evidence base, is needed

Bostonia: The Boston University Alumni Magazine. Volume 9

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Fibrosis, Connexin-43, and Conduction Abnormalities in the Brugada Syndrome.

BACKGROUND: The right ventricular outflow tract (RVOT) is acknowledged to be responsible for arrhythmogenesis in Brugada syndrome (BrS), but the pathophysiology remains controversial. OBJECTIVES: This study assessed the substrate underlying BrS at post-mortem and in vivo, and the role for open thoracotomy ablation. METHODS: Six whole hearts from male post-mortem cases of unexplained sudden death (mean age 23.2 years) with negative specialist cardiac autopsy and familial BrS were used and matched to 6 homograft control hearts by sex and age (within 3 years) by random risk set sampling. Cardiac autopsy sections from cases and control hearts were stained with picrosirius red for collagen. The RVOT was evaluated in detail, including immunofluorescent stain for connexin-43 (Cx43). Collagen and Cx43 were quantified digitally and compared. An in vivo study was undertaken on 6 consecutive BrS patients (mean age 39.8 years, all men) during epicardial RVOT ablation for arrhythmia via thoracotomy. Abnormal late and fractionated potentials indicative of slowed conduction were identified, and biopsies were taken before ablation. RESULTS: Collagen was increased in BrS autopsy cases compared with control hearts (odds ratio [OR]: 1.42; p = 0.026). Fibrosis was greatest in the RVOT (OR: 1.98; p = 0.003) and the epicardium (OR: 2.00; p = 0.001). The Cx43 signal was reduced in BrS RVOT (OR: 0.59; p = 0.001). Autopsy and in vivo RVOT samples identified epicardial and interstitial fibrosis. This was collocated with abnormal potentials in vivo that, when ablated, abolished the type 1 Brugada electrocardiogram without ventricular arrhythmia over 24.6 ± 9.7 months. CONCLUSIONS: BrS is associated with epicardial surface and interstitial fibrosis and reduced gap junction expression in the RVOT. This collocates to abnormal potentials, and their ablation abolishes the BrS phenotype and life-threatening arrhythmias. BrS is also associated with increased collagen throughout the heart. Abnormal myocardial structure and conduction are therefore responsible for BrS