This document summarizes three studies that evaluated the effectiveness of repositioning schedules for preventing pressure ulcers in hospitalized patients. A systematic review by Gillespie et al. found insufficient evidence from three randomized controlled trials to determine whether particular repositioning positions or frequencies reduced pressure ulcer development. A study by Bergquist-Beringer et al. found that patients who were routinely repositioned every 24 hours had a 14% lower risk of pressure ulcers. A systematic review by Moore et al. did not identify any randomized controlled trials comparing different repositioning techniques or frequencies.
Clinical prediction rule in spinal painNityal Kumar
This lecture is on spinal pain and the clinical methods used in treating the pain. Clinical prediction rules is a research method done systematically describing when to use which method of treatment approach
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after ab...Takehiko Ito
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after abdominal surgery: A questionnaire survey. The 1st International Nursing Research Conference of World Academy of Nursing Science, Kobe: Program & Abstracts, 235.
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving sw...Veera Bagu
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving swallowing ability among Cerebrovascular Accident patients with dysphagia at selected Hospital, Erode
Clinical prediction rule in spinal painNityal Kumar
This lecture is on spinal pain and the clinical methods used in treating the pain. Clinical prediction rules is a research method done systematically describing when to use which method of treatment approach
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after ab...Takehiko Ito
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after abdominal surgery: A questionnaire survey. The 1st International Nursing Research Conference of World Academy of Nursing Science, Kobe: Program & Abstracts, 235.
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving sw...Veera Bagu
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving swallowing ability among Cerebrovascular Accident patients with dysphagia at selected Hospital, Erode
A very vital article that briefly and nicely describes how shpuld evidence be handled in order to evaluate it and make use of the information provided.
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
A very vital article that briefly and nicely describes how shpuld evidence be handled in order to evaluate it and make use of the information provided.
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
Contents lists available at ScienceDirectApplied Nursing RAlleneMcclendon878
Contents lists available at ScienceDirect
Applied Nursing Research
journal homepage: www.elsevier.com/locate/apnr
Original article
Optimize patient outcomes among females undergoing gynecological
surgery: A randomized controlled trial
Kari Johnson (PhD, RN, ACNS-BC, Hartford Scholar)⁎, Sherry Razo (M.A.-L., BSN, RN, NEA-BC),
Jeannie Smith (BSN, CMSRN), Alex Cain (RN), Kathi Soper (BSN, RN-BC)
Honor Health Thompson Peak Medical Center, 7400 E. Thompson Peak Parkway, Scottsdale, AZ 85255, United States
A R T I C L E I N F O
Keywords:
Gynecological surgery
Enhanced Recovery After Surgery (ERAS)
Hysterectomy
Bundle components
Institute of Healthcare Improvement
Length of stay
30 day readmission
Patient satisfaction
Randomized controlled trial
A B S T R A C T
Background: Optimizing early education in gynecological procedures utilizing an Enhanced Recovery after
Surgery (ERAS) program and a bundle concept may optimize patient outcomes after surgery.
Purpose: Evaluate whether an ERAS bundle compared to standard education can affect length of stay, 30 day
readmission, and patient satisfaction among patients undergoing gynecologic surgery.
Design: Prospective, comparative, randomized design
Setting: 28 bed Medical Surgical Unit
Sample/Intervention: 50 patients undergoing hysterectomy, 25 who received post-operative evidence based
bundle/standard education, and 25 who received standard education packet. Bundle components included 1)
early mobilization, 2) early transition to oral pain medication, 3) early feeding, and 4) chewing gum. A follow-up
phone call was made in two to three days following discharge for both groups utilizing teach-back.
Results: 84% (n = 21) patients in the bundle group were discharged in one day. There were no 30 day read-
missions for both groups. Twenty two (88%) participants met the bundle components 100% of the time. For the
indicator “walking helped with recovery” 100% (n = 25) responded “very good to excellent” for bundle group
and 96% (n = 24) responded “very good to excellent” for standard group. Twenty three (92%) of the bundle
group felt that that overall nursing care received was very good to excellent and 24 (96%) of the general group
felt that overall nursing care received was very good to excellent.
Conclusion: Optimizing peri-operative education using a bundle approach to provide evidence based interven-
tions can minimize risk and enhance early recovery for females undergoing gynecological surgery.
1. Introduction
A hysterectomy is a common gynecological surgical procedure with
minimally invasive methods including vaginal or laparoscopic proce-
dures. Studies have shown that preoperative patient education can
improve patient outcomes after surgery, including reduced length of
hospital stay, decreased post-operative complications, and increased
patient satisfaction with the surgical experience (Modesitt et al., 2016;
Steiner & Strand, 2017; Wijk, Franzen, Ljungqvist, & Nilsson, 2014).
Enhanced recovery p ...
Nursing Evidence Based Practice PPT for BSN Nurses.
This ppt assess effectiveness of using NPWT for DFUs with providing highest level of evidence. DFUs are a prevalent issue in many countries and is treated via dressings which take a long time to heal but utilizing this method will certainly make the recovery faster.
Alt PDFThe Journal of the CanadianChiropractic Associati.docxdaniahendric
Alt PDF
The Journal of the Canadian
Chiropractic Association
The Canadian Chiropractic Association
What is your research question?
An introduction to the PICOT
format for clinicians
John J. Riva, BA, DC, Keshena M.P. Malik, BSc,
DC, [...], and Jason W. Busse, DC, PhD
Additional article information
Introduction
Clinicians often witness impressive treatment
results in practice and may wish to pursue
research to formally explore their anecdotal
experiences. The potential to further new
knowledge both within the profession and to the
greater healthcare system is compelling. An
obvious next step for a practitioner considering
research is to connect with experienced
researchers to convey their idea for a study, who
may in turn ask, “What is your research
question?” With limited understanding of how to
respond, this interaction may result in the first
and last experience these clinicians will have with
the research community.
It has been estimated that between 1% and 7% of
the chiropractic profession in Canada is engaged
in research. Arguably, this low engagement
could be the result of practitioners’ perceived
importance of research and levels of research
literacy and capacity. However, increasing
demands for evidence-based approaches across
the health system puts pressure on all clinicians to
base their decisions on the best available
scientific evidence. Lack of clinician
representation in research has the probable effect
of limiting growth and new developments for the
profession. Furthermore, lack of clinician
involvement in research complicates the transfer
of study findings into practical settings.
The Canadian Institutes of Health Research
describes integrated knowledge translation as a
process that involves collaboration between
researchers and knowledge users at all stages of a
research project. This necessitates involvement
of clinicians to help in forming a research
question, interpreting the results, and moving
research findings into practice. This shared effort
between clinicians and researchers increases the
likelihood that research initiatives will be relevant
to practice. Conversely, it has been reported that
there is a growing communication gap between
clinicians and academics in chiropractic.
Clinicians have important practice-related
questions to ask, but many may lack the ability to
map out their research strategy, specifically in
communicating their question in a manner
required to develop a research protocol.
David L. Sackett, Officer of the Order of Canada
and the founding Chair of Canada’s first
Department of Clinical Epidemiology &
Biostatistics at McMaster University, highlights
the importance of mapping one’s research
strategy in exploration of the research question:
“one-third of a trial’s time between the germ of
your idea and its publication in the New England
Journal of Medicine should be spent fighting
about the research question.” (personal
communicat ...
Traditionally, physicians recruited clinical trial subjects, but pharmaceutical companies have become ever more involved through centralized campaigns. Physicians are vital to a trial and the pharmaceutical effort helps shift some of the recruitment demands away from the site to allow them to focus on the subjects. Thus, it is practical to understand if different recruitment methods could change or skew the study population. This study determines if differences or similarities occurred between subjects recruited by physicians and pharmaceutical companies. It discovered that some of both occurred. The pharmaceutical company efforts helped recruit potential subjects from the general population that were similar to subjects recruited by the physicians, but this particular campaign was limited by language which affected recruitment of Hispanic subjects. The social impact of this study provides insight about pharmaceutical company recruitment. Since the National Library of Medicine has indicated that clinical trials should reflect the broader diseased population, the efforts of the pharmaceutical company can help support the physicians’ efforts by recruiting from the broader population. Together, both efforts can create a global good by allowing the trial to reflect the population of post-approval use. These findings still raise a question about the proper balance between the two recruitment groups so that the intended characteristics of the diseased population are maintained. Because differences between physician and pharmaceutical recruited subjects can exist, the potential of one group to bias the trial results exist. As such, some analysis by recruitment method can help ensure that variations in the study population are minimal without skewing the data to create positive study results.
Beyond Randomized Clinical Trials: emerging innovations in reasoning about he...jodischneider
Talk at the 3rd European Conference on Argumentation
ABSTRACT: Specialized fields may at any time invent new inference rules—that is, new warrants—to improve on their stock of resources for drawing and defending conclusions. Yet disagreement over the acceptability of an invented warrant can always be re-opened. Randomized Clinical Trial is widely regarded as the gold standard for making inferences about causal relationships between medical treatments and patient outcomes. Once controversial, RCT achieved broad acceptance within the field as a result of warrant-establishing arguments circulating in the medical literature starting in the 1950s. And RCT has accumulated a very impressive track record of generating new conclusions that withstand critical scrutiny.
Here we look at two emerging innovations whose purpose is to support reasoning about health, offering ways to generate different classes of conclusions. These innovations could be seen as complementary to RCTs, but for both there are also hints of challenge to the enormous prestige of RCTs. We see this most particularly in the gap that has developed between the RCT-generated fact base and the decisions doctors and health policy officials have to make about treatments for patients. We’ve mentioned before that specialized inference methods that become stabilized within an expert community can meet unexpected challenges when they become components of reasoning by other communities. The two innovations considered here each allow us to explore the tensions that arise from the contrasting perspectives of scientists, clinicians, and patients.
Brough et al perspectives on the effects and mechanisms of CST a qualitative ...
NYP EBP Cohort 8 Under Pressure
1. Under Pressure
Christopher Boroanka, BSN, RN; Chamir N. Chouloute, BSN, RN;
Meagan Groneman, BSN, RN; Iris Robles, BSN, RN
Problem Identification
Background
• Hospital-Acquired Pressure Ulcers
(HAPUs) are a known problem in acute
care facilities in the United States.
HAPUs reduce the patient quality of life,
are associated with higher in-hospital
mortality and ”contributed $1.99 billion
in excess health care costs for
Medicare patients between 2007 and
2009” (Bergquist-Beringer, Dong, He,
Dunton, 2013).
• Optimal turning frequencies must take
into account negative consequences of
frequent repositioning for patients, staff,
and healthcare (Gillespie BM, Chaboyer
WP, McInnes E, Kent B, Whitty JA,
Thalib L., 2014).
Clinical Question
Among elderly patients in an acute
care medical-surgical setting, is
repositioning every two hours more
effective than longer periods of time
when attempting to decrease the
incidence of pressure ulcers (PU)
during a patients stay?
Current NYP Practice
• NewYork-Presbyterian Hospital
(10/2015) states the RN “will implement
turning schedule, at least every 2 hours
while in bed/stretcher for all patients
found at risk. Patients will be
repositioned every 1 hour while in
chair, if unable to shift weight
independently.”
Evidence Review
• Although, there is no clear evidence
that supports the impact of
repositioning to reduce or prevent
pressure ulcers it does not mean that
repositioning is ineffective (Gillespie
et al.,2014).
• Bergquist-Beringer et al. (2013)
Gathered data from 1,419 NDNQI
participating hospitals and used a
hierarchical logistic regression
analysis to identify variables
associated with hospital acquired
pressure ulcer.
• Moore et al. (2012) conducted a
review to clarify the role of
repositioning in the management of
patients with pressure ulcers. RCTs
and CCTs that compared
repositioning with no repositioning,
different repositioning techniques and
frequencies were considered in the
review. The study found that there is
a lack of well-designed controlled
trials examining the effects of
repositioning.
Appraise Evidence
• Gillespie et al.(2014):
• Strengths: Authors found that all
three studies reported the proportion
of patients developing PU of any
grade, stage or category.
• Limitations of the studies were that
none the trials reported on pain, or
quality of life, and only one reported
on cost. All three trials were at high
risk of bias.
• Bergquist-Beringer et al. (2013):
• Strengths: The study used
information collected over a full year
which allowed for a complete
database. Meta analysis allows for
variable aspects to be taken into
consideration simultaneously.
• Limitations: Only NDNQI
participating hospitals were used in
this sample. Also there was a
disproportionate amount of Magnet
hospitals represented in this sample
in comparative to the national
average. Future studies could
include a wider variety of hospital
types.
• Moore et al. (2012):
• Strengths: The article that was
reviewed is a systematic review. The
review had a thorough plan to
extract and summarize the studies
and included multiple assessment
tools, expert advice, and explored
unpublished studies.
• Limitations: The authors declare that
every attempt was made to identify
all relevant studies but acknowledge
that it was possible to miss eligible
studies though highly unlikely.
Recommendations
• Moore et al. (2012) suggests that a
cluster-randomized study should be
conducted to validate the role of
repositioning in the healing of pressure
ulcers. Cluster-randomized focuses on
units rather than individual patients.
• Berquist-Beringer et al. (2013)
suggests that each variable they
studied should be looked at in more
detail to determine the impact on
pressure ulcer prevention.
Next Steps
• Consult with Nursing Research & EBP
Committee to conduct Randomized
Controlled Trials (RCTs) with clustered
randomization of units across all NYP
campuses to examine relationship
between repositioning interval and
HAPUs (2, 3 and 4 hour turning or
combination of).
• Increase frequency of Skin Care
Resource Nurse Program seminar and
make attendance mandatory for all new
nurses and aides on Med-Surg units.
References
NewYork-Presbyterian Hospital. (10/2015). Pressure Ulcer
Management, PROT 1860. Unpublished internal document.
Bergquist-Beringer, S. Dong, Dunton, N. He, J. (2013) Pressure
Ulcers and Prevention Among Acute Care Hospitals in the
United States. The Joint Commission Journal on Quality and
Patient Safety. Volume 39 Number 9.
Gillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA,
Thalib L. Repositioning for pressure ulcer prevention in adults.
Cochrane Database of Systematic Reviews 2014, Issue 4. Art.
No.:CD009958. DOI: 10.1002/14651858.CD009958.pub2.
Moore, Z.E. & Cowman, S. (2012). Repositioning for treating
pressure ulcers. Cochrane Database of Systematic Reviews, 9.
doi:10.1002/14651858. CD006898.pub3.
For more information, please contact: Christopher Boroanka (chb9157@nyp.org), Chamir N. Chouloute (cnc9017@nyp.org), Meagan Groneman (meg9072@nyp.org), Iris Robles (irr9016@nyp.org).
2. Under Pressure
Christopher Boroanka, BSN, RN; Chamir N. Chouloute, BSN, RN;
Meagan Groneman, BSN, RN; Iris Robles, BSN, RN
Research Article/
Author(s)/Year
Methods Results
Level of
Evidence
Gillespie BM, Chaboyer WP,
McInnes E, Kent B, Whitty JA,
Thalib L. Repositioning for
pressure ulcer prevention in
adults. Cochrane Database of
Systematic Reviews 2014, Issue
4. Art. No.: CD00995
The method used for this systemic review were databases to identify
reports of the relevant controlled trials: the Cochrane Wounds Group
Specialized Register ( searched 06 September 2013), the Cochrane
Central Register of Controlled Trials (Central )(2013, issue 8); Ovid
Medline (1948 to August, Week 4, 2013), OVIDE EMBASE(1974 to
2013,Week 35.); EBESCO CINAHL (1982 to August 30,2013; and
reference sections of studies that were included in the review. The
selection criteria used were Randomized Control Trials(RCT's),
Published or unpublished, that assessed the effects of any positioning
schedule or different patient positions and measured PU incidence in
adults in any setting.
This systemic review looked at three RCTs and one economic
study representing 502 randomized participants from acute and
long term care settings. Two of the trials compared the 30
degree and 90 degree tilt using similar
repositioning frequencies. The third RCT trial compared
alternative repositioning between 2-hourly and 3-hourly
repositioning on standard hospital mattress versus the 4-hourly
and 6-hourly repositioning on viscoelastic foam
mattresses. The economic study was looking at cost effective
analysis using data from one of the included parallel RCTs
compared 3-hourlyrepositioning using the 30 degree tilt
overnight with standard care consisting of 6 hour repositioning
using the 90 degree lateral rotation overnight. After analyzing
all three studies the conclusion was that there was not enough
evidence to support the use of repositioning to prevent pressure
ulcers. It is also unknown if particular positions or
frequencies of repositioning reduce pressure ulcer
development.
Level I: Systematic
Reviews and Meta-
Analysis
Bergquist-Beringer, S. Dong,
Dunton, N. He, J. (2013) Pressure
Ulcers and Prevention Among
Acute Care Hospitals in the
United States. The Joint
Commission Journal on Quality
and Patient Safety. Volume 39
Number 9.
This systemic review looked at three RCTs and one economic study
representing 502 randomized participants from acute and long term
care settings. Two of the trials compared the 30 degree and 90 degree
tilt using similar repositioning frequencies. The third RCT trial
compared alternative repositioning between 2-hourly and 3-hourly
repositioning on standard hospital mattress versus the 4-hourly and 6-
hourly repositioning on viscoelastic foam mattresses. The economic
study was looking at cost effective analysis using data from one of the
included parallel RCTs compared 3-hourlyrepositioning using the 30
degree tilt overnight with standard care consisting of 6 hour
repositioning using the 90 degree lateral rotation overnight. After
analyzing all three studies the conclusion was that there was not
enough evidence to support the use of repositioning to prevent
pressure ulcers. It is also unknown if particular positions or
frequencies of repositioning reduce pressure ulcer development.
The study of 710,626, 40%(282,500) of patients were
considered high-risk for pressure ulcers which was determined
by their last Braden score. Within this group 75% of the patients
were repositioned routinely within the last 24 hours. The
surveyors found that a failure to routinely reposition a patient
resulted in a 14% greater likelihood of acquiring a pressure
ulcer in a hospital setting. Level I: Systematic
Reviews and Meta-
Analysis
Moore, Z.E. & Cowman, S.
(2012). Repositioning for treating
pressure ulcers. Cochrane
Database of Systematic Reviews,
9. doi:10.1002/14651858.
CD006898.pub3
A collection of Randomized Controlled Trials and Controlled clinical
trials comparing repositioning with no repositioning, repositioning
techniques and repositioning frequencies were considered for the
systematic review. The participates of the review involved people of
any age, in any healthcare setting with existing pressure ulcers. The
following databases where searched: Cochrane Wounds Group
Specialized Register; The Cochrane Central Register of Controlled
Trials; Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL from the
years 2012-2014 and data was collected and analyzed by two review
authors independently.
The searches identified 362 citations. Following independent
review of the titles and abstracts of the citations by two review
authors, no papers met the inclusion criteria. No eligible studies
randomized controlled or controlled clinical trials were
identified. The use of repositioning is an integral part of
pressure ulcer prevention and management however little
evidence exists to base clinical decisions. There is no RCT
evidence that addresses the question of whether repositioning
patients improves the healing rates of pressure ulcers.
Level I: Systematic
Reviews and Meta-
Analysis
For more information, please contact: Christopher Boroanka (chb9157@nyp.org), Chamir N. Chouloute (cnc9017@nyp.org), Meagan Groneman (meg9072@nyp.org), Iris Robles (irr9016@nyp.org).