Nurses' Expectations of an Inpatient Portal for Hospitalized Patients and Caregivers.

BACKGROUND: Patient portals are intended to engage patients and enhance patient-centered care. Recent studies suggest that the information within portals could provide benefits to patients and their caregivers during hospitalization; however, few studies have examined nurse and staff expectations of portals when used in the hospital setting. OBJECTIVE: This article examines inpatient nurse and support staff expectations of a commercially available inpatient portal prior to its hospital-wide implementation. METHODS: In this cross-sectional study, nurses and support staff were surveyed 1 month prior to the implementation of an inpatient portal for patients. Items included respondent characteristics, satisfaction with online inpatient portal training, expectations of the effects of portal use on patients, caregivers, and staff, overall acceptance, and barriers to its implementation. RESULTS: Of 881 respondents, 73.0% were staff nurses, 18.4% nurse assistants, 4.3% unit coordinators, and 1.2% nurse managers. Respondents were generally satisfied with the portal information they received from online training. A majority liked the portal to some extent prior to its use (66.7%); however, they noted multiple implementation barriers, including: tablets would get lost/damaged (66.2% of respondents), patients and/or caregivers would have too many questions (48.5%), and staff would have problems integrating it into their workflow (44.7%). Respondents working on medical units had higher expectations (p < 0.001) and acceptance (p < 0.01) of the portal than those on surgical and intensive care units. Nurse managers were more positive than respondents with other job roles were (all p < 0.001). CONCLUSION: Overall, nurse and support staff had high expectations of the effects of inpatient portal use prior to its hospital-wide implementation. They thought it would benefit patients and/or their caregivers; however, they also perceived several barriers to its implementation. These results will be used in conjunction with patient and caregiver perspectives to inform future efforts to evaluate and improve upon inpatient portal implementation and dissemination across health systems.

Supporting nurse manager certification.

Professional certification is desirable for nursing staff and leaders to demonstrate high levels of knowledge and expertise. Nurse managers can be role models for staff by attaining certification. The organization highlighted in this article developed a process that included an in-house nurse manager certification review course resulting in increased certification rates from 33% to 50% for nurse managers in a 14-month period.

Outcomes of liver transplantation for glycogen storage disease: a matched-control study and a review of literature.

BACKGROUND: The clinical characteristics and outcomes of patients with glycogen storage disease (GSD) who undergo liver transplantation (LT) have not been well defined. In this study, our objective was to determine the outcome of LT in patients with GSD and compare it with a comparable group of patients without GSD (matched controls). METHODS: UNOS data from 1986 to 2007 were used for this study. For each GSD patient (n = 95; men 62%) who was transplanted, three patients (n = 285, men 60%) without GSD (case controls) matched for age ± five yr, year of transplantation and donor risk index (DRI) ± 0.2 were identified from the UNOS database in a random manner. Unadjusted patient survival was determined by Kaplan-Meier survival analysis and significance determined by log-rank test. RESULTS: The mean age of the group was 17.9 yr. GSD patients had lower BMI (22 vs. 24, p = 0.002), lower serum bilirubin (2.7 vs. 13.5 mg/dL, p < 0.0001), higher serum albumin (3.7 vs. 3.1 g/dL, p < 0.0001), and higher wait-list time (239 vs. 74 d, p < 0.0001) compared to case controls. Recipient age and DRI were similar between the groups. Tumors were more common in GSD group (13.7% vs. 5%). Patient survival was significantly better (p = 0.024) in GSD group at one, five, and 10 yr (82%, 76%, and 64%) than non-GSD (73%, 65%, and 59%) group. CONCLUSIONS: In this matched-control study, patients who underwent LT for GSD had a better long-term survival than a comparable group of patients without GSD.

Test-retest reliability and validity of the 400-meter walk test in healthy, middle-aged women.

BACKGROUND: The 400 m walk test has been used in older adults; however, the applicability in middle-aged populations is unknown. METHODS: Data were obtained from the Evaluation of Physical Activity Measures in Middle-Aged Women (PAW) Study and included 66 women (52.6 ± 5.4 years). Participants were instructed to walk at a brisk, maintainable pace; time taken to complete the 400 m was recorded in seconds. Intraclass correlation coefficients (ICC) were used to assess test-retest reliability. Spearman rank order correlation coefficients were used to examine the concurrent validity of the walk test with cardiorespiratory fitness and associations with physical activity, body composition, flexibility, static balance, and muscular fitness, adjusted for age and body mass index. RESULTS: Participants completed the walk at visits 4 and 5 in 248.0 and 245.0 seconds, respectively. The walk test had excellent reproducibility [ICC = 0.95 (95% CI: 0.92, 0.97)] and was significantly associated with estimated (ρ = -0.43; P < 0.0001) and measured (ρ = -0.56; P < 0.001) VO2max. The walk test was also significantly related to physical activity, body composition, flexibility, and balance. CONCLUSIONS: These findings support the utility of the 400 m walk test to estimate cardiorespiratory fitness and reflect free-living physical activity in healthy, middle-aged women.

Insulin resistance and microalbuminuria are associated with microvascular disease in patients with cirrhosis.

Cardiovascular (CV) disease has a significant impact on post-liver transplantation (LT) survival. Finding surrogate markers for occult CV disease would improve CV assessment in the LT evaluation. This study was designed to determine the prevalence of microvascular disease (MVD) and the utility of both microalbuminuria and the homeostatic model for insulin resistance (HOMA-IR) for assessing the presence of MVD in potential LT recipients. In this study, we examined the prevalence of MVD in 72 diabetics and 71 nondiabetics; both groups were matched for age, sex, race, and etiology of cirrhosis while awaiting LT. We prospectively collected data including fasting serum insulin and glucose levels, urine creatinine and microalbumin, and macrovascular and microvascular complications. MVD was present in 58 (40.5%) patients; MVD was more common in diabetics (n = 45, 62.5%) than nondiabetics (n = 13, 18.3%). The presence of diabetes mellitus (DM; P = 0.03), insulin use (P = 0.002), and duration (months) of DM (85.3 +/- 96.1 versus 22.1 +/- 46.3, P < 0.0001), hypertension (51.3 +/- 101.5 versus 22.7 +/- 58.2, P = 0.03), and hypertriglyceridemia (7.2 +/- 17.4 versus 3.8 +/- 18.5, P = 0.04) were associated with MVD. Significant microalbuminuria had a sensitivity of 85%, a specificity of 100%, and a positive predictive value of 100% for the presence of MVD. HOMA-IR also was associated with MVD (P = 0.0001). In conclusion, at our center, 62.5% of DM patients and 18% of non-DM patients awaiting LT have MVD. Patients with DM, significant microalbuminuria, or an elevated HOMA-IR should undergo rigorous CV assessment prior to LT.

Cardiac resynchronization therapy: left or left-and-right for optimal symptomatic effect--the LOLA ROSE study.

AIMS: Biventricular (BiV) pacing and left univentricular (LUV) pacing can each produce clinical benefits in heart failure. The impact of modern refinements in pacing optimization on the relative benefits of these two modes is unknown. We aimed to compare these two modes in patients with heart failure, using Echo-based optimization of each pacing mode. METHODS AND RESULTS: Paired data were collected on 18 patients (age 72 +/- 8 years; 16 male) with refractory heart failure symptoms, sinus rhythm, and LBBB with QRS duration>120 ms. Patients were randomized to an initial 8 weeks of either BiV or LUV pacing, followed by 8 weeks of the other mode, in a blinded cross-over design. Echocardiography was used to optimize atrioventricular delay for both modes and right ventricular-left ventricular offset for BiV mode. Peak oxygen consumption (baseline 13.6 +/- 2.7; BiV 15.8 +/- 3.0; LUV 15.2 +/- 3.1 mL/kg/min), 6 min walk distance (baseline 258 +/- 47; BiV 290 +/- 63; LUV 287 +/- 69 m), and scores on SF36 health questionnaire (baseline 41.5 +/- 16.8; BiV 58.6 +/- 19.6; LUV 51.8 +/- 21.3) did not differ between BiV and LUV modes. New York Heart Association class was significantly better in BiV than in LUV mode (P < 0.01). CONCLUSION: In this pilot study, we found no differences in major clinical outcome measures between the two modes of resynchronization.

Analysis of treatment delivery errors in brachytherapy using formal risk analysis techniques.

PURPOSE: To identify hazardous situations in treatments, analyze the nature of errors committed, and assess the value of several analysis techniques. MATERIALS AND METHODS: The study applied several risk analysis techniques to brachytherapy events (misadministrations) reported to the U.S. Nuclear Regulatory Commission and the International Atomic Energy Agency. RESULTS: (1) Events usually have multiple causes. (2) Failure to consider human performance in the design of equipment led to a large fraction of the events. (3) Verification procedures often were ineffectual. (4) Many events followed the failure of persons involved to detect that the situation was abnormal, often even though many indications pointed to that fact. Once the event was identified, the response often included actions appropriate for normal conditions, but inappropriate for the conditions of the event. (5) Events tended to happen most with actions having the least time available. (6) Lack of training and procedures covering unusual conditions frequently contributed to events. (7) New procedures or new persons joining a case in the middle present increased hazards. CONCLUSIONS: Risk analysis tools common in industry provide useful information for error reduction in medical settings, although not as effectively, and modification of such techniques could improve their efficacy.