RESUMO
The National Institutes of Health Clinical Center (NIH CC) is the largest hospital in the United States devoted entirely to clinical research, with a highly diverse spectrum of patients. Patient safety and clinical quality are major goals of the hospital, and therapy is often complicated by multiple cotherapies and comorbidities. To this end, we implemented a pharmacogenomics program in 2 phases. In the first phase, we implemented genotyping for HLA-A and HLA-B gene variations with clinical decision support (CDS) for abacavir, carbamazepine, and allopurinol. In the second phase, we implemented genotyping for drug-metabolizing enzymes and transporters: SLCO1B1 for CDS of simvastatin and TPMT for CDS of mercaptopurine, azathioprine, and thioguanine. The purpose of this review is to describe the implementation process, which involves clinical, laboratory, informatics, and policy decisions pertinent to the NIH CC.
Assuntos
Pesquisa Biomédica/organização & administração , National Institutes of Health (U.S.)/organização & administração , Farmacogenética/métodos , Sistemas de Apoio a Decisões Clínicas , Genótipo , Humanos , Informática Médica , Política Organizacional , Estados UnidosRESUMO
Nurses manage patients with common infectious diseases by following institutional guidelines based on expert advice, evidence in the literature, and a wealth of experience. Today nurses are challenged to provide care to patients with multidrug-resistant organisms and virulent infectious diseases such as Ebola virus disease. Management of some patients with virulent infectious diseases occurs in the context of minimal experience with the pathogen, course of infection, diagnostics, nursing care, and treatment. Limited evidence exists in the US or international literature about direct nursing care of patients with virulent infectious diseases in the community, clinic, or hospital. Workplaces may have insufficient supplies, equipment, and knowledge of the management of patients with these diseases. At the National Institutes of Health Clinical Center in Bethesda, Maryland, nursing education strategies for enhanced experiential learning are used to prepare staff to care for patients with virulent infectious diseases, especially Ebola virus disease.
Assuntos
Doenças Transmissíveis Emergentes/prevenção & controle , Surtos de Doenças , Pessoal de Saúde/educação , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/enfermagem , Prevenção Primária/educação , Feminino , Necessidades e Demandas de Serviços de Saúde , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Masculino , Saúde Ocupacional , Medição de Risco , Estados UnidosAssuntos
Acidentes por Quedas/prevenção & controle , National Institutes of Health (U.S.)/organização & administração , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Segurança do Paciente , Gestão da Segurança/organização & administração , Enfermagem Baseada em Evidências , Humanos , Pesquisa em Avaliação de Enfermagem , Projetos Piloto , Medição de Risco/métodos , Estados UnidosRESUMO
Sickle cell disease (SCD) is an illness that affects red blood cells. Patients with SCD can have chronic pain or acute pain episodes, which must be managed with medical therapy. Although many options are available for pain management, utilization of subcutaneous patient-controlled analgesia for pain management has positive outcomes for patients in both pain management and satisfaction.
Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Anemia Falciforme/enfermagem , Manejo da Dor/métodos , Analgesia Controlada pelo Paciente/instrumentação , Analgesia Controlada pelo Paciente/enfermagem , Humanos , Injeções Subcutâneas , Registros de EnfermagemRESUMO
Many diseases of the blood are treated with blood transfusion therapy. Chronic transfusions can cause iron overload, and, if untreated, can cause end-organ damage. Chelation therapy provides a way of treating iron overload and minimizing its adverse effects. Nurses need to understand that iron overload is a consequence of chronic blood transfusion, and they need to know what effects it has on end organs and what treatment options are available.