Indwelling Peritoneal Catheters for Managing Malignancy-Associated Ascites.

We investigated use of the tunnelled catheter in a large palliative population with malignancy-associated ascites employing retrospective analysis of a prospectively maintained patient database of tunnelled peritoneal catheter insertions for refractory malignancy-associated ascites or new rapidly accumulating ascites. We found that a 100 percent procedural success rate was achieved with 395 tunnelled catheters inserted in 386 patients. Catheters remained in situ for 66 days, on average. In a total of 22 cases (5.57 percent), complications developed. Nonfatal infections occurred most commonly--in 15 cases (3.80 percent). Ascites stopped reaccumulating in 16 cases (4.05 percent), leading to catheter removal. The mean Baseline Dyspnea Index was 3.79 (95 percent confidence interval [CI], 3.64-3.94); the mean Transitional Dyspnea Index postinsertion was 5.14 (95 percent CL, 4.94-5.34). In all, 13 patients completed serial European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires. Postinsertion, overall quality of life improved significantly (p < 0.05), as did all functional domains and fatigue, pain, dyspnea, and appetite symptoms. The tunnelled peritoneal catheter is feasible and safe and causes minimal complications. Its use results in significant improvement in dyspnea and improvement in overall quality of life for a small number of patients.

Clinical predictors of successful and earlier pleurodesis with a tunnelled pleural catheter in malignant pleural effusion: a cohort study.

BACKGROUND: Tunnelled pleural catheters used to treat malignant pleural effusions may achieve pleurodesis. We aimed to identify factors associated with higher pleurodesis rates and earlier catheter removal. METHODS: We retrospectively reviewed a prospective database of tunnelled pleural catheters inserted consecutively between May 2006 and June 2013 for confirmed malignant pleural effusion. The cohort included patients who underwent medical thoracoscopy. Clinical, radiologic and pleural fluid data were recorded. We used logistic regression and Cox regression to assess rates of and days to pleurodesis, respectively. RESULTS: We analyzed data for 1071 tunnelled pleural catheters in 956 patients. Increased rates of pleurodesis were associated with lymphoma (odds ratio [OR] 3.49, 95% confidence interval [CI] 1.93-6.33), ovarian cancer (OR 2.93, 95% CI 1.68-5.11), Eastern Cooperative Oncology Group Scale of Performance Status grade 2 or less (OR 2.79, 95% CI 1.79-4.34), medical thoracoscopy (OR 2.21, 95% CI 1.28-3.85), protein level (OR 1.03, 95% CI 1.01-1.06), albumin level (OR 1.07, 95% CI 1.03-1.12) and percent eosinophils (OR 1.04, 95% CI 1.00-1.07). Reduced rates of pleurodesis were associated with gastrointestinal cancers (OR 0.41, 95% CI 0.19-0.87), hydropneumothorax on the postdrainage chest radiograph (OR 0.62, 95% CI 0.41-0.94) and percent other cells on cell count (OR 0.98, 95% CI 0.97-0.99). Earlier pleurodesis was associated with ovarian cancer (hazard ratio [HR] 1.48, 95% CI 1.06-2.08), medical thoracoscopy (HR 1.45, 95% CI 1.10-1.92), protein level (HR 1.03, 95% CI 1.01-1.04) and percent eosinophils (HR 1.02, 95% CI 1.00-1.04). Delayed pleurodesis was associated with breast cancer (HR 0.61, 95% CI 0.46-0.81), hydropneumothorax with 80% or less lung expansion (HR 0.55, 95% CI 0.38-0.80) and percent other cells (HR 0.99, 95% CI 0.98-1.00). INTERPRETATION: Clinicians should consider numerous factors to predict the probability of and timing to pleurodesis with tunnelled pleural catheters.

Implementation of an Electronic Data Collection Tool to Monitor Nursing-Sensitive Indicators in a Large Academic Health Sciences Centre.

BACKGROUND: Monitoring the quality of nursing care is essential to identify patients at risk, measure adherence to hospital policies and evaluate the effectiveness of best practice interventions. However, monitoring nursing-sensitive indicators (NSI) is a challenge. Prevalence surveys are one method used by some organizations to monitor NSI, which are patient outcomes that are directly affected by the quantity or quality of nursing care that the patient receives. OBJECTIVE: The aim of this paper is to describe the development of an innovative electronic data collection tool to monitor NSI. METHODS: In the preliminary development work, we designed a mobile computing application with pre-populated patient census information to collect the nursing quality data. In subsequent phases, we refined this process by designing an electronic trigger using The Ottawa Hospital's Patient Safety Learning System, which automatically generated a case report form for each inpatient based on the hospital's daily patient census on the day of the prevalence survey. OBSERVATIONS: Both of these electronic data collection tools were accessible on tablet computers, which substantially reduced data collection, analysis and reporting time compared to previous paper-based methods. The electronic trigger provided improved completeness of the data. CONCLUSION: This work leveraged the use of tablet computers combined with a web-based application for patient data collection at point of care. Overall, the electronic methods improved data completeness and timeliness compared to traditional paper-based methods. This initiative has resulted in the ability to collect and report on NSI organization-wide to advance decision-making support and identify quality improvement opportunities within the organization.