Efficacy of ferumoxytol versus sodium ferric gluconate in anemia management in outpatient hemodialysis patients: A prospective cohort study.

BACKGROUND: Intravenous iron is one of the main therapies for anemia management in hemodialysis-dependent patients. Data comparing the efficacy of ferumoxytol versus other parenteral iron supplements are scarce. The objective of the study was to compare the efficacy of ferumoxytol with that of sodium ferric gluconate in outpatient hemodialysis patients. MATERIALS AND METHODS: A prospective, observational study was conducted in outpatients receiving ferumoxytol 510 mg once or twice quarterly compared to sodium ferric gluconate 125 mg weekly in a single center hemodialysis center in Ontario, Canada. Patient demographics, hemoglobin levels, iron indices, iron doses, and erythropoiesis-stimulating agent (ESA) doses were collected. RESULTS: The study sample consisted of 291 observations from 173 patients. Generalized estimating equations of multiple linear regression modeling were conducted to compare the outcomes while adjusting for baseline scores. Approximately 25% of the study participants received ferumoxytol while 75% received sodium ferric gluconate. Patients treated were mainly males (58.4%), and the mean age was 68.73 (SD ± 13.03) years. Both groups did not show significant differences in their hemoglobin levels (Wald z = 0.54; p = 0.46), ESA utilization at 3 months (Wald z = 0.20; p = 0.65), and TSAT levels (Wald z = 3.45; p = 0.06). However, the iron levels (Wald z = 4.24; p = 0.04) and ferritin levels (Wald z = 5.14; p = 0.02) were higher in the ferric gluconate group (Wald z = 58.78; p ≤ 0.001), and patients who received ferumoxytol received more blood transfusions as compared to those who received sodium ferric gluconate (χ2 = 16.71; p ≤ 0.001). CONCLUSION: Both iron products maintained hemoglobin levels, but patients receiving ferumoxytol had lower iron indices and received more blood transfusions compared to patients who received sodium ferric gluconate.

Perceptions and experiences of person-centered care among nurses and nurse aides in long term residential care facilities: A systematic review of qualitative studies.

OBJECTIVE: The aim of this study is to report the findings of meta-synthesis of the experiences and perceptions of person-centered care among nurses and nurse aides in long term care facilities to help managers and policy makers in providing and improving health services. METHODS: This is a meta-synthesis of qualitative studies guided by seven steps process of meta-ethnography developed by Noblit and Hare. Systematic literature searching was conducted in CINAHL, MEDLINE, Web of Science, PubMed, PsycINFO, Scopus, Cochrane library and ProQuest dissertations databases. We assessed quality of the studies using Critical Appraisal Skills Program tool. RESULTS: Eleven studies and one dissertation were identified as relevant for the review. The analysis of this systematic review was resulted in three categories: Recognizing resident's emotional needs and preferences under the task-based workload; holistic understanding to build relationship and participation; teamwork, being recognized and ongoing training to overcome the challenges. CONCLUSION: The concept of PCC in direct care level is perceived well with majority of the study participants but the reality between perceived and practicing PCC is different which indicates mostly lack of organizational rearrangements and support.

Efficacy of alteplase 1 versus 2 mg dose in restoring haemodialysis catheter function (Alte-dose 2): A randomized double-blind controlled study.

AIM: Data about the optimal alteplase dose required to treat haemodialysis catheter occlusion (HDC) are scarce. The purpose of the clinical trial was to examine the effectiveness of alteplase 2 mg as compared with 1 mg in restoring HDC function. METHODS: A double-blind, randomized, controlled clinical trial was conducted in a single-centre in southwestern Ontario, Canada. Rate of clot resolution, catheter replacements, catheter stripping, and mean catheter survival time were assessed using Kaplan-Meier, Cox-proportional hazard and clustered logic regression analyses. RESULTS: On a sample of 48 haemodialysis patients who provided 252 catheter occlusion events, the rate of clot resolution at the catheter site in the 2 mg group was 85.7% as opposed to 84.9% in the 1 mg group. There were only six catheter removals and 10 catheter stripping events. Cox regression analysis revealed no difference between the two groups in the hazard of occlusion on the primary 48 observations after the initial alteplase management (P = 0.267; hazard ratio = 0.72; 95% confidence interval 0.40-1.3). Correlated logistic regression on all 252 observations indicated no difference in the rate of post alteplase clot resolution (P = 0.336; odds ratio = 2.4, 95% confidence interval 0.399-14.6) between the two groups. CONCLUSION: Alteplase 1 mg is as effective as 2 mg in restoring HDC malfunction and may result in cost reduction in haemodialysis units.

Self-Reported Sensory Gating and Stress-Related Hypertension.

BACKGROUND: Increasing evidence views hypertension as a stress-induced disorder. Stressors must be "gated" by the brain before any inflammatory or immune processes that contribute to hypertension are initiated. No studies were found that examined sensory gating in relation to hypertension. OBJECTIVES: The aim of the study was to determine if disturbances in self-reported sensory gating could differentiate normotensive from hypertensive young adults. METHODS: A nonmatched, case-control design was used. We administered an online survey to 163 young adult participants. Participants were predominantly female, in their mid-20s, well educated, and approximately evenly distributed by race and hypertension status. The Sensory Gating Inventory (SGI) measured gating disturbances. RESULTS: The mean SGI scores were significantly higher among persons diagnosed with hypertension, reflecting a moderate effect size of sensory gating. After adjusting for confounders, however, the normotensive and hypertensive groups were not significantly different on their SGI scores. DISCUSSION: With an observed moderate effect size of 0.35, but low power, more research is warranted regarding the role of gating disturbances in the development of stress-induced hypertension. Clinically, the SGI may be important for screening patients who would benefit from ambulatory blood pressure monitoring to identify persons with masked hypertension.

A Descriptive Study of Bullying Victimization Among Arab American Adolescents in Southeast Michigan Middle and High Schools.

PURPOSE: This cross-sectional study examined the frequency of different forms of bullying victimization (verbal, physical, and social), predictors of victimization, and whether bullying is reported to an adult. DESIGN AND METHODS: The study utilized a community sample of 150 Arab American adolescents, age 12 to 16 years. The Adolescent Peer Relations Instrument-Victimization Scale was used to determine the participant's experiences of victimization in the past year. The adolescents indicated where bullying occurred, why, and whether they reported the incidence to an adult. RESULTS: Approximately 30% of the study sample reported that victimization occurred occasionally (once a month or more frequent). Classrooms and hallways were the most common locations where bullying had occurred. Country-of-origin and obesity were the most frequent reasons for victimization. Predictors varied among the different forms of victimization; however, cyber-victimization [OR = 24.5; 95% CI 5-119.5)], perceived problematic attire [OR = 8.4; 95% CI 2.2-31.9)], female gender [OR = 5.2; 95% CI 1.2-22.7)], and being overweight [OR = 0.14; 95% CI 0.01-2.6)] all predicted overall victimization. CONCLUSIONS: Our findings provide a foundation for future research focusing on Arab American adolescents, an underrepresented population, more research is needed to understand the scope of bullying victimization among Arab American adolescents. PRACTICE IMPLICATIONS: This study will inform future intervention research and practice to consider victimization and related factors among Arab American adolescents. Culturally sensitive and multilevel interventions are imperative to decrease bullying victimization among Arab American adolescents and prevent negative effects on their health and families.

Predictors of Nonurgent Emergency Visits at a Midsize Community-Based Hospital System: Secondary Analysis of Administrative Health Care Data.

INTRODUCTION: Nonurgent visits to the emergency department compromise efficiency in treating patients with urgent conditions and inversely influence the satisfaction of patients and staff. There is inconclusive evidence of the factors associated with nonurgent ED visits. Therefore, the purpose of this study was to explore the independent factors associated with nonurgent ED visits in a midsize community-based Canadian hospital system. METHODS: This was a retrospective, secondary analysis of data from 2 community hospitals in southwestern Ontario, Canada. We included ED patients in the analysis if they were local residents from the city or the surrounding county. RESULTS: Nonurgent visits constituted approximately 27% of all ED visits and were more likely to be associated with patients with a primary care provider referral (odds ratio = 2.87; 95% confidence interval, 2.75-2.99) and with patients who had no primary care provider (odds ratio = 1.10; 95% confidence interval, 1.04-1.16). Other predictors included younger age, season, time of day, ED arrival mode, geographical proximity of residence to the emergency department, and case presentation. DISCUSSION: The findings of this study may assist health care providers and stakeholders in developing strategies to minimize nonurgent ED visits.

One Stop: Examining the Reasons Patients Use the Emergency Department for Nonurgent Care and the Barriers They Face.

INTRODUCTION: Despite the plethora of research on the use of emergency department services for nonurgent primary health care, the vast majority of this research is quantitative in nature. To date, there is little research that reports on the problem from the patients' perspective and/or lived experience, which compromises health care providers' understanding of the essence of the problem as described by the patients. Thus, this study will provide a qualitative description of nonurgent ED visits from the patients' perspective. Specifically, this study answers the following research questions: 1) What are the reasons for patients and/or caregivers visiting the emergency department for nonurgent health conditions? and 2) What are the barriers experienced by patients and/or caregivers when seeking access to health care? METHODS: A qualitative descriptive design with face-to-face interviews of 33 consenting participants was conducted at 4 emergency departments. All interviewed participants were triaged as nonurgent patients by the ED personnel. RESULTS: Three themes surfaced from the data regarding reasons for using the emergency department: 1) Practitioner referral; 2) Efficacy of care; and 3) Time saver. When describing barriers that participants experienced when seeking care outside of the emergency department for their nonurgent conditions, 3 themes that emerged are lack of primary care provider, financial difficulties, and lack of comprehensive care outside the emergency department. DISCUSSION: The results of the study can help inform patient-centered care and future policy initiatives that will address the practices and barriers contributing to nonurgent ED visits.

Univariate Outliers: A Conceptual Overview for the Nurse Researcher.

The presence of statistical outliers is a shared concern in research. If ignored or improperly handled, outliers have the potential to distort the estimate of the parameter of interest and thus compromise the generalizability of research findings. A variety of statistical techniques are available to assist researchers with the identification and management of outlier cases. The purpose of this paper is to provide a conceptual overview of univariate outliers with special focus on common techniques used to detect and manage univariate outliers. Specifically, this paper discusses the use of histograms, boxplots, interquartile range, and z-score analysis as common univariate outlier identification techniques. The paper also discusses the outlier management techniques of deletion, substitution, and transformation.

Exploring the Predictors of Emergency Department Triage Acuity Assignment in Patients With Sepsis.

Background and purpose Evidence suggests that septic patients, who require prompt medical attention, may be undertriaged, resulting in delayed treatment. The purpose of this study was to examine patient and contextual variables that contribute to high- versus low-acuity triage classification of patients with sepsis. Methods Data were abstracted from the medical records of 154 adult patients with sepsis admitted to hospital through a Canadian Emergency Department. Logistic regression was used to explore the predictors of triage classification. Results Language barriers or chronic cognitive impairment (odds ratio 5.7; 95% confidence interval 2.15, 15.01), acute confusion (odds ratio 3.4; confidence interval 1.3, 8.2), unwell appearance (odds ratio 3.4; 95% confidence interval 1.7, 7.0), and hypotension (odds ratio 0.98; confidence interval 0.96, 1.0) were predictive of higher acuity classification. Temperature, heart rate, respiratory rate, and contextual factors were not related to triage classification. Conclusions Several patient-related factors were related to triage classification. However, the finding that temperature and heart and respiratory rates were not related to triage classification was troubling. Our findings point to a need for enhanced education for triage nurses regarding the physiological indices of sepsis. The sensitivity of the Canadian Triage Assessment Scale, used in Canadian Emergency Rooms, also needs to be examined.

Evaluating the Effectiveness of a Nurse Practitioner-Led Outreach Program for Long-Term-Care Homes.

An observational prospective cohort study was conducted on 1,353 observations from a convenience sample of 311 long-term-care (LTC) residents to evaluate the effectiveness of a nurse practitioner-led outreach program on the health outcomes, emergency department (ED) transfers, and hospital admissions of LTC residents. The results show that ED transfers by the NPs were 27% less likely to be non-urgent than transfers made by MDs (OR = .73; 95% CI .54-.97) and that ED transfers by the NPs were 3.23 times more likely to be admitted to hospital than transfers by MDs (OR = 3.23; 95% CI 1.17-8.90). These findings highlight the potential benefits of the NP-led outreach program for LTC residents and for the health-care system.

Dans le cadre d'une étude de cohorte prospective observationnelle, 1 353 observations provenant d'un échantillon de commodité composé de 311 bénéficiaires de soins de longue durée ont été soumises à un examen visant à évaluer l'efficacité d'un programme d'extension des services dirigé par des infirmières praticiennes en ce qui a trait aux résultats sur la santé, aux transferts vers le service des urgences et à l'hospitalisation des bénéficiaires de soins de longue durée. Les résultats indiquent que les patients transférés au service des urgences par des infirmières praticiennes étaient dans une proportion de 27 % moins susceptibles d'être non urgents que ceux transférés par des médecins (rapport de cotes = 0,73; intervalle de confiance à 95 % de 0,54 à 0,97), et 3,23 fois plus susceptibles d'être admis à l'hôpital que ceux transférés par des médecins (rapport de cotes = 3,23; intervalle de confiance à 95 % de 1,17 à 8,90). Ces constatations ont permis de mettre en évidence les avantages possibles d'un programme d'extension des services dirigé par des infirmières praticiennes pour les bénéficiaires de soins de longue durée et le système de soins de santé.

Exploring the Impact of Prostate Cancer Radiation Treatment on Functions, Bother, and Well-Being.

Though many studies have explored the effects of radiation therapy on urinary, sexual, and bowel function and/or bother, few have focused on symptom experiences from diagnosis through the first year following completion of radiation therapy. The purpose of this study was to compare the effect of 3 types of radiation treatment on functions, bother, and well-being in men with prostate cancer at 1, 6, and 12 months after completion of treatment. A repeated measures survey (N = 73) found that none of the function, bother, emotional, social, or functional well-being scores were significantly different among the 3 groups. However, within-subjects-only repeated measures ANCOVA suggested that emotional well-being and social well-being are different over time. The findings show that clinical treatment of prostate cancer has an impact on functions, bother, and well-being of patients. Thus, it is important that nurses and other healthcare providers listen to what patients are saying before, during, and after treatment.

Bien que de nombreuses études aient examiné les effets de la radiothérapie sur les fonctions ou les gênes urinaires, sexuelles et intestinales, peu ont mis l'accent sur les symptômes ressentis à partir du diagnostic jusqu'à la fin de l'année suivant le traitement. L'objectif de cette étude était de comparer les effets de trois types de radiothérapie sur les fonctions, les gênes et le bien-être d'hommes atteints d'un cancer de la prostate un mois, six mois et douze mois après la fin du traitement. Un sondage intégrant des mesures répétées (N = 73) a permis de constater qu'il n'y avait pas de variation importante entre les trois groupes quant aux mesures touchant les fonctions corporelles, les gênes physiques ou le bien-être social, émotionnel ou fonctionnel. Toutefois, l'analyse de covariance des mesures répétées touchant les sujets uniquement laisse entendre que le bien-être émotionnel et le bien-être social évoluent dans le temps. Les conclusions de l'étude indiquent que le traitement clinique du cancer de la prostate a une incidence sur les fonctions corporelles, les gênes physiques et le bien-être des patients. Il est par conséquent important que le personnel infirmier et les autres professionnels de la santé prennent le temps d'écouter les patients avant, pendant et après leur traitement.

Self-Reported Study Analyzing Physicians' Personal Compliance with Health Prevention Guidelines in a Medium-Sized Canadian Community.

There have only been limited studies that have assessed the attitude of Canadian physicians toward their own physical health. The aim of our study was to explore the self-reported health maintenance behavior and the predictors of health practices among physicians in a small-medium sized Canadian community. We used a descriptive mailed in self-report survey to contact all 649 physicians registered with the Essex County Medical Society, with a 36% response rate. Our results showed that 81% of physicians in Windsor-Essex County were satisfied with how well they care for themselves, despite reporting low levels of physical activity and a lower percentage of respondents having family physicians than the general population. Five independent factors were identified with physician self-perceived health satisfaction: Physician age of 45 to 54 (95% CI 0.17-0.92; OR 0.39), graduating from Canadian medical schools (95% CI 0.15 to 0.80; OR 0.35), having more than one co-morbidity (95% CI 0.13-0.72; OR 0.31), physicians who had a regular family doctor (95% CI 1.12-5.52; OR 2.43), and engagement in regular moderate weekly exercise (95% CI 1.05-4.94; OR 2.28). We also contrasted the preventive health screening markers of our study to compliance rates of the general population as well as the national physician study. Our results showed that screening rates among our study physician group differed markedly from the general population. For colorectal and breast cancers, physicians in our study reported screening rates of 77.8% and 37.3% respectively, compared with the general population, who's screening rates are 32.3% and 72.5%. Future studies exploring specific targeted health promotion interventions that could address these factors may be warranted in order to further improve Canadian physician health, and ultimately improve their ability to take care of their patients.

Development and psychometric assessment of the undergraduate nursing student academic satisfaction scale (UNSASS).

BACKGROUND AND PURPOSE: To examine the psychometric properties of a newly developed instrument: The Undergraduate Nursing Student Academic Satisfaction Scale (UNSASS). METHODS: A self-report test-retest questionnaire was administered to a convenience sample of 313 students enrolled in Bachelor of Science in Nursing (BScN) program in Ontario, Canada. RESULTS: The psychometric analysis yielded a 48-item multidimensional instrument. Validity testing revealed a content validity index (CVI) of .83. Factor analysis suggested a four-dimension scale with distinct factor loadings that all exceeded .4 and explained 50% of the variance. The scale had an overall Cronbach's alpha coefficient of .96 and a test-retest correlation coefficient of .88, indicating a highly reliable instrument. CONCLUSIONS: The newly developed instrument provides a tool to comprehensively measure the satisfaction of nursing students with the academic aspects of their nursing programs.