RESUMO
BACKGROUND: Bloodstream infections (BSIs) cause substantial morbidity in hemodialysis patients. In 2009, the US Centers for Disease Control and Prevention (CDC) sponsored a collaborative project to prevent BSIs in outpatient hemodialysis facilities. We sought to assess the impact of a set of interventions on BSI and access-related BSI rates in participating facilities using data reported to the CDC's National Healthcare Safety Network (NHSN). STUDY DESIGN: Quality improvement project. SETTING & PARTICIPANTS: Patients in 17 outpatient hemodialysis facilities that volunteered to participate. QUALITY IMPROVEMENT PLAN: Facilities reported monthly event and denominator data to NHSN, received guidance from the CDC, and implemented an evidence-based intervention package that included chlorhexidine use for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback of infection and adherence rates to staff. OUTCOMES: Crude and modeled BSI and access-related BSI rates. MEASUREMENTS: Up to 12 months of preintervention (January 2009 through December 2009) and 15 months of intervention period (January 2010 through March 2011) data from participating centers were analyzed. Segmented regression analysis was used to assess changes in BSI and access-related BSI rates during the preintervention and intervention periods. RESULTS: Most (65%) participating facilities were hospital based. Pooled mean BSI and access-related BSI rates were 1.09 and 0.73 events per 100 patient-months during the preintervention period and 0.89 and 0.42 events per 100 patient-months during the intervention period, respectively. Modeled rates decreased 32% (P = 0.01) for BSIs and 54% (P < 0.001) for access-related BSIs at the start of the intervention period. LIMITATIONS: Participating facilities were not representative of all outpatient hemodialysis centers nationally. There was no control arm to this quality improvement project. CONCLUSIONS: Facilities participating in a collaborative successfully decreased their BSI and access-related BSI rates. The decreased rates appeared to be maintained in the intervention period. These findings suggest that improved implementation of recommended practices can reduce BSIs in hemodialysis centers.
Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Pacientes Ambulatoriais , Melhoria de Qualidade , Diálise Renal , Dispositivos de Acesso Vascular/efeitos adversos , HumanosRESUMO
Infections are a significant complication for dialysis patients. The CDC estimates that 37,000 central line-related bloodstream infections occurred in hemodialysis patients in 2008 and dialysis-associated outbreaks of hepatitis C continue to be reported. While established hospital-based infection prevention programs have existed since the 1970s, few dialysis facilities have an established in-center program, unless the dialysis facility is hospital-associated. This review focuses on essential core components required for an effective infection prevention program, extrapolating from acute-care programs and building on current dialysis guidelines and recommendations. An effective infection prevention program requires infrastructure, including leaders who place infection prevention as a top priority, active involvement from a multidisciplinary team, surveillance of outcomes and processes with feedback, staff and patient education, and consistent use of evidence-based practices. The program must be integrated into the existing Quality Assessment and Performance Improvement program. Best practice recommendations for the prevention of infection, specific to dialysis, continue to evolve as the epidemiology of dialysis-associated infections is further researched and new evidence is gathered. A review of case studies illustrates that with an effective program in place, infection prevention becomes part of the culture, reduces infection risk, and improves patient safety.
Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Patógenos Transmitidos pelo Sangue/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Controle de Infecções/organização & administração , Diálise Renal/efeitos adversos , Instituições de Assistência Ambulatorial/normas , Infecções Bacterianas/prevenção & controle , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Guias de Prática Clínica como Assunto , Prevenção Primária/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Controle de Qualidade , Diálise Renal/métodos , Medição de Risco , Dispositivos de Acesso Vascular/efeitos adversos , Dispositivos de Acesso Vascular/microbiologiaRESUMO
OBJECTIVE: To determine the level of agreement between a telehealth and in-person assessment of a representative sample of patients with chronic musculoskeletal conditions referred to an advanced-practice physiotherapy screening clinic. DESIGN: Repeated-measures study design. PARTICIPANTS: 42 patients referred to the Neurosurgical & Orthopaedic Physiotherapy Screening Clinic (Queensland, Australia) for assessment of their chronic lumbar spine, knee or shoulder condition. INTERVENTION: Participants underwent two consecutive assessments by different physiotherapists within a single clinic session. In-person assessments were conducted as per standard clinical practice. Telehealth assessments took place remotely via videoconferencing. Six Musculoskeletal Physiotherapists were paired together to perform both assessment types. MAIN OUTCOME MEASURES: Clinical management decisions including (i) recommended management pathways, (ii) referral to allied health professions, (iii) clinical diagnostics, and (iv) requirement for further investigations were compared using reliability and agreement statistics. RESULTS: There was substantial agreement (83.3%; 35/42 cases) between in-person and telehealth assessments for recommended management pathways. Moderate to near perfect agreement (AC1â¯=â¯0.58-0.9) was reached for referral to individual allied health professionals. Diagnostic agreement was 83.3% between the two delivery mediums, whilst there was substantial agreement (81%; AC1â¯=â¯0.74) when requesting further investigations. Overall, participants were satisfied with the telehealth assessment. CONCLUSION: There is a high level of agreement between telehealth and in-person assessments with respect to clinical management decisions and diagnosis of patients with chronic musculoskeletal conditions managed in an advanced-practice physiotherapy screening clinic. Telehealth can be considered as a viable and effective medium to assess those patients who are unable to attend these services in person.
Assuntos
Assistência Ambulatorial/métodos , Programas de Rastreamento/métodos , Doenças Musculoesqueléticas/diagnóstico , Telemedicina/métodos , Triagem/métodos , Comunicação por Videoconferência , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/métodos , Queensland , Reprodutibilidade dos TestesRESUMO
Among dialysis facilities participating in a bloodstream infection (BSI) prevention collaborative, access-related BSI incidence rate improvements observed immediately following implementation of a bundle of BSI prevention interventions were sustained for up to 4 years. Overall, BSI incidence remained unchanged from baseline in the current analysis. Infect Control Hosp Epidemiol 2016;37:863-866.
Assuntos
Infecção Hospitalar/prevenção & controle , Diálise Renal/efeitos adversos , Sepse/prevenção & controle , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Humanos , Relações Interinstitucionais , Pacotes de Assistência ao Paciente , Diálise Renal/métodos , Sepse/epidemiologiaRESUMO
STUDY DESIGN: Fine-wire EMG rotator cuff onset time analysis in 2 matched groups of throwers with and without pain. OBJECTIVE: To identify if there is a difference in the activation patterns of the rotator cuff muscles during a rapid shoulder external rotation task between throwers with and without pain. BACKGROUND: The coordinated action of the rotator cuff is recognized as essential for glenohumeral joint control in the throwing athlete. Identification of abnormalities occurring in muscle activation patterns for injured athletes is relevant when prescribing rehabilitative exercises. METHODS AND MEASURES: Twelve throwers with shoulder pain were compared to a matched group of 11 asymptomatic throwers. Participants were matched for age, height, body mass, and habitual activity. Fine-wire EMG electrodes were inserted into the subscapularis, supraspinatus, and infraspinatus. EMG activity was measured during a reaction time task of rapid shoulder external rotation in a seated position. The timing of onset of EMG activity was analyzed in relation to visualization of a light (reaction time) and to the onset of infraspinatus activity (relative latency). RESULTS: In the group with shoulder pain, the onset of subscapularis activity was found to be significantly delayed (reaction time, P = .0018; relative latency, P = .0005) from the onset of infraspinatus activity when compared to the control group. CONCLUSIONS: The presence of shoulder pain in these athletes was associated with a difference in the onset of subscapularis EMG activity during a rapid shoulder external rotation movement. This was an initial step in the understanding of the joint protection mechanisms of the glenohumeral joint and the problems that occur in throwers. This information may assist in providing future guidelines for more effective rehabilitation and prevention strategies for this condition.
Assuntos
Dor , Rotação , Manguito Rotador/fisiologia , Articulação do Ombro/fisiologia , Adulto , Beisebol , Eletromiografia , Humanos , MasculinoRESUMO
BACKGROUND: Simulation-based training has been associated with reduced central line-associated bloodstream infection (CLABSI) rates. We measured the combined effect of simulation training, electronic medical records (EMR)-based documentation, and standardized kits on CLABSI rates in our medical (MICU) and surgical (SICU) intensive care units (ICU). METHODS: CLABSI events and catheter-days were collected for 19 months prior to and 37 months following an intervention consisting of simulation training in central line insertion for all ICU residents, incorporation of standardized, all-inclusive catheter kits, and EMR-guided documentation. Supervising physicians in the MICU (but not the SICU) also completed training. RESULTS: Following the intervention, EMR-based documentation increased from 48% to 100%, and documented compliance with hand hygiene, barrier precautions, and chlorhexidine use increased from 65%-85% to 100%. CLABSI rate in the MICU dropped from 2.72 per 1,000 catheter-days over the 19 months preceding the intervention to 0.40 per 1,000 over the 37 months following intervention (P = .01) but did not change in the SICU (1.09 and 1.14 per 1,000 catheter-days, P = .86). This equated to 24 fewer than expected CLABSIs and $1,669,000 in estimated savings. CONCLUSION: Combined simulation training, standardized all-inclusive kits, and EMR-guided documentation were associated with greater documented compliance with sterile precautions and reduced CLABSI rate in our MICU. To achieve maximal benefit, refresher training of senior physicians supervising practice at the bedside may be needed.
Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/métodos , Registros Eletrônicos de Saúde , Controle de Infecções/métodos , Capacitação em Serviço , Unidades de Terapia Intensiva/estatística & dados numéricos , Sepse/prevenção & controle , Cateteres Venosos Centrais/efeitos adversos , Infecção Hospitalar/prevenção & controle , Documentação , Humanos , Unidades de Terapia Intensiva/normas , Internato e ResidênciaRESUMO
BACKGROUND: Major depression is a common disorder among teenagers and is associated with significant morbidity and mortality. Suicide is the third leading cause of death among 15-24 year olds. Early identification and treatment is essential to prevent suicide. Depression education is a potential intervention for improving knowledge about depression and help-seeking behavior. METHODS: The Adolescent Depression Awareness Program (ADAP) is a school-based depression education intervention with a core message that depression is a treatable medical illness. 710 high school students from six schools in Tulsa, OK participated in the study comparing changes in knowledge about depression and attitudes toward treatment-seeking between students receiving the intervention and those who did not. Changes in depression knowledge and attitude toward help-seeking were measured using the ADAP Depression Knowledge Questionnaire (ADKQ). RESULTS: There was a significant positive change in ADKQ score for students receiving the intervention but not in the control group. The intervention group also demonstrated a significant difference in willingness to "tell someone" if concerned about depression in a peer, which was not present in the control group. LIMITATIONS: The students were not randomized to the intervention and control groups. The ADKQ evaluates attitudes about help-seeking but not behavior. CONCLUSIONS: A school-based educational intervention improved knowledge about depression and attitudes toward help-seeking in adolescents. Future studies should investigate if such change in knowledge results in help-seeking behaviors.
Assuntos
Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/psicologia , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Estudantes/psicologia , Prevenção do Suicídio , Adolescente , Comportamento do Adolescente , Conscientização , Feminino , Humanos , Masculino , Grupo Associado , Instituições Acadêmicas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Although academics are trained in research methods, few receive formal training in strategies for implementing equitable community engaged research. Academics and their community partners can benefit from such direction and assistance as they establish and maintain community-based participatory research (CBPR) partnerships. Research partners from the University of Pittsburgh, the Johns Hopkins Center for Injury Research and Policy, and the House of Ruth Maryland, one of the nation's leading domestic violence centers serving Baltimore and the surrounding areas, joined together to design, implement, and evaluate a series of activities to increase local CPBR capacity. OBJECTIVES: This article provides an overview of process and findings from two CBPR workshops jointly held for academic and community members and explores specific suggestions from the workshop participants about how to put the CBPR principles into practice to promote community engaged research to address intimate partner violence (IPV). METHODS: Twenty-four academic and community partners with experience addressing IPV participated in the two workshops. Facilitators led discussions based on the core CPBR principles. Participants were asked to interpret those principles, identify actions that could help to put the principles into practice, and discuss challenges related to CBPR approaches for IPV research. Observational notes and transcripts of the discussions and workshop evaluations are summarized. RESULTS: The CBPR principles were interpreted and revised through consensus into common language that reflected the group discussion of the core CBPR principles. Workshop participants provided a range of actions for putting the principles into practice and identified the need for sensitivity in relation to IPV research. A majority of participants felt that the workshop generated novel ideas about how they could use CPBR in their own work. CONCLUSIONS: Translating CBPR principles into common, action-oriented language is a useful first step when building a new academic-community research partnership.
Assuntos
Pesquisa Participativa Baseada na Comunidade/organização & administração , Comportamento Cooperativo , Maus-Tratos Conjugais/prevenção & controle , Pesquisa Translacional Biomédica/organização & administração , Baltimore , Fortalecimento Institucional , Comunicação , Relações Comunidade-Instituição , Humanos , Disseminação de Informação , Integração de SistemasRESUMO
In an effort to decrease the suicide rate in adolescents, many interventions have focused on school-based suicide prevention programs. Alternatively, depression education in schools might be effective in decreasing the morbidity, mortality, and stigma associated with adolescent depression. The Adolescent Depression Awareness Program (ADAP) developed a 3-hour curriculum to teach high school students about the illness of depression. The purpose of this study was to assess the effectiveness of the ADAP curriculum in improving high school students' knowledge about depression. From 2001 to 2005, 3,538 students were surveyed on their knowledge about depression before and after exposure to the ADAP curriculum. The number of students scoring 80% or higher on the assessment tool more than tripled from pretest to posttest (701 to 2,180), suggesting the effectiveness of the ADAP curriculum. Further study and replication are required to determine if improved knowledge translates into increased treatment-seeking behavior.
Assuntos
Transtorno Depressivo , Educação em Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Escolar/organização & administração , Prevenção do Suicídio , Adolescente , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de SaúdeAssuntos
Anti-Infecciosos Locais/efeitos adversos , Clorexidina/análogos & derivados , Toxidermias/epidemiologia , Sepse/prevenção & controle , Álcoois/efeitos adversos , Álcoois/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Cateteres de Demora/efeitos adversos , Clorexidina/efeitos adversos , Clorexidina/uso terapêutico , Toxidermias/etiologia , Humanos , Percepção , Prevalência , Diálise Renal/efeitos adversos , Sepse/microbiologia , Inquéritos e QuestionáriosRESUMO
Adolescent depression and suicide are major public health concerns. Best practices for suicide prevention and education in high schools are not well understood. The Adolescent Depression Awareness Program (ADAP) was developed to address depression education as an effective means towards decreasing the morbidity and mortality associated with adolescent depression. Adolescents' baseline knowledge about depression was assessed to enhance curriculum development. The survey was administered to 5,645 high school students between 1999 and 2003. Results indicated that students had a cursory knowledge of depression facts but had gaps in knowledge about treatment and symptom identification.