Quality evaluation of the usefulness of an emergency department fall risk assessment tool.

INTRODUCTION: Falls that occur within a hospital setting are difficult to predict, however, are preventable adverse events with the potential to negatively impact patient care. Falls have the potential to cause serious or fatal injuries and may increase patient morbidity. Many hospitals utilize fall "predictor tools" to categorize a patient's fall risk, however, these tools are primarily studied within in-patient units. The emergency department (ED) presents a unique environment with a distinct patient population and demographic. The Memorial Emergency Department Fall Risk Assessment Tool (MEDFRAT) has shown to be effective with predicting a patient's fall risk in the ED. This IRB-approved study aims to assess the predictive validity of the MEDFRAT by evaluating the sensitivity and specificity for predicting a patient's fall risk in an emergency department at a level 1 trauma center. METHODS: A retrospective cohort analysis was conducted using an electronic medical record (EMR) for patients who met study inclusion criteria at a level 1 trauma center ED. Extracted data includes MEDFRAT components, demographic information, and data from the Moving Safely Risk Assessment (MSRA) Tool, our institution's current fall assessment tool. A receiver operating characteristic (ROC) curve was constructed to determine the best cutoff for identifying any fall risk. Sensitivity, specificity, accuracy, positive likelihood ratio (LR+) and negative LR (LR-), with 95% CIs were then calculated for the cutoff value determined from the ROC curve. To compare overall tool performance, the areas under the ROC curves (AUC) were determined and compared with a z-test. RESULTS: The MEDFRAT had a significantly higher sensitivity compared to the MSRA (83.1% vs. 66.1%, p = 0.002), while the MSRA had a significantly higher specificity (84.5% vs. 69.0%, p = 0.012). For identifying any level of fall risk, ROC curve analysis showed that the cutoff providing the best trade-off between sensitivity and specificity for the MEDFRAT was a score of ≥1. Additionally, area under the curve was determined for the MEDFRAT and MSRA (0.817 vs. 0.737). CONCLUSION: This study confirms the validity of the MEDFRAT as an acceptable tool to predict in-hospital falls in a level 1 trauma center ED. Accurate identification of patients at a high risk of falling is critical for decreasing healthcare costs and improving health outcomes and patient safety.

Death of a child in the emergency department.

The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have collaborated to identify practices and principles to guide the care of children, families, and staff in the challenging and uncommon event of the death of a child in the emergency department in this policy statement and in an accompanying technical report.

Death of a child in the emergency department.

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.

Death of a child in the emergency department.

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.

Death of a child in the emergency department.

The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have collaborated to identify practices and principles to guide the care of children, families, and staff in the challenging and uncommon event of the death of a child in the emergency department in this policy statement and in an accompanying technical report.

Impact of heartfulness meditation practice compared to the gratitude practices on wellbeing and work engagement among healthcare professionals: Randomized trial.

OBJECTIVE: To investigate whether Heartfulness meditation practice, compared to Gratitude practice, leads to measurable changes in mental wellbeing among healthcare providers across the US. METHOD: Participants were randomly assigned to one of the following 6-week interventions: the trainer-guided virtual Heartfulness meditation program or the podcast-based self-guided gratitude practice group. The Professional Quality of Life Scale-5 (ProQOL-5) was used to determine Compassion Satisfaction (CS) and risk for Burnout (BO) and secondary traumatic stress (STS). The Utrecht Work Engagement Scale (UWES) was used to assess vigor, dedication, and absorption at work. Outcomes were collected at baseline and the end of the study period. Qualitative questions regarding the experience of learning and practicing were also offered at the end of the six weeks. RESULTS: The majority of participants were nurses (50%), followed by allied healthcare professionals (37%) and physicians (13%) (N = 83). There was a general trend towards increases in CS in the Heartfulness group compared to the gratitude group. However, this was not statistically significant. Strong evidence suggests there was a significant improvement in BO for the Heartfulness group between Week 0 and Week 6 (p = 0.002), as well as STS (p = 0.0004) and vigor (p = 0.0392). Qualitative data analysis revealed that the subjects in the Heartfulness arm reported improved sleep and decreased reactivity to stress. Subjects in the gratitude arm reported improved mood and favorable results using gratitude practices at home with family members. CONCLUSION: In our study, Heartfulness meditation practice was associated with a significant improvement in burnout and vigor at work, with a trend towards compassion satisfaction after six weeks compared with gratitude practices. Qualitative analysis indicates the benefits of both Heartfulness and Gratitude practices. Further randomized trials with a larger sample size are needed to explore these science-based practices for the wellbeing of healthcare workers.

Marked prolongation of porcine renal xenograft survival in baboons through the use of alpha1,3-galactosyltransferase gene-knockout donors and the cotransplantation of vascularized thymic tissue.

The use of animal organs could potentially alleviate the critical worldwide shortage of donor organs for clinical transplantation. Because of the strong immune response to xenografts, success will probably depend upon new strategies of immune suppression and induction of tolerance. Here we report our initial results using alpha-1,3-galactosyltransferase knockout (GalT-KO) donors and a tolerance induction approach. We have achieved life-supporting pig-to-baboon renal xenograft survivals of up to 83 d with normal creatinine levels.

Mobility and Functional Status Among Hospitalized COPD Patients.

Older adults with chronic obstructive pulmonary disease (COPD) are at known risk for deconditioning and functional decline during hospitalization. The purpose of this study was to examine correlations between in-hospital mobility activities and functional status indicators in hospitalized older adults with COPD. A predictive correlational, secondary analysis design using multivariate analyses assessed the relationship between mobility events and functional status indicators in patients with COPD (n = 111) and non-COPD (n = 190) diagnoses. Ambulation to the bathroom, ambulation outside the room, and number of days to first out-of-bed activity predicted discharge to home versus extended care facility (ECF; p ≤ .05); days to first out-of-bed activity and out-of-room ambulation predicted reduced length of stay (LOS; p ≤ .05); no variables predicted 30-day readmission. COPD patients experienced more nonweight-bearing activity and longer lengths of stay than non-COPD patients. Specific early weight-bearing activities were associated with positive functional status-related outcomes in hospitalized COPD patients.

Sports cream and arthritic rubs: the hidden dangers of unrecognized salicylate toxicity.

I am a clinical nurse specialist in a busy family practice with many elderly patients experiencing osteoarthritis. During an evaluation for the management of long-term pain, a patient stated that he would not use a sports cream since he had heard on the news that someone had died as a result of use. What are the risks and toxicity associated with the use of these pain-relieving products?