RESUMO
OBJECTIVE: The aim of the study was to identify which fall-risk tool is most accurate for assessing adults in the hospital setting. BACKGROUND: Falls can have physical, emotional, social, and financial consequences. Risk assessment affords the first opportunity in prevention. METHODS: To standardize the use of a fall-risk tool across the Baylor Health Care System, nurse executives undertook a meta-analysis of published research on fall-risk assessment tools used with adult inpatients. RESULTS: Both random-effects and fixed-effects models showed that Morse Fall Scale had significantly higher sensitivity than St Thomas's Risk Assessment Tool (STRATIFY). Specificity of Morse Fall Scale was significantly lower than that of STRATIFY with the fixed-effects model, but the random-effects model showed the opposite. Morse Fall Scale had a significantly higher Youden index than STRATIFY with the fixed-effects model (P = .001), but the result from random-effects model indicated no significant difference (P = .117). The sensitivity, specificity, and Youden index fell within the 95% confidence intervals. CONCLUSIONS: Meta-analysis is a useful methodology for evaluating current evidence when variation exists in the literature.
Assuntos
Acidentes por Quedas , Hospitalização , Pacientes Internados , Adulto , Humanos , Medição de Risco/métodosRESUMO
Primary myelofibrosis (PMF) is a myeloproliferative neoplasm characterized by remodelling of the bone marrow, including progressive myelofibrosis and exaggerated angiogenesis. Advanced PMF frequently shows a full-blown fibre meshwork, which avoids aspiration of cells, and the expression profile of genes related to stroma pathology at this stage remains largely undetermined. We investigated bone marrow core biopsies in PMF showing various degrees of myelofibrosis by custom-made low density arrays (LDA) representing target genes with designated roles in synthesis of extracellular matrix, matrix remodelling, cellular adhesion and motility. Among a set of 11 genes up-regulated in advanced stages of PMF (P < or = 0.01) three candidates, PTK2 protein tyrosine kinase 2 (PTK2), transforming growth factor beta type II receptor (TGFBR2) and motility-related protein-1 (CD9 molecule, CD9), were investigated in more detail. PTK2, TGFBR2 and CD9 were significantly overexpressed in larger series of advanced PMF stages (P < or = 0.01 respectively). Endothelial cells of the increased microvessel network in PMF could be identified as a predominant source for PTK2, TGFBR2 and CD9. CD9 also strongly identified activated fibroblasts in advanced myelofibrosis. We conclude that PTK2, TGFBR2 and CD9 represent new target molecules involved in bone marrow remodelling of PMF and warrant further investigation for potential targeted therapy.
Assuntos
Antígenos CD/genética , Quinase 1 de Adesão Focal/genética , Glicoproteínas de Membrana/genética , Mielofibrose Primária/genética , Proteínas Serina-Treonina Quinases/genética , Receptores de Fatores de Crescimento Transformadores beta/genética , Regulação para Cima , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antígenos CD/análise , Exame de Medula Óssea , Linfócitos T CD4-Positivos/química , Estudos de Casos e Controles , Feminino , Quinase 1 de Adesão Focal/análise , Perfilação da Expressão Gênica , Humanos , Imuno-Histoquímica , Masculino , Glicoproteínas de Membrana/análise , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Mielofibrose Primária/imunologia , Mielofibrose Primária/patologia , Probabilidade , Proteínas Serina-Treonina Quinases/análise , Receptor do Fator de Crescimento Transformador beta Tipo II , Receptores de Fatores de Crescimento Transformadores beta/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Baço/química , Tetraspanina 29RESUMO
This article focuses on improving hand hygiene compliance using a multidisciplinary approach. Historically, hand hygiene compliance among health care workers and physicians has been far below an acceptable level. The facility discussed in this article uses an ongoing "Hand Hygiene" campaign, which is multidisciplinary and addresses numerous barriers to compliance.
Assuntos
Educação Médica/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos/métodos , Pessoal de Saúde , Infecção Hospitalar/prevenção & controle , HumanosRESUMO
This article is the second in a two-part series focusing on catheter-associated urinary tract infections. Part I of the series focused on the most significant modifiable risk factor, avoiding use of urethral catheters. Part II focuses on the second major modifiable risk factor, reducing catheter-days. A quality improvement case is provided to illustrate the strategies for limiting the duration of catheter use. Together, these two articles provide important information on the two most significant risk facts for eliminating the incidence of catheter-associated urinary tract infections.
Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Urinário/enfermagem , Infecções Urinárias/prevenção & controle , Infecção Hospitalar/prevenção & controle , Prática Clínica Baseada em Evidências , Humanos , Estudos de Casos Organizacionais , Garantia da Qualidade dos Cuidados de Saúde/métodos , Gestão de Riscos , Texas , Fatores de Tempo , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/etiologiaRESUMO
This article is the first in a two-part series focusing on catheter-associated urinary tract infections. There is a convergence of factors necessitating zero tolerance toward catheter-associated urinary tract infections, including the risks associated with patient safety and to a lesser extent the changes in reimbursement. Part I of this series focuses on the most significant modifiable risk factor, avoiding use of urethral catheters. A quality improvement case study is highlighted along with a practice bundle for evidence-based practice. Part II focuses on the second most significant risk factor, reducing urethral catheter-days.