Multifactorial Strategies for Sustaining Safe Patient Handling and Mobility.

Reduction in nursing staff injuries has occurred with the use of an evidence-based approach to safe patient handling and mobility. Parts of the evidence-based practice initiative include having the appropriate equipment, such as mechanical patient-lifting devices, a no-lift policy, and the use of peer coaches. The combination of the implementation of a culture of safety can sustain evidence-based, safe patient-handling practices that reduce patient-handling injuries. Patient-handling programs should include adaptations for an aging nursing workforce. The use of safety checklists in health care can improve communication and compliance with safe patient-handling and mobility policy and program components.

Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items; Update to the Master List of Items Frequently Subject to Unnecessary Utilization. Master list deletions.

This document announces the deletion of four Healthcare Common Procedure Coding System (HCPCS) codes from the Master List of Items Frequently Subject to Unnecessary Utilization that could be potentially subject to Prior Authorization as a condition of payment.

The influence of ergonomic devices on mechanical load during patient handling activities in nursing homes.

OBJECTIVES: Mechanical load during patient handling activities is an important risk factor for low back pain among nursing personnel. The aims of this study were to describe required and actual use of ergonomic devices during patient handling activities and to assess the influence of these ergonomic devices on mechanical load during patient handling activities. METHODS: For each patient, based on national guidelines, it was recorded which specific ergonomic devices were required during distinct patient handling activities, defined by transferring a patient, providing personal care, repositioning patients in the bed, and putting on and taking off anti-embolism stockings. During real-time observations over ~60 h among 186 nurses on 735 separate patient handling activities in 17 nursing homes, it was established whether ergonomic devices were actually used. Mechanical load was assessed through observations of frequency and duration of a flexed or rotated trunk >30° and frequency of pushing, pulling, lifting or carrying requiring forces <100 N, between 100 and 230 N, and >230 N from start to end of each separate patient handling activity. The number of patients and nurses per ward and the ratio of nurses per patient were used as ward characteristics with potential influence on mechanical load. A mixed-effect model for repeated measurements was used to determine the influence of ergonomic devices and ward characteristics on mechanical load. RESULTS: Use of ergonomic devices was required according to national guidelines in 520 of 735 (71%) separate patient handling activities, and actual use was observed in 357 of 520 (69%) patient handling activities. A favourable ratio of nurses per patient was associated with a decreased duration of time spent in awkward back postures during handling anti-embolism stocking (43%), patient transfers (33%), and personal care of patients (24%) and also frequency of manually lifting patients (33%). Use of lifting devices was associated with a lower frequency of forces exerted (64%), adjustable bed and shower chairs with a shorter duration of awkward back postures (38%), and an anti-embolism stockings slide with a lower frequency of forces exerted (95%). CONCLUSIONS: In wards in nursing homes with a higher number of staff less awkward back postures as well as forceful lifting were observed during patient handling activities. The use of ergonomic devices was high and associated with less forceful movements and awkward back postures. Both aspects will most likely contribute to the prevention of low back pain among nurses.

How much equipment is prescribed for people with spinal cord injury in Australia, do they use it and are they satisfied 1 year later?

BACKGROUND AND PURPOSE: The purpose of this study was to determine the amount and type of equipment prescribed to aid mobility and self-care for patients with spinal cord injuries (SCI) in Australia and to determine how frequently the equipment is used 1 year later and whether patients are satisfied with it. METHODS: A consecutive series of 61 patients admitted for rehabilitation to two Sydney SCI units were recruited. All mobility and self-care equipment worth more than $AU50 prescribed by therapists before patients' discharge was recorded. This included wheelchairs, commodes, shower chairs, hoists, electric beds, pressure-relieving cushions, bed mattresses, slideboards, walking aids, orthoses, electrical stimulation systems and other pieces of notable exercise equipment. Patients were interviewed 1 year later and asked about each piece of equipment they had been prescribed. Specifically, they were asked about how frequently they had used each piece of equipment and whether they were satisfied with it. Data were analysed using descriptive statistics. RESULTS: Three hundred and fourteen pieces of equipment, including 68 wheelchairs, were prescribed for the 61 patients. Most of the equipment (226/314) was used more than 20 times in the 2 months preceding the 1-year review. Most patients were satisfied or highly satisfied with the majority of equipment prescribed, although patients were very dissatisfied or only partly dissatisfied with 18/314 pieces of equipment. DISCUSSION: Patients were generally satisfied with the equipment they were prescribed. There was a small amount of equipment prescribed that was not used 1 year later or with which patients were dissatisfied.

Biodegradable polymer drug-eluting stents versus durable polymer drug-eluting stents for percutaneous coronary intervention: a contemporary registry-based analysis.

AIMS: We aimed to compare the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with biodegradable polymer drug-eluting stents (BP-DES) versus durable polymer drug-eluting stents (DP-DES). METHODS AND RESULTS: Among 11 517 PCIs with second-generation DES performed in our institution between 2007 and 2019, we identified 8042 procedures performed using DP-DES and 3475 using BP-DES. The primary outcome was target lesion failure, the composite target lesion revascularization (TLR), target vessel myocardial infarction and death. Propensity score matching was used to create a well-balanced cohort. Mean follow-up was 4.8 years. Of the 3413 matched pairs, 21% were females, and the mean age was 66 years. At 1 year, the primary outcome occurred in 8.3% patients versus 7.1% (P = 0.07), and TLR rate was 3% versus 2% (P = 0.006) in patients with DP-DES and BP-DES respectively. Within 5 years, the primary outcome occurred in 23.1% versus 23.4% (P = 0.44), and the rate of TLR was 7.2% versus 6.5% (P = 0.07) in patients with DP-DES and BP-DES, respectively. CONCLUSION: Similar rates of the composite outcome were observed throughout the entire follow-up. Target lesion revascularization rates were lower in the BP-DES group at 1-year but equalized within 5 years.

Individual and organisational determinants of use of ergonomic devices in healthcare.

OBJECTIVE: This study aims to identify individual and organisational determinants associated with the use of ergonomic devices during patient handling activities. METHODS: This cross-sectional study was carried out in 19 nursing homes and 19 hospitals. The use of ergonomic devices was assessed through real-time observations in the workplace. Individual barriers to ergonomic device use were identified by structured interviews with nurses and organisational barriers were identified using questionnaires completed by supervisors and managers. Multivariate logistic analysis with generalised estimating equations for repeated measurement was used to estimate determinants of ergonomic device use. RESULTS: 247 nurses performed 670 patient handling activities that required the use of an ergonomic device. Ergonomic devices were used 68% of the times they were deemed necessary in nursing homes and 59% in hospitals. Determinants of lifting device use were nurses' motivation (OR 1.96), the presence of back complaints in the past 12months (OR 1.77) and the inclusion in care protocols of strict guidance on the required use of ergonomic devices (OR 2.49). The organisational factors convenience and easily accessible, management support and supportive management climate were associated with these determinants. No associations were found with other ergonomic devices. CONCLUSIONS: The use of lifting devices was higher in nursing homes than in hospitals. Individual and organisational factors seem to play a substantial role in the successful implementation of lifting devices in healthcare.

Evaluation of the medtronic exponent self-expanding carotid stent system with the medtronic guardwire temporary occlusion and aspiration system in the treatment of carotid stenosis: combined from the MAVErIC (Medtronic AVE Self-expanding CaRotid Stent System with distal protection In the treatment of Carotid stenosis) I and MAVErIC II trials.

BACKGROUND AND PURPOSE: Embolic protection devices and improved stent technology have advanced the endovascular treatment of carotid artery disease. A combined analysis was performed of the MAVErIC (Medtronic AVE Self-expanding CaRotid Stent System with distal protection) I and II trials to evaluate the safety and feasibility of this system among patients at high risk for surgical endarterectomy. METHODS: Four hundred ninety-eight patients were enrolled in the MAVErIC I (99 patients) and MAVErIC II (399 patients) studies from June 2001 to October 2004. The results were pooled for statistical analysis of a common primary end point, the 365-day rate of major adverse events. Clinical follow-up took place at 30 days, 6 months, and 365 days postprocedure. RESULTS: The 365-day major adverse event rate, defined as death, stroke, or myocardial infarction within 30 days, and death, ipsilateral stroke, or myocardial infarction from days 31 to 365 was 12.5%. The incidence of neurological death through 365 days was 1.1%. The 30-day major adverse event rate was 5.4%. Subgroup analyses showed no notable differences in the 365-day major adverse event rate for symptomatic patients compared with asymptomatic patients. CONCLUSIONS: Treatment of carotid artery disease with carotid artery stenting with a self-expanding stent and distal embolic protection results in a low 30-day adverse event rate, including the occurrence of stroke in patients at high risk for carotid endarterectomy.

A timeline for predicting durable medical equipment needs and interventions for amyotrophic lateral sclerosis patients.

ALS is progressive with increasing patient needs for durable medical equipment (DME) and interventions (gastric feeding tube - PEG, and non-invasive ventilation - NIV). We performed a chart review of deceased patients to determine the time-course of needs and their estimated costs. A timeline of needs was based on when clinic personnel felt an item was necessary. The point in time when an item or intervention was needed was expressed as a percentage of a patient's total disease duration. A wide range of DME and interventions was needed irrespective of site of ALS symptom onset (bulbar, upper, lower extremity), beginning at 10% of disease duration of lower extremity onset and increasing thereafter for all sites. The cumulative probability of costs of items and interventions began at 25%-50% of disease duration and increased to between $18,000 and $32,000 (USD), highest for lower extremity onset due to the cost of wheelchairs. We conclude that a high percentage of ALS patients will need a full spectrum of major DME items and interventions during the second half of disease duration. This results in a linear rise in costs over the second half of the disease duration.

Quality of antenatal care and obstetrical coverage in rural Burkina Faso.

Improving maternal health is one of the Millennium Development Goals of the United Nations. Despite the efforts to promote maternal and neonatal care to achieve this goal, the use of delivery care remains below expectations in Burkina Faso. This situation raises the question of the quality of care offered in maternity wards. The aim of this study was to identify primary healthcare facility and antenatal care characteristics predictive of an assisted delivery in rural Burkina Faso. A cross-sectional study was carried out in Gnagna province (North-East Burkina Faso) in November 2003. The operational capacities of health facilities were assessed, and a non-participating observation of the antenatal care (ANC) procedure was undertaken to evaluate their quality. Scores were established to summarize the information gathered. The rate of professional childbirth (obstetrical coverage) was derived from the number of childbirths registered in the health facility compared to the size of the population. The established scores were related to the obstetrical coverage using non-parametric tests (Kendall). In total, 17 health facilities were visited, and 81 antenatal consultations were observed. Insufficiencies were observed at all steps of ANC (mean total score for the quality of ANC=10.3 +/- 3.0, ranging from 6 to 16, out of a maximum of 20). Health facilities are poorly equipped, and the availability of qualified staff remained low (mean total score for the provision of care was 22.9 +/- 4.2, ranging from 14 to 33). However, these scores were not significantly related to the rate of professional childbirth (tau Kendall=0.27: p=0.14 and 0.01, p=0.93 respectively). The ability of the primary health centres to provide good antenatal care remains low in rural Burkina Faso. The key factors involved in the limited use of professional childbirth relating to maternal health services may be the quality of ANC.

Investigation of Relationship Between Spatial Distribution of Medical Equipment and Preventable Mortality.

The aim of the study is to investigate the relationship between the spatial distribution of the selected medical equipment and the preventable mortality rate in the regions of the Slovak Republic. The main analytical approach is carried out through the cluster analysis based on a Euclidean distance technique in order to get similarity of the administrative divisions in form of a district and a pseudot2 approach aimed at the determination of a number of the districts in a cluster. A number of medical equipment had a rising tendency from the year 2008. The most extreme position according to a localisation distribution of the computed tomographs and the magnetic resonance imaging scanners is held by the Kosice IV District at the level of 7.50630. From an angle of view of the preventable mortality, the Piestany District holds the most extreme position peaking at the level of 10.97969 for the female sex and the Kezmarok District with the value of 9.44088. The study has the significant dissemination outputs for health policy interventions, especially to draw up regional health plans for computed tomography and magnetic resonance imaging deployment, mainly in locations with a high preventable mortality rate for both sexes.

Using Lean methodologies to streamline processing of requests for durable medical equipment and supplies for children with complex conditions.

BACKGROUND: An improvement team from the Complex Care Center at our large pediatric medical center participated in a 60-day initiative to use Lean methodologies to standardize their processes, eliminate waste and improve the timely and reliable provision of durable medical equipment and supplies. METHODS: The team used value stream mapping to identify processes needing improvement. Improvement activities addressed the initial processing of a request, provider signature on the form, returning the form to the sender, and uploading the completed documents to the electronic medical record. Data on lead time (time between receiving a request and sending the completed request to the Health Information Management department) and process time (amount of time the staff worked on the request) were collected via manual pre- and post-time studies. RESULTS: Following implementation of interventions, the median lead time for processing durable medical equipment and supply requests decreased from 50 days to 3 days (p < 0.0001). Median processing time decreased from 14min to 9min (p < 0.0001). The decrease in processing time realized annual cost savings of approximately $11,000. CONCLUSIONS: Collaborative leadership and multidisciplinary training in Lean methods allowed the CCC staff to incorporate common sense, standardize practices, and adapt their work environment to improve the timely and reliable provision of equipment and supplies that are essential for their patients. IMPLICATIONS: The application of Lean methodologies to processing requests for DME and supplies could also result in a natural spread to other paperwork and requests, thus avoiding delays and potential risk for clinical instability or deterioration.

Low use of durable medical equipment by chronically disabled elderly.

Assistive devices are a common effective approach to mitigating the effects of chronic disability. The Medicare Durable Medical Equipment (DME) benefit is intended to provide patients with equipment to meet the challenges of health-related disability; the penetrance of benefit among the disabled is unclear. A nationally representative cohort of 4,687 community-dwelling elderly enrolled in fee-for-service Medicare (part of the Medicare Current Beneficiary Survey in 1999 and 2000) assessed self-reported disability, and receipt of Medicare DME was assessed through linked claims. Fewer than half the chronically disabled, and less than one-quarter of the newly disabled, received any DME from Medicare. These data suggest underuse of the benefit by the disabled elderly.

A new era for Nuclear Medicine neuroimaging in Spain: Where do we start from in Spain? / Nuevos tiempos para la neuroimagen de Medicina Nuclear en España: ¿de dónde partimos?

OBJECTIVE: To determine the status of neuroimaging studies of Nuclear Medicine in Spain during 2013 and first quarter of 2014, in order to define the activities of the neuroimaging group of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM). MATERIAL AND METHODS: A questionnaire of 14 questions was designed, divided into 3 parts: characteristics of the departments (equipment and professionals involved); type of scans and clinical indications; and evaluation methods. The questionnaire was sent to 166 Nuclear Medicine departments. RESULTS: A total of 54 departments distributed among all regions completed the questionnaire. Most departments performed between 300 and 800 neuroimaging examinations per year, representing more than 25 scans per month. The average pieces of equipment were three; half of the departments had a PET/CT scanner and SPECT/CT equipment. Scans performed more frequently were brain SPECT with 123I-FP-CIT, followed by brain perfusion SPECT and PET with 18F-FDG. The most frequent clinical indications were cognitive impairment followed by movement disorders. For evaluation of the images most sites used only visual assessment, and for the quantitative assessment the most used was quantification by region of interest. CONCLUSIONS: These results reflect the clinical activity of 2013 and first quarter of 2014. The main indications of the studies were cognitive impairment and movement disorders. Variability in the evaluation of the studies is among the challenges that will be faced in the coming years.

Responses to the acquisition and use of power mobility by individuals who have multiple sclerosis and their families.

PURPOSE: To develop an understanding of family members' reactions to the acquisition of power mobility by persons with multiple sclerosis (MS) from the perspectives of the end users and their family members. METHODS: Data were obtained through semistructured interviews with seven persons with MS using or considering power mobility and four of their family members. RESULTS: Three major themes emerged from the data. Recognizing the Need for Power Mobility resulted from the interaction between multiple sclerosis progression and the participants' desired performance. Family decision making and communication, insurance funding and approval, and the physical and social environment were just some of the factors affecting the process of Deciding and Obtaining the Power Mobility. Using Power Mobility resulted in positive, negative, and neutral outcomes. CONCLUSIONS: This study uncovered an overall lack of resources and some issues within the family environment, such as communication and decision making, both of which can negatively impact the acquisition and use of power mobility for persons with MS. Understanding these challenges may assist occupational therapists to facilitate this transition with their clients.

Determining the space needed to operate a mobile and an overhead patient hoist.

Inadequate bed space affects manual handling techniques and the ability to carry out nursing care tasks. Many nurses will join a trust on the basis of the workspace design of the wards. This paper looks at the space required to operate two types of hoist and argues for the recommended bed space dimensions to be increased.

An overview of polyurethane foams in higher specification foam mattresses.

Soft polyurethane foams exist in thousands of grades and constitute essential components of hospital mattresses. For pressure ulcer prevention, the ability of foams to control the immersion and envelopment of patients is essential. Higher specification foam mattresses (i.e., foam mattresses that relieve pressure via optimum patient immersion and envelopment while enabling patient position changes) are claimed to be more effective for preventing pressure ulcers than standard mattresses. Foam grade evaluations should include resiliency, density, hardness, indentation force/load deflection, progressive hardness, tensile strength, and elongation along with essential criteria for higher specification foam mattresses. Patient-specific requirements may include optimal control of patient immersion and envelopment. Mattress cover characteristics should include breathability, impermeability to fluids, and fire safety and not affect mattress function. Additional determinations such as hardness are assessed according to the guidelines of the American Society for Testing and Materials and the International Organization for Standardization. At this time, no single foam grade provides an optimal combination of the above key requirements, but the literature suggests a combination of at least 2 foams may create an optimal higher specification foam mattress for pressure ulcer prevention. Future research and the development of product specification accuracy standards are needed to help clinicians make evidence-based decisions about mattress use.

Technology assessment of multileaf collimation: a North American users survey.

PURPOSE: The American Association of Physicists in Medicine (AAPM) initiated an Assessment of Technology Subcommittee (ATS) to help the radiotherapy community evaluate emerging technologies. The ATS decided to first address multileaf collimation (MLC) by means of a North American users survey. The survey attempted to address issues such as MLC utility, efficacy, cost-effectiveness, and customer satisfaction. METHODS AND MATERIALS: The survey was designed with 38 questions, with cross-tabulation set up to decipher a particular clinic's perception of MLC. The surveys were coded according to MLC types, which were narrowed to four: Elekta, Siemens, Varian 52-leaf, and Varian 80-leaf. A 40% return rate was desired. RESULTS: A 44% (108 of 250) return was achieved. On an MLC machine, 76.5% of photon patients are being treated with MLC. The main reasons for not using MLC were stair stepping, field size limitation, and physician objection. The most common sites in which MLC is being used are lung, pelvis, and prostate. The least used sites are head & neck and mantle fields. Of the facilities, 31% claimed an increase in number of patients being treated since MLC was installed, and 44% claimed an increase in the number of fields. Though the staffing for block cutting has decreased, therapist staffing has not. However, 91% of the facilities claimed a decreased workload for the therapists, despite the increase in daily treated patients and fields. Of the facilities that justified MLC purchase for more daily patients, 63% are actually treating more patients. Only 26% of the facilities that justified an MLC purchase for intensity-modulated radiotherapy (IMRT) are currently using it for that purpose. The satisfaction rating (1 = low to 5 = high) for department groups averaged 4.0. Therapists ranked MLC as 4.6. CONCLUSIONS: Our survey shows that most users have successfully introduced MLC into the clinic as a block replacement. Most have found MLC to be cost-effective and efficient. The use of MLC for IMRT has progressed slower, but users anticipate escalated use.

Characteristics and treatment of patients not reusing dialyzers in reuse units.

Dialyzer reuse is practiced in more than 75% of the patients and dialysis units in the United States. However, reuse is not practiced in a small fraction of patients treated in reuse units (RUUs). This study evaluates both patient and facility characteristics associated with nonreuse in RUUs. The data source is from the Dialysis Mortality and Morbidity Study, Waves 1, 3, and 4, of the US Renal Data System. Only facilities that practiced dialyzer reuse were included in the analysis. A total of 12,094 patients from 1,095 reuse facilities were studied. Patients undergoing hemodialysis as of December 31, 1993, were selected. Of all patients treated in RUUs, 8% did not reuse dialyzers. Nonreuse was significantly (P < 0.02) more common, based on adjusted odds ratios (ORs), among patients who were younger (OR = 1.16 per 10 years younger), had primary glomerulonephritis (OR = 1.26 versus diabetes), had lower serum albumin level (OR = 1.72 per 1 g/dL lower), had more years on dialysis, and had higher level of education. Nonreuse patients were more likely to be treated with low-flux dialyzers (OR = 7.35; P < 0. 0001) and have a lower dialysis dose. No reuse was more likely in larger units and in not-for-profit and hospital-based units. Patient refusal accounted for one fourth of nonreuse in RUUs and was associated with the same factors, as well as with fewer comorbid conditions and non-Hispanic ethnicity. Significant geographic variations (up to eightfold) were documented. Nonreuse patients are treated with smaller, low-flux dialyzers and, on average, receive a lower Kt/V than reuse patients in the same units.

Service provision for patients with ALS/MND: a cost-effective multidisciplinary approach.

Optimal management of patients with ALS/MND requires a team approach, with early referral to paramedical services for clinical assessment and prompt intervention. As the condition progresses, a flexible approach to management must be adopted by the medical team, with an ability to intervene at very short notice. We have developed an efficient multi-disciplinary clinic that services the ALS/MND population of Ireland by combining the existing infrastructure of community services with a hospital-based specialist clinic. The clinic operates on a weekly basis, and is staffed by a core team including a neurologist, a liaison nurse, and the director of the ALS/MND Association. On-site and same-day physiotherapy, occupational therapy and speech therapy is available, as is pulmonary evaluation. All patients utilising the clinical services are automatically included on the Irish Register of Motor Neurone Disease, and are tracked by the liaison nurse. The core members of the clinic interact regularly with paramedical staff within the community, ensuring that necessary community services are made available within 1-2 weeks of the clinic visit. Equipment necessary for the patient's well being is made available free of charge by the Irish Motor Neurone Disease Association, following an appropriate request from the regional para-medical staff. We have thus demonstrated that an effective multi- disciplinary care service for ALS/MND can be developed at modest cost by close personal liaison between the existing health care structures and core members of a multidisciplinary team.