Diagnosis and treatment outcomes from prebronchodilator spirometry performed alongside lung cancer screening in a Lung Health Check programme.

INTRODUCTION: Incorporating spirometry into low-dose CT (LDCT) screening for lung cancer may help identify people with undiagnosed chronic obstructive pulmonary disease (COPD), although the downstream impacts are not well described. METHODS: Participants attending a Lung Health Check (LHC) as part of the Yorkshire Lung Screening Trial were offered spirometry alongside LDCT screening. Results were communicated to the general practitioner (GP), and those with unexplained symptomatic airflow obstruction (AO) fulfilling agreed criteria were referred to the Leeds Community Respiratory Team (CRT) for assessment and treatment. Primary care records were reviewed to determine changes to diagnostic coding and pharmacotherapy. RESULTS: Of 2391 LHC participants undergoing prebronchodilator spirometry, 201 (8.4%) fulfilled the CRT referral criteria of which 151 were invited for further assessment. Ninety seven participants were subsequently reviewed by the CRT, 46 declined assessment and 8 had already been seen by their GP at the time of CRT contact. Overall 70 participants had postbronchodilator spirometry checked, of whom 20 (29%) did not have AO. Considering the whole cohort referred to the CRT (but excluding those without AO postbronchodilation), 59 had a new GP COPD code, 56 commenced new pharmacotherapy and 5 were underwent pulmonary rehabilitation (comprising 2.5%, 2.3% and 0.2% of the 2391 participants undergoing LHC spirometry). CONCLUSIONS: Delivering spirometry alongside lung cancer screening may facilitate earlier diagnosis of COPD. However, this study highlights the importance of confirming AO by postbronchodilator spirometry prior to diagnosing and treating patients with COPD and illustrates some downstream challenges in acting on spirometry collected during an LHC.

Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/SWHPN Policy Statement.

Background: Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes. Goals: This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this. Methods: An international and interprofessional expert committee, including patients and caregivers, achieved consensus across a diverse working group representing pulmonary-critical care, palliative care, bioethics, health law and policy, geriatrics, nursing, physiotherapy, social work, pharmacy, patient advocacy, psychology, and sociology. Results: The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains: 1) delivery models, 2) comprehensive symptom assessment and management, 3) advance care planning and goals of care discussions, 4) caregiver support, 5) health disparities, 6) mass casualty events and emergency preparedness, and 7) research priorities. The recommendations encourage timely integration of palliative care, promote innovative primary and secondary or specialist palliative care delivery models, and advocate for research and policy initiatives to improve the availability and quality of palliative care for patients and their caregivers. Conclusions: This multisociety policy statement establishes a framework for early palliative care in serious respiratory illness and provides guidance for pulmonary-critical care clinicians and policymakers for its proactive integration.

Project to improve storage, access and incorporation of advance care plans in a regional Australian hospital.

PROBLEM: Despite acknowledged benefits, the impact of advance care planning on usual care is inconsistent. DESIGN: Quality improvement study. SETTING: A Western Australian regional hospital. KEY MEASURES FOR IMPROVEMENT: This project aimed to create a system for storing, accessing and incorporating advance care planning documents in clinical care. STRATEGIES FOR CHANGE: Interventions over 18 months addressed four areas: medical records processes for receiving and processing advance care planning documents; information technology solutions for electronic storage and alerts; clerical staff duties in regards advance care planning documents; and clinician education. EFFECTS OF CHANGE: There was a 12-fold increase in advance care planning documents stored electronically and 100% of audited notes had correct filing of advance care planning documents with an alert in place at follow-up audit. Clinician recognition of the presence of an advance care planning document improved. Detailed examples of interventions are described. LESSONS LEARNT: Repeated exposure to different forms of advance care planning education, in conjunction with simple but effective system changes can make a difference in changing established hospital practice. Final impact of these changes on end-of-life care requires further audit.

Health-services utilisation amongst older persons during the last year of life: a population-based study.

BACKGROUND: Accurate population-based data regarding hospital-based care utilisation by older persons during their last year of life are important in health services planning. We investigated patterns of acute hospital-based service use at the end of life, amongst older decedents in New South Wales (NSW), Australia. METHODS: Data from all persons aged ≥70 years who died in the state of NSW Australia in 2007 were included. Several measures of hospital-based service utilisation during the last year of life were assessed from retrospectively linked data comprising data for all registered deaths, cause of death, hospital care during the last year of life (NSW Admitted Patient Data Collection [APDC] and Emergency Department [ED] Data Collection [EDDC]), and the NSW Cancer Registry. RESULTS: Amongst 34,556 decedents aged ≥70 years, 82% (n = 28,366) had ≥1 hospitalisation during the last year of life (median 2), and 21% > 3 hospitalisations. Twenty-five percent (n = 5485) of decedents attended ED during the last week of life. Overall, 21% had a hospitalisation > 30 days in the last year of life, and 7% spent > 3 months in hospital; 79% had ≥1 ED attendance, 17% > 3. Nine percent (n = 3239) spent time in an intensive care unit. Fifty-three percent (n = 18,437) died in an inpatient setting. Hospital records had referenced palliative care for a fifth (7169) of decedents. Adjusting for age group, sex, place of residence, area-level socioeconomic status, and cause of death, having > 3 hospitalisations during the last year of life was more likely for persons dying from cancer (35% versus 16% non-cancer deaths, adjusted odds ratio [aOR] 2.33), 'younger' old decedents (29% for age 70-79 and 20% for age 80-89 versus 11% for 90+, aOR 2.42 and 1.77 respectively) and males (25% versus 17% females, aOR 1.38). Patterns observed for other hospital-based service use were similar. CONCLUSIONS: This population-based study reveals high use of hospital care among older persons during their last year of life, although this decreased with increasing older age, providing important data to inform health services planning for this population, and highlighting aspects requiring further study.

Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients.

BACKGROUND: Advance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. AIM: To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. METHODS: A pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer. RESULTS: When compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03). CONCLUSION: An increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care.

Evaluating the Liverpool Care Pathway for care of the terminally ill in rural Australia.

PURPOSE: This study evaluates a pilot implementation of the Liverpool Care Pathway (LCP), a clinical tool used to guide the care of dying patients in the last days of life, on the end-of-life care for dying patients in three regions in rural Australia. METHODS: The LCP was implemented at 13 participating sites: nine hospitals (general wards), one community-based palliative care service, and three in-hospital palliative care units. To evaluate the implementation of the LCP, 415 eligible patient records were examined: 223 pre-implementation and 192 post-implementation (116 on the LCP and 76 receiving usual care). The primary analysis compared all patients pre-implementation of the LCP versus all patients post-implementation. RESULTS: Increases were found post-implementation for communication with other health professionals and with patients or family (pre-69 %, post-87 %; p ≤ 0.000), use of palliative medications (pre-87 %, post-98 %; p ≤ 0.000) and frequency of symptom assessments (pre-66 %, post-82 %; p ≤ 0.000). Fewer blood and radiological investigations were conducted and venous access devices used in the post-implementation groups than in the pre-implementation period. CONCLUSIONS: This study suggests that when rigorously implemented, the LCP improves important components of end-of-life care for dying patients and their families.

Acute hospital-based services used by adults during the last year of life in New South Wales, Australia: a population-based retrospective cohort study.

BACKGROUND: There is limited information about health care utilisation at the end of life for people in Australia. We describe acute hospital-based services utilisation during the last year of life for all adults (aged 18+ years) who died in a 12-month period in Australia's most populous state, New South Wales (NSW). METHODS: Linked administrative health data were analysed for all adults who died in NSW in 2007 (the most recent year for which cause of death information was available for linkage for this study). The data comprised linked death records (2007), hospital admissions and emergency department (ED) presentations (2006-2007) and cancer registrations (1994-2007). Measures of hospital-based service utilisation during the last year of life included: number and length of hospital episodes, ED presentations, admission to an intensive care unit (ICU), palliative-related admissions and place of death. Factors associated with these measures were examined using multivariable logistic regression. RESULTS: Of the 45,749 adult decedents, 82% were admitted to hospital during their last year of life: 24% had >3 care episodes (median 2); 35% stayed a total of >30 days in hospital (median 17); 42% were admitted to 2 or more different hospitals. Twelve percent of decedents spent time in an ICU with median 3 days. In the metropolitan area, 80% of decedents presented to an ED and 18% had >3 presentations. Overall 55% died in a hospital or inpatient hospice. Although we could not quantify the extent and type of palliative care, 24% had mention of "palliative care" in their records. The very elderly and those dying from diseases of the circulatory system or living in the least disadvantaged areas generally had lower hospital service use. CONCLUSIONS: These population-wide health data collections give a highly informative description of NSWhospital-based end-of-life service utilisation. Use of hospital-based services during the last year of life was common, with substantial variation across sociodemographic groups, especially defined by age, cause of death and socioeconomic classification of the decedents' place of residence. Further research is now needed to identify the contributors to these findings. Gaps in data collection were identified - particularly for palliative care and patient-reported outcomes. Addressing these gaps should facilitate improved monitoring and assessment of service use and care.

Validity and reliability of an online extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E2) to measure nurses' fitness.

AIMS AND OBJECTIVES: To describe modifications to a second extended version of the Nordic Musculoskeletal Questionnaire for online use in nursing populations, and check validity and reliability. BACKGROUND: The Nordic Musculoskeletal Questionnaire has been used to assess the severity and impact of musculoskeletal symptoms in occupational groups. The reliability of a previous extended version was established for paper-based, self-administration among nursing students. This current study extended the questionnaire to collect more information regarding musculoskeletal symptoms in all nine body regions and their work-relatedness, as an instrument is needed to gather evidence about the impact of fitness levels on occupational musculoskeletal disorders among nurses. DESIGN: Psychometric evaluation. METHOD: Sixty-five undergraduate nurses completed the online extended Nordic Musculoskeletal Questionnaire twice. Content validity was examined by expert review and construct validity by exploratory factor analysis of 90 responses from the first completion. Reliability was checked by examining internal consistency, kappa statistics, proportions of observed, and positive and negative agreements, intra-class correlation coefficient and standard error of measurement. RESULTS: The instrument had high internal consistency and exploratory factor analysis revealed it was a relatively homogenous (unidimensional) measure of musculoskeletal symptom severity. Age of onset of symptoms questions were reliable, with high mean intra-class correlation coefficients and low mean standard errors of measurement. Overall, questions showed high mean strengths of agreement and proportions of observed agreement: three-quarters of the prevalence questions and 99% of the severity/impact questions had 10% or fewer disagreements. CONCLUSIONS: Modifications to the Nordic Musculoskeletal Questionnaire and online administration did not diminish its validity or reliability for obtaining information about the severity of nurses' musculoskeletal symptoms. RELEVANCE TO CLINICAL PRACTICE: Occupational musculoskeletal disorders are an issue for nurses. This questionnaire can be used to monitor nurses' musculoskeletal health, and in musculoskeletal disorder prevention studies.

Nursing education for disaster preparedness and response.

Catastrophic mass casualty events (MCEs), such as pandemic influenza outbreaks, earthquakes, or large-scale terrorism-related events, quickly and suddenly yield thousands of victims whose needs overwhelm local and regional health care systems, personnel, and resources. Such conditions require deploying scarce resources in a manner that is different from the more common multiple casualty event. This article presents issues associated with providing nursing care under MCE circumstances of scarce resources and the educational needs of nurses to prepare them to effectively respond in these emergencies.

Exploring the quality of life at the end of life (QUAL-E) instrument with Australian palliative care hospital patients: hurdles and directions.

The provision of care that enhances the quality of life at the end of life is a fundamental goal of palliative care services. This pilot study explored the application of the Quality of Life at the End of Life (QUAL-E) instrument in a sample of 52 patients who were hospitalized in two metropolitan Western Australian hospitals. Participants were given the option to complete the QUAL-E either as a self-report (n = 9, 17.3 percent) or, aided by a research assistant, as a structured interview (n = 43, 82.7 percent). The instrument demonstrated patient acceptability and face validity, particularly when it was administered with the assistance of a research assistant. Despite having difficulty with some questions, patients expressed their appreciation at being given the opportunity to contribute to the research and to reflect upon and give voice to their thoughts and feelings. Health practitioners indicated that the instrument could be a valuable tool for holistic assessment and service evaluation. We suggest that minor changes be made to the QUAL-E before it is used further in an Australian context; we also recommend that this instrument be tested in other settings and populations.

The Histopathological Spectrum of Scrotal Lesions in a Tertiary Care Hospital: A Cross-Sectional Study.

BACKGROUND: The incidence and clinical presentation of testicular and paratesticular lesions are variable. A preoperative diagnosis is often difficult with only a clinical examination. The diagnosis of testicular lesions is mainly based on histological investigation, despite advances in imaging and tumor marker testing. This study aimed to document the histopathological spectrum of scrotal lesions, including testicular and paratesticular lesions. AIM: The study aimed to research the histopathological spectrum of scrotal lesions. SETTINGS AND DESIGN: This was a cross-sectional study conducted at NKP Salve Institute of Medical Sciences & Research Centre and Lata Mangeshkar Hospital, a tertiary care hospital in Nagpur, India. MATERIALS AND METHODS: Following the institutional ethics committee's approval, a two-year cross-sectional study was carried out in the tertiary care hospital. Seventy operated scrotal specimens sent for histopathological examination were included in the study. The clinical details and investigations of the patients, as well as the gross and histopathological findings of all the specimens, were studied carefully. STATISTICAL ANALYSIS: The clinical details and gross and histopathological findings were noted in a proforma, entered in a Microsoft Excel sheet (Microsoft Corp., Redmond, WA), and verified. The data were presented in a tabular form using tablets, pie charts, and bar diagrams. The collected data were analyzed and presented in percentages and frequencies. RESULTS: The present study evaluated the histopathological spectrum of scrotal lesions in 70 operated scrotal masses. The mean age of the participants in the study was 46.55 ± 18.69 years, with the youngest patient at four years and the oldest being 88 years of age. Sixty-six (80%) of the 70 cases were of non-neoplastic lesions, while 14 (20%) were of neoplastic lesions. Testicular atrophy (16 cases) was the most common non-neoplastic lesion. The most frequent neoplastic lesion in the present study was a seminoma (seven cases). CONCLUSION: This study strongly recommends routine histopathological examination of all scrotal specimens for the detection of various testicular and paratesticular lesions, as well as neoplasms. Histopathology not only provides a tissue diagnosis in scrotal disorders, but it also adds to understanding etiopathogenesis and can aid in the development of future treatment options.

The Effectiveness of a Tailored Faculty Development Program for Undergraduate Mentoring and Its Impact on Mentor's Perceptions: A Mixed Methods Study.

OBJECTIVE: "Anubandh" the existing mentorship program at our institute used to start with enthusiasm but lacked sustainability throughout the year. This study aimed to assess the need for designing and conducting a faculty development program (FDP) and evaluating its impact on effective mentoring. METHODOLOGY: FDP was designed by assessing the perception of 50 teachers regarding undergraduate (UG) mentoring at a tertiary care teaching institute in central India, the NKP Salve Institute of Medical Sciences and Research Center and Lata Mangeshkar Hospital, Nagpur, India. It was developed and conducted by focusing on the global overview, mentoring policies of the institute and rationale while implementing mentorship. The effectiveness of FDP was tested by a change in pretest-posttest scores for assessing their knowledge and reflections on undergraduate mentoring. RESULTS: In the pre-FDP perceptions by mentors, the majority agreed that mentorship should be an integral part of the UG curriculum. Teachers felt that mentorship is an additional workload that needs to be given weightage in self-appraisal forms. A total of 81.2% of mentors emphasized on need for academic, social, and personal mentoring. After the FDP, there was a statistically significant improvement in the knowledge and attitude of mentors in all the assessed domains (χ2=2.648; df=6; p<0.05) like the need for UG mentoring in medical college and the role of faculties as a mentor. FDP sessions were appreciated by mentors for being motivating, interactive, and highly engaging with speakers having good oratory skills and using inspiring techniques with an overall rating of 9.2/10. CONCLUSION: There was an overall positive attitude about mentoring but many expressed the need for training in mentorship. The FDP was highly effective in improving the knowledge and attitude of mentors for effective mentoring.

Improving patient outcomes following a cancer diagnosis.

Cancer survival is improving, incidence is increasing and, for many, cancer is now being regarded as a long-term condition. Traditional followup services are no longer meeting the needs of patients, nor are they sustainable. Based on a long-term conditions model, NHS Improvement is working with test sites to develop new pathways of cancer aftercare. This article describes the new self-managed pathways and how they support recovery and health and wellbeing. With half of people with a cancer diagnosis having at least one other chronic condition (Elliott et al, 2011) and cancer more commonly being a disease affecting the elderly, community nurses have a role to play in sustaining self-management and supporting the seamless and coordinated delivery of these pathways. They are well placed to reinforce messages given in secondary care, to sell the benefits of a healthy lifestyle, to be aware of the local amenities to signpost patients to, and to encourage their uptake and embed self-management.

Clinical staff perceptions on the quality of end-of-life care in an Australian acute private hospital: a cross-sectional survey.

Objective To explore the perceptions of clinical staff on the quality of end-of-life care in an acute private hospital. Methods A descriptive cross-sectional study with a convenience sample of clinical staff in an acute private hospital were surveyed using a validated end-of-life survey. Data from the surveys were analysed using descriptive statistics for quantitative responses and inductive content analysis for the open-ended responses. Results Overall, 133 staff completed the survey. Of these, 107 had cared for a dying patient in the hospital. In total, 87.6% of participants felt confident in their ability to recognise a dying patient and 66.7% felt confident in their ability to talk to the patient and family. Almost one-third had not received specific training in the area. Conclusions Hospitals need to take the lead in ensuring end-of-life care processes are embedded across clinical areas. This includes providing staff with end-of-life care education and support in the delivery of end-of-life care. These strategies will facilitate safe and quality end-of-life care, including better collaboration between patients, families and staff. What is known about the topic? Key to providing quality end-of-life care in hospitals are strategic guidelines that support good clinical governance and adequately trained staff to deliver the care. What does the paper add? This study highlights the importance of clinical staff in all areas having skills and confidence in providing care to dying patients and their families. What are the implications for practitioners? It is important that all health practitioners implement strategies to overcome gaps in staff education and support, to ensure all patients and families receive quality end-of-life care.

Feasible choices in diagnostic methods of malaria.

BACKGROUND & OBJECTIVES: The present study was undertaken to find out a new easy method in the diagnosis of malaria by centrifuged buffy coat smear, which was found to be a feasible and reasonable procedure. METHODS: Blood samples collected from 120 patients suspected of malaria were subjected to all three diagnostic modalities-peripheral blood smear (PS), centrifuged buffy coat smear (CBCS) and antigen detection test using pLDH and aldolase (AG). RESULTS: The results of various methods were compared. It was seen that addition of centrifugation (i.e. CBCS) to conventional method of PS (i.e. thick and thin smears) improved its sensitivity from 85 to 93.3%. Antigen detection and CBCS were found superior to PS in sensitivity. CBCS gives combined sensitivity and specificity of both antigen and PS. CONCLUSION: CBCS is as sensitive as antigen test and as specific as PS in species identification. It is a reasonable and feasible procedure too.

Impact of a Nurse-Led Advance Care Planning Intervention on Satisfaction, Health-Related Quality of Life, and Health Care Utilization Among Patients With Severe Respiratory Disease: A Randomized Patient-Preference Trial.

CONTEXT: Previous work has found that facilitated advance care planning (ACP) interventions are effective in increasing ACP uptake among patients with severe respiratory disease. OBJECTIVES: The objective of this study was to investigate whether a nurse-led, facilitated ACP intervention among participants with severe respiratory disease impacts self-reported or clinical outcomes. METHODS: A multicenter, open-label, patient-preference, randomized controlled trial of a nurse-led facilitated ACP intervention was performed. Outcome measures included self-report scales (health care satisfaction and EQ-5D-5L health-related quality of life at three- and six-month follow-up), 12-month mortality, and health care utilization during the final 90 days of life. RESULTS: One hundred forty-nine participants were recruited across two study settings (metropolitan tertiary hospital respiratory department and rural sites) and 106 were allocated to receive the ACP intervention. There was no effect of the intervention on satisfaction with health care, health-related quality of life, or 12-month mortality rates. Among those participants who died during the follow-up period (N = 54), those allocated to the ACP intervention had significantly fewer outpatient consultations (7.51 vs. 13.6, P < 0.001). There were no changes in emergency department attendances, total hospital admissions or length of stay, or home nursing visits. Among those allocated to the ACP intervention, there was a reduced length of stay in acute hospital settings (7.76 vs. 11.5 nights, P < 0.001) and increased length of stay in palliative hospital settings (5.54 vs. 2.08, P < 0.001) during the final 90 days of life. CONCLUSION: A facilitated ACP intervention among patients with severe respiratory disease did not have an impact on satisfaction, health-related quality of life, or 12-month mortality rate. Facilitated ACP may be associated with a different type of health care utilization during the end-of-life period.

Evidence for improving palliative care at the end of life: a systematic review.

BACKGROUND: Many persons and their families are burdened by serious chronic illness in late life. How to best support quality of life is an important consideration for care. PURPOSE: To assess evidence about interventions to improve palliative and end-of-life care. DATA SOURCES: English-language citations (January 1990 to November 2005) from MEDLINE, the Database of Abstracts of Reviews of Effects, the National Consensus Project for Quality Palliative Care bibliography, and November 2005 to January 2007 updates from expert reviews and literature surveillance. STUDY SELECTION: Systematic reviews that addressed "end of life," including terminal illness (for example, advanced cancer) and chronic, eventually fatal illness with ambiguous prognosis (for example, advanced dementia), and intervention studies (randomized and nonrandomized designs) that addressed pain, dyspnea, depression, advance care planning, continuity, and caregiving. DATA EXTRACTION: Single reviewers screened 24,423 titles to find 6381 relevant abstracts and reviewed 1274 articles in detail to identify 33 high-quality systematic reviews and 89 relevant intervention studies. They synthesized the evidence by using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) classification. DATA SYNTHESIS: Strong evidence supports treating cancer pain with opioids, nonsteroidals, radionuclides, and radiotherapy; dyspnea from chronic lung disease with short-term opioids; and cancer-associated depression with psychotherapy, tricyclics, and selective serotonin reuptake inhibitors. Strong evidence supports multi component interventions to improve continuity in heart failure. Moderate evidence supports advance care planning led by skilled facilitators who engage key decision makers and interventions to alleviate caregiver burden. Weak evidence addresses cancer-related dyspnea management, and no evidence addresses noncancer pain, symptomatic dyspnea management in advanced heart failure, or short-acting antidepressants in terminal illness. No direct evidence addresses improving continuity for patients with dementia. Evidence was weak for improving caregiver burdens in cancer and was absent for heart failure. LIMITATIONS: Variable literature indexing for advanced chronic illness and end of life limited the comprehensiveness of searches, and heterogeneity was too great to do meta-analysis. CONCLUSION: Strong to moderate evidence supports interventions to improve important aspects of end-of-life care. Future research should quantify these effects and address the generalizability of insights across the conditions and settings of the last part of life. Many critical issues lack high-quality evidence.

The relationship between specialty nurse certification and patient, nurse and organizational outcomes: A systematic review.

OBJECTIVES: To review the current evidence on the relationship between specialty nurse certification and outcomes. DESIGN: A structured and comprehensive systematic review was undertaken using the Joanna Briggs Institute framework to include both published research studies and expert opinion papers. DATA SOURCES: Four electronic databases CINAHL, MEDLINE, PubMed, and PsychINFO were searched between 2000 and 2018. The search for expert opinion papers included nursing organizations, OaLster, Grey Literature Report, and The National Database of Nursing Quality Indicators. REVIEW METHODS: The records generated through the search were exported to EndNote X8 and duplicates were removed. Title and abstracts of the records were screened by three reviewers for eligibility using the selection criteria. In the absence of an abstract, records were retained for full text review. Full text assessment of each paper was conducted by two reviewers with a third referee, if necessary, to review any discrepancies. In the case of multiple articles drawing on one set of primary data, only one article was included. A review of each article was completed using the JBI Quality Appraisal checklists to assess internal and external reliability and validity. Both quality appraisal and data extraction were conducted by the review team independently and were validated by one other member of the team. Discrepancies were resolved through rigorous discussion between the reviewers. RESULTS: Forty one original research studies were included in the final analysis of the literature. The findings from the included articles were synthesized into three major categories and subsequent sub-categories: Patient outcomes, nurse outcomes and organizational outcomes. Twenty seven findings contributed to the sub-category of specialty nurse certification and patient outcomes. Patient outcomes were further classified into nurse sensitive outcomes, patient mortality and patient satisfaction. Fifty-four findings related to nurse outcomes with the sub-categories: personal and professional factors, knowledge and skills, organizational commitment, job satisfaction, empowerment and confidence. Six findings related to organizational benefits: including the sub-categories of nursing turnover and vacancy rates, perception of healthcare, and costs to the organization. CONCLUSIONS: The current model risks driving further proliferation of specialty certifications and certifying organizations without questioning the assumptions underlying the goals of certification. The challenges of measuring impact and the cost and value to individual nurses and healthcare organizations are key areas for consideration.

Analysis of Failure Rates for COVID-19 Entrance Screening at a US Academic Medical Center.

This quality improvement study analyzes the rate of failures in entrance screening for COVID-19 among individuals entering a large academic medical center.

A systematic review of measures of end-of-life care and its outcomes.

OBJECTIVE: To identify psychometrically sound measures of outcomes in end-of-life care and to characterize their use in intervention studies. DATA SOURCES: English language articles from 1990 to November 2005 describing measures with published psychometric data and intervention studies of end-of-life care. STUDY DESIGN: Systematic review of end-of-life care literature. EXTRACTION METHODS: Two reviewers organized identified measures into 10 major domains. Eight reviewers extracted and characterized measures from intervention studies. PRINCIPAL FINDINGS: Of 24,423 citations, we extracted 200 articles that described 261 measures, accepting 99 measures. In addition to 35 measures recommended in a prior systematic review, we identified an additional 64 measures of the end-of-life experience. The most robust measures were in the areas of symptoms, quality of life, and satisfaction; significant gaps existed in continuity of care, advance care planning, spirituality, and caregiver well-being. We also reviewed 84 intervention studies in which 135 patient-centered outcomes were assessed by 97 separate measures. Of these, 80 were used only once and only eight measures were used in more than two studies. CONCLUSIONS: In general, most measures have not undergone rigorous development and testing. Measure development in end-of-life care should focus on areas with identified gaps, and testing should be done to facilitate comparability across the care settings, populations, and clinical conditions. Intervention research should use robust measures that adhere to these standards.