Unveiling the Interfacial Effects for Enhanced Hydrogen Evolution Reaction on MoS2 /WTe2 Hybrid Structures.

Using the MoS2 -WTe2 heterostructure as a model system combined with electrochemical microreactors and density function theory calculations, it is shown that heterostructured contacts enhance the hydrogen evolution reaction (HER) activity of monolayer MoS2 . Two possible mechanisms are suggested to explain this enhancement: efficient charge injection through large-area heterojunctions between MoS2 and WTe2 and effective screening of mirror charges due to the semimetallic nature of WTe2 . The dielectric screening effect is proven minor, probed by measuring the HER activity of monolayer MoS2 on various support substrates with dielectric constants ranging from 4 to 300. Thus, the enhanced HER is attributed to the increased charge injection into MoS2 through large-area heterojunctions. Based on this understanding, a MoS2 /WTe2 hybrid catalyst is fabricated with an HER overpotential of -140 mV at 10 mA cm-2 , a Tafel slope of 40 mV dec-1 , and long stability. These results demonstrate the importance of interfacial design in transition metal dichalcogenide HER catalysts. The microreactor platform presents an unambiguous approach to probe interfacial effects in various electrocatalytic reactions.

Patient, Nurse, and Organizational Factors That Influence Evidence-Based Fall Prevention for Hospitalized Oncology Patients: An Exploratory Study.

BACKGROUND: Hospital falls remain common despite decades of studies and guidelines to reduce their rate. Research evidence alone is insufficient, and integration of patient values and preferences, clinician expertise and experiences, and organizational culture is needed to ensure sustainable practice changes. Little is known about the best strategies for integrating these constructs to sustain effective fall prevention programs. AIMS: Guided by the Comprehensive Framework for Implementation Research (CFIR), this study aimed to identify patient, nursing staff, and organizational-level factors that influence effective and sustainable fall prevention strategies with the goal of identifying variables amenable to targeted interventions. METHODS: A descriptive research design engaged four oncology units in a Midwestern academic medical center and included patients (N = 39) and nursing staff (N = 70). Questionnaire data were collected from patients with interview assistance, and nursing staff completed a demographic form and two standardized instruments adapted for the study. Data were analyzed using descriptive statistics and narrative summaries. RESULTS: Findings indicated two-thirds of patients did not see themselves at risk for falling, despite nearly half having a fall history. Nursing staff indicated knowledge gaps related to specific known risks and interventions, and confidence in fall prevention management was lowest for team communication about patient risks and engaging patients and families in preventing falls. LINKING EVIDENCE TO ACTION: Engagement of patients in fall risk assessment and management, clear and routine communication among team members, and creating a culture of true engagement with appropriate leadership and resources can potentially improve the sustainability of successful fall prevention programs. The CFIR can guide the planning of fall prevention and other evidence-based practice changes to become hardwired and sustainable over time even with the ongoing introduction of new initiatives.

Usability Evaluation and Implementation of a Health Information Technology Dashboard of Evidence-Based Quality Indicators.

Health information technology dashboards that integrate evidence-based quality indicators can efficiently and accurately display patient risk information to promote early intervention and improve overall quality of patient care. We describe the process of developing, evaluating, and implementing a dashboard designed to promote quality care through display of evidence-based quality indicators within an electronic health record. Clinician feedback was sought throughout the process. Usability evaluations were provided by three nurse pairs and one physician from medical-surgical areas. Task completion times, error rates, and ratings of system usability were collected to compare the use of quality indicators displayed on the dashboard to the indicators displayed in a conventional electronic health record across eight experimental scenarios. Participants rated the dashboard as "highly usable" following System Usability Scale (mean, 87.5 [SD, 9.6]) and Poststudy System Usability Questionnaire (mean, 1.7 [SD, 0.5]) criteria. Use of the dashboard led to reduced task completion times and error rates in comparison to the conventional electronic health record for quality indicator-related tasks. Clinician responses to the dashboard display capabilities were positive, and a multifaceted implementation plan has been used. Results suggest application of the dashboard in the care environment may lead to improved patient care.

Sacred cow gone to pasture: a systematic evaluation and integration of evidence-based practice.

BACKGROUND: Sacred cows (SC) are old habits in practice, considered routine and above dispute, regardless of evidence to the contrary. PURPOSE: This is the first known report that aims to conduct a systematic evaluation of practices that have been described in the literature as SC and strategies for planned implementation of evidence-based practices (EBP). METHODS: A large, complex, academic medical center department of nursing compared SC to EBP. Nurses systematically reviewed and rated the degree to which current practices adhered to best-evidence versus SC. This initiative, "Sacred Cow: Gone to Pasture," was developed, structured, and implemented according to the Iowa Model of Evidence-Based Practice to Promote Quality Care, as well as Everett Rogers' Diffusions of Innovations Theory. Implementation of EBP followed a phase plan using the Implementation Strategies for Evidence-Based Practice to help to support adoption and integration. RESULTS: Review of organization-specific policies and procedures and reports of actual practices revealed that SC persist, even in a center internationally recognized as a leader in EBP. The SC initiative caught the attention of busy clinicians, and raised awareness of SC and the importance of adherence to EBP. The SC initiative resulted in policy and practice changes and sparked new EBP and research, resulting in numerous improvements, including a significant decline in catheter-associated urinary tract infections and shifting from basins to commercially prepared cloths for patient bathing. LINKING EVIDENCE TO ACTION: A strategic approach is crucial to eliminating SC and integrating EBP. This report calls nurses globally to action, to identify and abandon ineffective healthcare practices. Further research should compare and test the efficacy of implementation strategies, in particular how to sustain EBP in clinical settings.

Monitoring sedation in patients receiving opioids for pain management.

Excessive sedation precedes opioid-induced respiratory depression. An evidence-based practice project standardized systematic sedation monitoring by nurses using an opioid sedation scale and respiratory assessment when opioids are administered for pain management. Nurses were educated and documentation updated. Nurses demonstrated increased ability to identify at-risk patients (3.2 pre-implementation; 3.6 post-implementation; 1-4 Likert scale) and reported understanding the tool to assess for oversedation (2.6 pre-implementation; 3.2 post-implementation). Documentation compliance improved, and patient safety was maintained.

CE: Original Research: Are Milk and Molasses Enemas Safe for Hospitalized Adults? A Retrospective Electronic Health Record Review.

: Background: Constipation in hospitalized patients is common. As a treatment of last resort for unresolved constipation, a milk and molasses enema is often used by nursing staff. But there has been little research investigating the safety and efficacy of this approach. PURPOSE: The purpose of this retrospective study was to evaluate the safety of milk and molasses enemas for hospitalized adults with constipation that remained unresolved after standard treatment options were exhausted. METHODS: Data were extracted from the electronic health records (EHRs) of 615 adult patients who had received a milk and molasses enema between July 2009 and July 2013 at a large midwestern academic medical center. Data analysis occurred for a random subset of this group.Participant characteristic variables included age, sex, admitting diagnosis, diet orders, medications, laxatives and enemas administered before the milk and molasses enema, and laboratory values. Serious complication variables included bacteremia, bowel perforation, electrolyte abnormalities, allergic reaction, abdominal compartment syndrome, cardiac arrhythmia, dehydration, and death. FINDINGS: The final sample of 196 adults had a mean age of 56 years; 61.2% were female and 38.8% were male. Of 105 admitting diagnoses, the most frequent (9.7%) was abdominal pain, unspecified site. Of the 14 discharge dispositions, the most frequent was home or self-care (50.5%). A laxative order was present for 97.4% of patients and a stool softener order was present for 86.2%. Sodium and potassium levels remained within normal limits during hospitalization. For the subset of patients who had these values measured within 48 hours before and after milk and molasses enema administration, no significant changes were found. No cases of nontraumatic abdominal compartment syndrome or other serious adverse enema-related events were documented in the EHR. CONCLUSIONS: No safety concerns were identified from this retrospective EHR review of hospitalized adults who received a milk and molasses enema for constipation relief. The findings indicate that this treatment is safe, although further study examining its efficacy in this population is needed.

Evaluation of emergency department derived delirium prediction models using a hospital-wide cohort.

OBJECTIVE: Delirium is acute disorder of attention and cognition. We conducted an observational study using a hospital-wide database to validate three delirium prediction models that were developed to predict prevalent delirium within the first day of hospitalization after ED visit. METHODS: This was a retrospective cohort study at the academic medical center to evaluate the predictive ability of three previously developed prediction models for delirium from 2014 to 2017. We included patients aged 65 years and older who were hospitalized from ED. Nurses used the Delirium Observation Screening Scale (DOSS) twice daily while hospitalized. We extracted variables to examine the three prediction models with a positive DOSS screen within the first day of admission. The predictive ability was summarized using the area under the curve (AUC). RESULTS: We identified 2582 visits with a positive DOSS screen and 877 visits with a diagnosis of delirium from ICD9/10 codes among 12,082 encounters. The AUC of these prediction models ranged from 0.71 to 0.80 when predicting a positive DOSS screen, and 0.68 to 0.72 when predicting a ICD9/10 diagnosis of delirium. In our cohort, the delirium risk score which uses the cutoff of positive or negative predicted DOSS positive delirium with the AUC of 0.8 (p < .0001). The model demonstrated the sensitivity and the specificity of 91.2 (95% CI 90.0-92.3) and 50.3 (95% CI 49.3-51.3). CONCLUSION: In this study, the delirium risk score had the highest predictive ability for prevalent delirium defined by a positive DOSS within the first day of hospitalization.

CE: Original Research: Exploring Clinicians' Perceptions About Sustaining an Evidence-Based Fall Prevention Program.

: Purpose: This study aimed to address the knowledge gap between implementing and sustaining evidence-based fall prevention practices for hospitalized patients by exploring perspectives of the interprofessional health care team. DESIGN: A qualitative design was used to capture insights from clinicians across disciplines in a large midwestern academic medical center. METHODS: Four homogenous semistructured focus groups and three individual interviews involving a total of 20 clinicians were conducted between October 2013 and March 2014. Audio-recorded data were transcribed and analyzed using inductive qualitative analysis. FINDINGS: Two primary themes emerged from participants regarding the sustainability of an evidence-based fall prevention program: communication patterns within the interprofessional health care team and influences of hospital organizational practices and elements. Several subthemes also emerged. Participants gave nursing staff primary responsibility for fall risk assessment and prevention. CONCLUSIONS: Individual professional perceptions and practices, as well as organizational characteristics, affect the sustainability of evidence-based fall prevention practices. While all team members recognized patient falls as a significant quality and safety issue, most believed that direct care nurses hold primary responsibility for leading fall prevention efforts. The data support the importance of effective interprofessional team communication and organizational practices in sustaining an evidence-based fall prevention program across inpatient units. Furthermore, the data call into question the wisdom in labeling quality indicators as "nursing sensitive"; the evidence indicates that a team approach is best.