RESUMEN
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.
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Accidentes por Caídas , Hospitalización , Pacientes Internos , Adulto , Humanos , Medición de Riesgo/métodosRESUMEN
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.
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Antígenos CD/genética , Quinasa 1 de Adhesión Focal/genética , Glicoproteínas de Membrana/genética , Mielofibrosis Primaria/genética , Proteínas Serina-Treonina Quinasas/genética , Receptores de Factores de Crecimiento Transformadores beta/genética , Regulación hacia Arriba , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Antígenos CD/análisis , Examen de la Médula Ósea , Linfocitos T CD4-Positivos/química , Estudios de Casos y Controles , Femenino , Quinasa 1 de Adhesión Focal/análisis , Perfilación de la Expresión Génica , Humanos , Inmunohistoquímica , Masculino , Glicoproteínas de Membrana/análisis , Persona de Mediana Edad , Análisis de Secuencia por Matrices de Oligonucleótidos , Mielofibrosis Primaria/inmunología , Mielofibrosis Primaria/patología , Probabilidad , Proteínas Serina-Treonina Quinasas/análisis , Receptor Tipo II de Factor de Crecimiento Transformador beta , Receptores de Factores de Crecimiento Transformadores beta/análisis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Bazo/química , Tetraspanina 29RESUMEN
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.
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Educación Médica/métodos , Adhesión a Directriz/estadística & datos numéricos , Desinfección de las Manos/métodos , Personal de Salud , Infección Hospitalaria/prevención & control , HumanosRESUMEN
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.
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Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Urinario/enfermería , Infecciones Urinarias/prevención & control , Infección Hospitalaria/prevención & control , Práctica Clínica Basada en la Evidencia , Humanos , Estudios de Casos Organizacionales , Garantía de la Calidad de Atención de Salud/métodos , Gestión de Riesgos , Texas , Factores de Tiempo , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/etiologíaRESUMEN
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.