Adapting Simulation Education During a Pandemic.

Nursing education faced unprecedented challenges in maintaining quality clinical and simulation instruction during the COVID-19 pandemic. Strategies to maintain clinical engagement and meet course objectives included using virtual simulation and safely reopening simulation laboratories as soon as it was possible. When using virtual experiences for replacement of clinical or simulation, it is critical that standards of best practice are implemented. Safely reopening laboratories required plans for social distancing, health screening, personal protective equipment, disinfecting, and educating users on the new protocols. Combining these strategies resulted in delivering quality instruction without interruption during the pandemic.

Improving Patient Safety and Quality in Physical Medicine and Rehabilitation Through Participation in the American Board of Physical Medicine and Rehabilitation Continuing Certification Program.

ABSTRACT: The American Board of Medical Specialties Continuing Certification Program's Improvement in Medical Practice Standard requires physicians to participate in practice improvement activities. Despite this universal requirement, there has been no assessment of this requirement or its potential impact on patient care. Because of its continuing certification oversight structure, the American Board of Physical Medicine and Rehabilitation is in a unique position to provide this assessment. Review of quality improvement projects submitted to the American Board of Physical Medicine and Rehabilitation for continuing certification compliance revealed that most diplomates (70.1%) used available topic-specific options. These projects are designed to be directive and easy to use for physicians with limited quality improvement experience. Examples of topic-directed project potential impact on patient care include preventing wrong-site injections through implementing a preprocedure timeout or decreasing opioid prescribing risk through implementation of an opioid risk assessment tool. Thirty percent of submissions described improvement efforts in other areas of practice. These projects were directed toward areas of patient care including safety, communication/education, satisfaction, processes, and outcomes. This study demonstrates the efforts of physiatrists to improve care and the potential impact of these efforts on patient care and safety through participation in continuing certification.

Interrater Reliability in the American Board of Physical Medicine and Rehabilitation Part II Certification Examination: Impact of a New Assessment Design.

OBJECTIVE: The design of medical board certification examinations continues to evolve with advances in testing innovations and psychometric analysis. The potential for subjectivity is inherent in the design of oral board examinations, making improvements in reliability and validity especially important. The purpose of this quality improvement study was to analyze the impact of using two examiners on the overall reliability of the oral certification examination in physical medicine and rehabilitation. DESIGN: This was a retrospective quality improvement study of 422 candidates for the American Board of Physical Medicine and Rehabilitation Part II Examination in 2020. Candidates were examined by examiner pairs, each of whom submitted independent scores. Training for all 116 examiners included examination case review, scoring guidelines, and bias mitigation. Examiner performance was analyzed for both internal consistency (intrarater reliability) and agreement with their paired examiner (interrater reliability). RESULTS: The reliability of the Part II Examination was high, ranging from 0.93 to 0.94 over three administrations. The analysis also demonstrated high interrater agreement and examiner internal consistency. CONCLUSIONS: A high degree of interrater agreement was found using a new, two-examiner format. Comprehensive examiner training is likely the most significant factor for this finding. The two-examiner format improved the overall reliability and validity of the Part II Examination.

A Computer-Based Tutor to Teach Nursing Trauma Care That Works as an Adjunct to High-Fidelity Simulation.

Educators are challenged to prepare nurses to care for low-frequency, high-stakes problems such as trauma. Computer-based tutors provide a cost-effective teaching strategy without risking patient safety. Evidence for the efficacy of this type of instruction is limited; thus, we tested the learning outcomes of a tutor on trauma care knowledge with senior nursing students. Participants were randomly assigned to either the tutor or a control condition (textbook learning). Instructional design elements incorporated into the tutor included use of multimedia content, emphasis of key points, frequent quizzing with instant feedback, and unfolding case studies to summarize key concepts. Use of the tutor led to a larger increase in trauma nursing knowledge than use of a textbook. In addition, the knowledge was retained as well as book-based learning. The effect size of the tutor, 1.15, was relatively high as well-the average for computer tutors is 0.79. Qualitative focus groups revealed that participants expressed favorable views of the tutor in comparison to textbook learning. They found it more engaging and more enjoyable and reported that it effectively organized the content. The results of this study support the efficacy of a well-designed computer-based tutor for learning key concepts of trauma nursing.

Enteral Feeding Tube Clogging: What Are the Causes and What Are the Answers? A Bench Top Analysis.

BACKGROUND: Clogged enteral feeding tubes remain a significant barrier to the delivery of nutrition, hydration, and medications to patients who cannot tolerate oral intake. There is limited research that compares the relative efficacy of different methods used to clear a clogged feeding tube. The objectives of this study were to better understand the factors that contribute to enteral feeding tube clogging and to test the efficacy of 3 methods for clearing clogged feeding tubes. METHODS: Three formulations of clogs were artificially created and tested in vitro and composed of various quantities of crushed medication (ie, aspirin) and 0.15 g coagulated protein (ie, tofu). The following 3 clog clearing strategies were tested on all clog types (n = 5 clogs/formulation/treatment): warm water flushes, an enzyme treatment, and an actuated mechanical occlusion clearing device. RESULTS: The variable among the clog types that appears most responsible for decreased clearing success is the state of the coagulated protein. Dried-out protein appears to makes a greater difference than increasing the medication quantity. The actuated mechanical occlusion clearing device was significantly more successful (93%) when compared with warm water flushes (20%) and the commercially available enzyme treatment (33%; P < .005) at clearing the clogs. The actuated device required significantly less total procedure time (P < .005) and total nursing time (P < .005) when compared with the other 2 clearing methods. CONCLUSIONS: When clogs occur, they can be quickly and effectively resolved by the actuated device, but other methodologies such as water and enzyme treatments may be of assistance.

Lessons from the field: challenges in accruing hospice heart failure patients to intervention research.

Recent clinical practice guidelines suggest that hospice can be a valuable alternative for patients with advanced heart failure (HF). Unfortunately, there are very few evidence-based nursing interventions to guide symptom management for HF patients in hospice and their caregivers. Nevertheless, conducting clinical research in hospice populations remains fraught with methodological and ethical challenges. Our research team was not naive to the fact that hospice research is difficult. We believed that we had prepared well for a number of contingencies before the beginning of our clinical trial testing the feasibility of delivering a psychosocial intervention to caregivers of patients with HF. Despite the team expertise and well-defined recruitment strategies, the recruitment, both accrual and attrition, remained daunting in this population. The purpose of this article was to report the challenges of recruiting hospice patients with HF and caregivers for our randomized clinical trial, those we anticipated and those we did not.

Predictors of Quality of Life in Elderly Hospice Patients with Cancer.

PURPOSE: While quality of life is the focus of care in hospices, limited research has been conducted on the quality of life of cancer patients in hospice home care. The purpose of this study was to explore the predictors of quality of life of older adults who are receiving hospice care in their homes. METHODS: A secondary analysis of data from a larger study was conducted using linear regression and including the following predictor variables: age, functional status, number of symptoms endorsed, overall symptom distress, pain intensity, and depressive symptoms. The outcome variable was quality of life. RESULTS: The sample consisted of 533 adults with an average age of 78.1 years (SD=7.4). A regression model that included symptom distress, number of symptoms, depression, and functional status accounted for 46% of the variance in quality of life. Pain, age, and caregiver depression did not contribute to predicting quality of life and therefore were not included in the final model. CONCLUSIONS AND IMPLICATIONS: Because both physical symptoms and depression are predictors of quality of life, a continued focus is needed on these factors by those providing care to older adults with cancer near the end of life.

Patentes de medicamentos em evidência: compartilhando experiência prática sobre patentes de produtos farmacêuticos / Medicine patents in evidence: sharing practical experience on patents of pharmaceutical products

Apresenta informações técnicas sobre patentes de produtos farmacêuticos. Discute o Acordo sobre Aspectos de Direitos de Propriedade Intelectual Relacionadas ao comércio - TRIPS, estabelecido em 1994. Traz quatro conceitos chave para entender as patentes de medicamento. Mostra a razão pela qual o sistema de patente deveria responder aos interesses públicos dos países. Orienta como ler e usar uma tabela de patente

Patentes de medicamentos em evidência: compartilhando experiência prática sobre patentes de produtos farmacêuticos / Drug patents in evidence: sharing practical experience on pharmaceutical patents

Apresenta informações técnicas sobre patentes de produtos farmacêuticos. Discute o Acordo sobre Aspectos de Direitos de Propriedade Intelectual Relacionadas ao comércio - TRIPS, estabelecido em 1994. Traz quatro conceitos chave para entender as patentes de medicamento. Mostra a razão pela qual o sistema de patente deveria responder aos interesses públicos dos países. Orienta como ler e usar uma tabela de patente