One Year Post-Discharge Outcomes After Implementation of an ICU Early Mobility Protocol.

BACKGROUND: Early mobility benefits include improved strength, decreased length of stay (LOS), and delirium. The impact of an early mobility protocol on return to activities of daily living (ADL) is less studied. OBJECTIVE: The aim of this study was to examine 1-year outcomes including ADL performance after the institution of an ICU early mobility protocol. METHODS: One year after the initiation of an early mobility protocol in 7 intensive care units (ICUs) at an academic medical center, patients with an ICU stay of 7 days or more were enrolled in a 1-year follow-up phone call study. Baseline demographic data included the following: average ICU mobility and highest ICU mobility level achieved (4 levels), highest ICU mobility score (10 levels) at ICU admission, ICU discharge (DC), hospital DC, LOS, and delirium positive days. At 4 time points after DC (1, 3, 6, 12 months), patients were contacted regarding current residence, employment, readmissions, and current level of ADL from the Katz ADL (scored 0-6) and Lawton instrumental ADL scales (scored 0-8). RESULTS: A convenience sample of 106 patients was enrolled with a mean age of 58 ± 15.4 years, ICU LOS of 18 ± 11.5 days, and hospital LOS of 37.5 ± 31 days; 58 (55%) were male; 4 expired before DC. Mobility results included mean mobility level of 1.6 ± 0.8, mean highest mobility level 3.3 ± 0.9; ICU mobility score was 5.9 ± 2.4 at time of ICU DC and 7.3 ± 2.5 at hospital DC. Katz ADL scores improved from 4.8 at 1 month to 5.6 at 12 months (P = .002), and Lawton IADL scores improved from 4.2 to 6.6 (P < .001). Mobility scores were predictors of 1 month Katz (P = .004) and Lawton (P < .001) scores. None of the mobility levels or scores were predictive for readmissions. Most patients were not working before admission, and not all returned to work. Days positive for delirium were predictive of 1 month Katz and Lawton (P = .014, .002) scores. Impact of delirium was gone by 1 year. DISCUSSION: In this critically ill patient population followed for 1 year, ICU mobility positively impacted return to ADLs and improved ADLs over time but not readmissions. Delirium positive days decreased ADL scores, but the effect diminished over time.

A qualitative study of life with a left ventricular assist device as a bridge to transplant: A new normal.

OBJECTIVE: To explore the lived experiences of individuals with a left ventricular assist device (LVAD) as a bridge to transplant. DESIGN: A qualitative descriptive study of ten patients in the Midwestern United States between 30 and 60 years, with a device implanted between six and 18 months were interviewed. A semi-structured interview guide was utilized to elicit a detailed account of individuals living with an LVAD. Content analysis with an inductive coding approach was used to analyze the interview transcripts. FINDINGS: Three major themes, encompassing several sub themes emerged from the data. (1) physical adjustments (reality shock, carrying the batteries, a new routine, showering, and sleep) (2) emotions (decision making, attitude, gratitude, and uncertainty) (3) psychosocial aspects (intimacy adaptations, self-perception, and perception by others) CONCLUSION: The reality of living with a device was 'not normal' but with time it became their new normal. Findings from this study will inform healthcare professionals (HCP) on the lived experience of patients with LVADs. This new knowledge will assist HCPs to engage in realistic discussions with patients contemplating an LVAD implant. Sharing the challenges of patients with LVADs will help future transplant recipients to be better prepared for their new lifestyle.

Recombinant Anti-Müllerian Hormone (rAMH) for Stalling In Vitro Granulosa Cell Replication.

To investigate whether recombinant AMH (rAMH) is able to decrease cellular proliferation/apoptosis in luteinized granulosa cells (GCs) through hormonal regulation, a primary culture of GCs was established from GCs obtained at time of oocyte retrieval from follicular fluid of 3 patients. Cells were seeded in well cell culture plates at a density of 100,000 cells/well in medium and treated with rAMH 20 ng/ml (rAMH group), or phosphate-buffered saline (PBS-control group), for 24 h. Total RNA was extracted from all cells, followed by cDNA synthesis and real-time RT-PCR to quantify the expression levels of AMH, AMH-R2, FSH-R, inhibin B, cell proliferation (Ki67), and apoptosis (Caspase 3). We used independent sample t test (SPSS v25) and a p < 0.05 significance. Cellular expressions of AMH, AMH-R2, FSH-R, and inhibin B were reduced greater than 50% in the rAMH group, compared with that of the the control group (p ≤ 0.005 for all). Ki67 and Caspase3 were also reduced greater than 30% in the rAMH group (p ≤ 0.001 for both). Our findings show a direct inhibitory effect of AMH on luteinized GCs' expression of the major regulatory hormones, in addition to a significant decrease in markers of cell proliferation and apoptosis. These results confirm the inhibitory effects of AMH on follicular development.

Effects of a Mindfulness Intervention on Hospitalized Patients With Hematologic Malignancies and Their Caregivers.

OBJECTIVES: To examine the effects of a mind-body intervention on the psychological distress of hospitalized patients with hematologic malignancies and their caregivers. SAMPLE & SETTING: 29 patients with hematologic malignancies and 5 caregivers were recruited from the bone marrow transplantation unit at Barnes-Jewish Hospital in St. Louis, Missouri. METHODS & VARIABLES: After completing the Rotterdam Symptom Checklist (RSCL) to rate their levels of psychological and physiologic distress and quality of life, participants were taught a mindfulness activity. Two weeks postintervention, participants completed the RSCL again, reported how often they practiced the activity, and answered qualitative questions regarding their experience. RESULTS: Participants reported increased relaxation and improved sleep and showed interest in practicing mindfulness as a part of their treatment plan. IMPLICATIONS FOR NURSING: Nurses can help to alleviate symptoms of distress in patients with hematologic malignancies by integrating education on how to perform short and simple mindfulness activities into the care plan.

The Male Voice: A Qualitative Assessment of Young Men's Communication Preferences About HPV and 9vHPV.

In the U.S. there is an epidemic of sexually transmitted diseases (STIs). One of the most prevalent STIs is the Human Papillomavirus (HPV). Certain high risk strains of HPV are believed to cause virtually all cervical cancers, over 90% of anal cancers, 70% of oropharyngeal cancers, and the majority of anal genital warts. HPV is preventable through vaccination and is available for both men and women. Several educational interventions have been employed, yet baseline awareness and knowledge related to HPV and 9vHPV remains relatively low among young men. What is not known is the most effective method for providing HPV and 9vHPV information to young men. The purpose of this qualitative study was to learn from young men on how they would like to receive HPV and 9vHPV information. Men between the ages of 18-26 were invited to participate in the study. Ten focus group sessions with a total of 68 participants were conducted from three Midwest community colleges. Analysis resulted in themes related to STIs, HPV and 9vHPV knowledge, 9vHPV receipt, sexual health communication, and communication strategies. Findings suggest that there is not a "one size fits all" preferred communication modality. Recommendations for effective HPV communication include healthcare practitioner self-awareness, community environments where healthcare practitioners can engage in HPV related cancer prevention activities and advocacy for medically accurate sexual health education. Insight into the best way to communicate HPV and 9vHPV information to young men will lead toward improvement in health literacy around HPV, increased 9vHPV uptake, as well as effective health promotion and disease prevention.

The Male Factor: Human Papillomavirus (HPV) and HPV4 Vaccine Acceptance Among African American Young Men.

The Human Papillomavirus (HPV) is one of the most prevalent sexually transmitted infections (STD) in the United States. In the U.S., racial and ethnic minorities are disproportionality affected by STDs. In 2009 the Food and Drug Administration approved the HPV4 vaccine for young men. It is necessary to understand African American young men's HPV knowledge, health beliefs, and perceived risk in relation to HPV4 vaccine acceptance. To date, there remains paucity in the literature regarding African American young men's HPV knowledge and HPV4 vaccine acceptance. The current study was a non-probability convenience sample of 68 African American college students. This study was part of a larger project of HPV4 vaccine acceptance. Participants completed a 68-item questionnaire about personal characteristics, HPV, and the HPV4 vaccine. A majority of the young men had heard about HPV (85%, n = 58), however, only 38% (n = 26) new about the HPV4 vaccine for women. Only 12.2% (n = 9) of the respondents knew of an HPV4 vaccine for men. The top three barriers to HPV4 vaccination were that insurance would not cover the vaccine; they would have to pay a lot for the vaccine and worrying that the vaccine is not safe. Study findings suggest that HPV and HPV4 education programs, and low or no cost HPV4 vaccinations for African American young men are needed.

Identification of pre-operative and intra-operative variables predictive of pressure ulcer development in patients undergoing urologic surgical procedures.

This study examined variables predictive of pressure ulcers among patients undergoing urologic surgical procedures. Anesthesia duration and total time of the diastolic blood pressure was less than 50 Hgmm were statistically significant predictors. Dynamic pressure-relieving devices are recommended to reduce incidences of pressure ulcer incidence.

Describing nurses' work: combining quantitative and qualitative analysis.

OBJECTIVE: To better understand nursing activities and working conditions. BACKGROUND: Nursing practice involves astute clinical decision making and the competent delivery of nursing care procedures. To complete nursing procedures, nurses must simultaneously organize and reorganize priorities and manage changing clinical information for multiple patients. Few researchers have examined the specific nature of nurses' activities and the effect of the environment on their work. METHODS: Quantitative and qualitative methods were used to collect data on 7 nurses engaged in nursing activities. Examples of methods include link analysis, subject matter expert, task analysis, cognitive pathway, and "stacking." Data collection focused on how nurses managed priorities, changing clinical information, and interruptions. RESULTS: The "cognitive pathway" graphically depicts the nature of nurses' work. Specifically, it reveals the shifting of the nurse's attention from patient to patient and the occurrence of interruptions. "Stacking" shows the number of tasks a nurse must balance at any one time. On average, nurses had 10 or more activities waiting to be performed and experienced 3.4 interruptions/hr. CONCLUSION: These methods provide unique insight into the dynamic nature of patient care and nursing work. APPLICATION: Extension of the methods demonstrated here may be useful in guiding efforts to change the work of nursing to better provide quality care and less stressful work environments.

Understanding the cognitive work of nursing in the acute care environment.

OBJECTIVE: To combine human factors engineering techniques with qualitative observation of nurses in practice to analyze the nature of nurses' cognitive work and how environmental factors create disruptions that pose risks for medical errors. BACKGROUND: Few researchers have examined the nature of nurses' cognitive work while in practice with patients. Researchers have described the broad range of thinking processes required in the acute care work setting, but have failed to examine how such processes are conducted and influenced by the complex care environment. A combined research methodology enables researchers to better understand how the nursing process becomes disrupted and the potential influence of this disruption on the safe and effective care of patients. METHODS: An ethnographic study, using mixed-methodological approaches, involved 7 staff registered nurses. The quantitative and qualitative data collection included field observation and summarative interviews. FINDINGS: A high number of cognitive shifts and interruptions, and a nurse's cumulative cognitive load, create the potential for disrupting a nurse's attention focus during care of patients. A majority of interruptions occurred as nurses performed interventions, particularly medication preparation. CONCLUSION: New attention must be given to how care systems and work processes complement or interfere with nurses' cognitive work.

Mapping the nursing process: a new approach for understanding the work of nursing.

The work of nursing is nonlinear and involves complex reasoning and clinical decision making. The use of human factors engineering (HFE) as a sole means for analyzing the work of nursing is problematic. Combining HFE analysis with qualitative observation has created a new methodology for mapping the nursing process. A cognitive pathway offers a new perspective for understanding the work of nursing and analyzing how disruptions to the nursing process may contribute to errors in the acute care environment.