Evaluating Child Passenger Restraint Use Education.

BACKGROUND: Despite recommendations and laws for child restraint use in motor vehicles, evidence of low restraint use remains, and there is a lack of evidence addressing the effectiveness of restraint use education. OBJECTIVE: This project aims to measure the impact of an education initiative on child passenger restraint use. METHODS: This pre- and postintervention study was conducted in six elementary schools in a Southwestern U.S. metropolitan area over 5 months from October 2022 to March 2023. Motor vehicle restraint use was collected from occupants arriving at elementary schools during the morning drop-off times. Participants were provided one-on-one education regarding child passenger safety guidelines and state laws. Comparison data were collected 1-3 weeks later at the same schools to evaluate the education provided. RESULTS: A total of 1,671 occupants in 612 vehicles were observed across six schools, with 343 adults and 553 children preintervention and 306 adults and 469 children postintervention. Overall restraint adherence in children improved postintervention from 42.3% to 56.1%, a 32.6% increase (p = < .001). In the primary age group of 4-8 years, restraint adherence improved postintervention from 34.8% to 54.2%, a 55.8% increase (p = <.001). CONCLUSIONS: The study results demonstrate that one-on-one education increases child passenger restraint use.

Alcohol Misuse Screening Performance Improvement Initiative.

BACKGROUND: A trauma registry review of our trauma center's alcohol misuse screening compliance noted inconsistent screening and data collection methods, putting our American College of Surgeons trauma center reverification at risk for a deficiency. OBJECTIVE: The objective of this study was to evaluate an alcohol misuse screening improvement initiative on screening compliance in trauma patients. METHODS: This before and after analysis of a quality improvement initiative to improve alcohol misuse screening was conducted from 2019 to 2021 at a Southwestern U.S. Level II trauma center on admitted trauma patients aged 13 years and older. The multicomponent initiative included a change in the screening instrument and timing of application, implementing electronic medical record documentation screens, and educating staff. The primary outcome measure was screening adherence. RESULTS: A total of n = 4,734 patients were included in the study period. Alcohol misuse screening improved from 2.9% to 87.4% and remained sustained for over a year after the initiative's implementation. CONCLUSION: The performance improvement initiative improved the alcohol misuse screening process, resulting in consistent screenings exceeding the American College of Surgeons standards of 80% for verified trauma centers.

Association between ventilator-associated events and implementation of acute respiratory distress syndrome (ARDS) ventilator weaning protocol.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe and life-threatening condition that can occur in critically ill patients. Mechanical ventilation is a commonly used intervention with ARDS patients, but weaning patients off the ventilator can be challenging. An ARDSnet-like ventilator weaning protocol was implemented with the goal of reducing triggers for ventilator-associated events (VAEs). METHODS: The implementation of the new protocol was used to complete a retrospective investigation of patient outcomes for 1,233 ventilator periods. Periods were included between April and December 2022 for any ventilated patient lasting at least 4 days. National Health Care Safety Network VAE criteria were used to surveille the patient data. Triggers were based on the positive end-expiratory pressure increases or fraction of inspired oxygen (FiO2) increases. The preset weaning criteria was a reduction by 2 cmH2O per 24 hours. RESULTS: Of the total 1,233 individual ventilator periods, VAE criteria were met in 10%. Of the total 126 periods with VAE, 39.2% met the criteria for appropriate protocol implementation. There was a statistically significant relationship between VAE identification and implementation of the protocol. CONCLUSIONS: The implementation of a protocol for ventilator weaning affects the outcome of developing a VAE. The findings emphasize the importance of implementing the ARDS weaning protocol as a template to reduce the triggers for VAEs and improve overall patient outcomes.

Ultrasonometric profiling of incidence and risk of osteoporosis in rural women.

BACKGROUND: It is estimated that over 200 million people worldwide have osteoporosis. The prevalence of osteoporosis is continuing to escalate with the increasingly aging population. The major complication of osteoporosis is an increase in fragility fractures leading to morbidity, mortality, and decreased quality of life. This investigation profiled the incidence and risk of osteoporosis in adult women from a rural setting using ultrasonic bone scanning technology. METHODS: Between 2001 and 2005, adult female subjects (n = 323) in the age range of 40-87 were drawn from an independent, community dwelling, convenience sample. Bone mineral density T-scores were evaluated using heel ultrasonometry. Demographic and risk factor data, Merck Osteoporosis Evaluation SCORE questionnaire data, and the Osteoporosis Risk Assessment questionnaire data were analyzed. RESULTS: Results of these scans indicate that 25% of the total population had a T-score < or = -1.0, implying a 1.5- to 2.0-fold increase in risk ratio of hip or spinal fracture for each standard deviational decrease. Age at menopause and weight had a positive correlation with T-scores. While the overall scores on the Merck SCORE questionnaire were inversely correlated to T-scores, no significant correlation was found between the Osteoporosis Risk Assessment questionnaire and T-score data. Additionally, women who had taken estrogen had significantly higher T-scores (p = 0.038) than those who had not. CONCLUSION: That approximately 25% of this sample has low bone mass or osteoporosis underscores the importance of early screening in order to develop preventative awareness and provide education on bone health management. This finding has particularly important ramifications, since the sample was rural women, who typically have limited access to diagnostic bone density procedures.

Ergonomic assessment of a critical care unit.

Although direct patient care providers in all settings suffer musculoskeletal injuries at unacceptable rates, high-risk tasks in nursing homes are the most frequently researched. Less is known about the high-risk tasks performed by critical care nurses. To identify the tasks in critical care that differ from those in nursing homes, this qualitative study used the Ergonomic Workplace Assessment Protocol for Patient Care Environments to assess a medical ICU. Results and recommendations for change are presented.

Ultrasonometric profiling of incidence and risk of osteoporosis on rural women.

It is estimated that over 200 million people worldwide have osteoporosis. The prevalence of osteoporosis is continuing to escalate with the increasingly elderly population. The major complication of osteoporosis is an increase in fragility fractures leading to morbidity, mortality, and decreased quality of life. This investigation aimed at profiling the incidence and risk of osteoporosis in adult women from a rural setting using ultrasonic bone scanning technology. Peri- and postmenopausal female subjects (n=234) were drawn from a convenience sample. After a non-radiative dual X-ray absorptiometric scanning, the bone mineral density was measured from the heel of the subjects using bone ultrasonometry, and their T-scores were recorded. Results of these scans indicate that in adult women in the age range of 32 and 87, 23.5% of the population had a heel ultrasonic T-score < or =1.0, implying a 1.5 to 2.0 fold increase in risk ratio of hip or spinal fracture for each standard deviational decrease. Age at menopause was positively correlated with T-scores (p= 0.032); the higher the age at menopause, the higher the T scores. Additionally, women who had taken estrogen had significantly higher T-scores (p=0.038) than those who had not. That approximately 25% of this sample has low bone mass or osteoporosis underscores the importance of early screening in order to develop awareness and provide education on bone health management.