The Association Between Magnet ® Recognition and Patient Outcomes : A Scoping Review.

BACKGROUND: Previous systematic reviews have explored nurse, patient, and organizational outcomes in Magnet®-recognized hospitals compared with non-Magnet hospitals, yet these did not comprehensively review a wide variety of patient outcomes. AIM: The purpose of this scoping review was to describe the findings from published research evaluating patient outcomes in Magnet-recognized hospitals compared with non-Magnet hospitals. METHODS: A medical librarian conducted a systematic search for published peer-reviewed, English-language literature and a search of the reference lists for retrieved publications to identify articles addressing Magnet compared with non-Magnet hospitals related to patient outcomes. RESULTS: Four patient outcomes improved in Magnet-designated hospitals: mortality, patient satisfaction, failure to rescue, and falls. Four patient outcomes showed undesirable or mixed outcomes. Five patient outcomes had insufficient evidence regarding patient outcomes when treated at Magnet-recognized hospitals. CONCLUSION: Magnet Recognition® is associated with improvement in a distinct set of patient outcomes, but not all key outcome measures. Standardized outcomes and rigorous study designs are needed to further explore the impact of Magnet Recognition on a wide variety of patient outcomes.

Budgetary investment in evidence-based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes.

BACKGROUND: Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. AIMS: This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. METHODS: A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. RESULTS: One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. LINKING EVIDENCE TO ACTION: Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.

Nurses' Perceptions of Adherence to the Central Line Maintenance Bundle: Linkages to Thoughts, Emotions, and Behavior.

The U.S. Centers for Disease Control established the central line maintenance care bundle in 2011, yet nurses' adherence to all seven components remains challenging. The specific aim of this study was to explore and understand intensive care nurses' perceptions and beliefs regarding central line maintenance, bundle care elements, and associated adherence. This qualitative study used a phenomenological approach. Three main themes emerged as follows: (1) thoughts about the ability to adhere to the central line bundle created feelings about central line maintenance care, (2) feelings about the nurses' ability to adhere to the central line bundle influenced behaviors, and (3) behaviors for central line bundle adherence reinforced thoughts. Each theme had several subthemes. Organizations must assess and mitigate the unique cognitive and behavioral factors that affect nurses' adherence to the central line-associated bloodstream infection (CLABSI) maintenance bundle. In addition, nursing adherence requires knowledge of CLABSI rates and direct care nurse involvement in identifying solutions.

Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review.

BACKGROUND: Evidence-based practice and decision-making have been consistently linked to improved quality of care, patient safety, and many positive clinical outcomes in isolated reports throughout the literature. However, a comprehensive summary and review of the extent and type of evidence-based practices (EBPs) and their associated outcomes across clinical settings are lacking. AIMS: The purpose of this scoping review was to provide a thorough summary of published literature on the implementation of EBPs on patient outcomes in healthcare settings. METHODS: A comprehensive librarian-assisted search was done with three databases, and two reviewers independently performed title/abstract and full-text reviews within a systematic review software system. Extraction was performed by the eight review team members. RESULTS: Of 8537 articles included in the review, 636 (7.5%) met the inclusion criteria. Most articles (63.3%) were published in the United States, and 90% took place in the acute care setting. There was substantial heterogeneity in project definitions, designs, and outcomes. Various EBPs were implemented, with just over a third including some aspect of infection prevention, and most (91.2%) linked to reimbursement. Only 19% measured return on investment (ROI); 94% showed a positive ROI, and none showed a negative ROI. The two most reported outcomes were length of stay (15%), followed by mortality (12%). LINKING EVIDENCE TO ACTION: Findings indicate that EBPs improve patient outcomes and ROI for healthcare systems. Coordinated and consistent use of established nomenclature and methods to evaluate EBP and patient outcomes are needed to effectively increase the growth and impact of EBP across care settings. Leaders, clinicians, publishers, and educators all have a professional responsibility related to improving the current state of EBP. Several key actions are needed to mitigate confusion around EBP and to help clinicians understand the differences between quality improvement, implementation science, EBP, and research.

Impact of a Formal Educational Skill-Building Program Based on the ARCC Model to Enhance Evidence-Based Practice Competency in Nurse Teams.

BACKGROUND: Implementation of evidence-based practice (EBP) is necessary for healthcare systems to improve quality, safety, patient outcomes, and costs. Yet, EBP competency is lacking in many nurses and clinicians across the country. AIM: The purpose of this initiative was to determine whether nursing teams (Executive Leader, Clinical/Mid-level Leader, and Direct Care Nurse) attending a 5-day EBP continuing education skill-building program (immersion) was an effective strategy to build EBP competence, practice, and culture sustainability over time. The Advancing Research and Clinical Practice Through Close Collaboration Model was used to guide this initiative. METHODS: A project team was assembled, including leaders with EBP expertise from the Air Force Medical Service and The Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare at The Ohio State University. Five survey instruments were used to evaluate outcomes, including Organizational Culture and Readiness for System-Wide Implementation of Evidence-Based Practice, Evidence-Based Practice Beliefs, Evidence-Based Practice Implementation, and Evidence-Based Practice Competencies, as well as the Knowledge Assessment Questionnaire test. Nursing teams were invited to participate and complete the program with the implementation of EBP projects over the following year. RESULTS: Participants' EBP knowledge, skills, competencies, and beliefs were significantly improved and sustained over 12 months. LINKING EVIDENCE TO ACTION: A team-based EBP skill-building program was an effective strategy for building EBP competence, practice, and culture. This initiative demonstrated that the direct involvement of leadership and infrastructure to support EBP were crucial factors for building and sustaining an EBP culture.

Cultivating evidence-based practice through mentorship.

BACKGROUND: Nurses' use of evidence-based practice (EBP) improves patient outcomes through provision of optimal patient care. AIM: The Evidence-Based Practice Mentorship Program (EBPMP) is a self-directed, year-long immersion program implemented for staff nurses to experience the EBP process with close mentor support. The aim of this program is to bolster a culture of EBP at a single large pediatric quaternary care hospital in the Northeast. RESULTS: A total of 81 nurses across 4 cohorts participated in this organization wide program from 2016 to 2019. To date the program has produced 46 internally and externally disseminated EBP projects. Of the graduates, 7-nurse mentees have become formal EBPMP mentor's, 3 have applied and been accepted into the organizational based Nursing Science Fellowship to carry out clinical inquiry projects to fill important literary gaps, and 6 have received promotions or career advancements. Most importantly, graduates have anecdotally reported that program participation inspired deeper critical reflection of patient care. SUMMARY: Utilizing mentorship to facilitate EBP was a key educational strategy for the busy mentors and mentees, as many of the nurse participants were direct care providers. This self-directed program resulted in a high project completion rate leading to continued organizational support for the program, which is now in its fourth year.

Development and Psychometric Testing of the Implementation Self-efficacy for EBP (ISE4EBP) Scale.

There is inadequate research about nurses' confidence in implementation strategies that foster the application and sustainability of evidence-based practice (EBP). Guided by Bandura's self-efficacy theory, we propose that self-efficacy (confidence) in EBP implementation strategies can accelerate the uptake of evidence into practice to improve health care quality. The purpose of this study was to develop and test the psychometric properties of the Implementation Self-efficacy for EBP (ISE4EBP) scale as a measure for evaluating self-efficacy in using EBP implementation strategies. In a sample of 65 registered nurses, the 29-item ISE4EBP scale demonstrated adequate content validity (via content validity index), internal consistency reliability (Cronbach's alpha = 0.987), and construct validity indicated by associations with organizational readiness for EBP. Clinicians may use the ISE4EBP scale to identify areas for building implementation confidence to accelerate the uptake of evidence to improve quality care.

Transforming Healthcare to Evidence-Based Healthcare: A Failure of Leadership.

The adoption of evidence-based decision-making and practice in healthcare has been slow. This article discusses the critical role of leaders in steering this transformative work.

The Effects of an Intensive Evidence-Based Practice Educational and Skills Building Program on EBP Competency and Attributes.

BACKGROUND AND SIGNIFICANCE: Evidence-based practice (EBP) is a systematic problem-solving approach to the delivery of health care that improves quality and population health outcomes as well as reduces costs and empowers clinicians to fully engage in their role, otherwise known as the quadruple aim in health care. The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare at The Ohio State University College of Nursing has been offering 5-day EBP immersion programs since 2012. The goal of the program is for the participants to acquire EBP competence (e.g., knowledge, skills, and attitude) and sustain it over time. PURPOSE AND AIMS: The purpose of this study was to evaluate the effects of the 5-day EBP immersion (i.e., an education and skills building program) on EBP attributes and competence over time. METHOD AND DESIGN: A longitudinal pre-experimental study was conducted that gathered data with an anonymous online survey from 400 program attendees who attended 16 5-day immersions between September 2014 and May 2016. Participants completed five valid and reliable instruments at four points over 12 months, including EBP beliefs, implementation, competency, knowledge, and perception of organizational readiness and culture. RESULTS: Findings indicated statistically significant improvements in EBP attributes and competency over time. The results of this study support the hypotheses that EBP competency and attributes can be significantly improved and sustained by attending an intensive 5-day EBP educational and skills building program such as the one described in this study. This study can help leaders and organizations to mitigate many of the traditional barriers to EBP. LINKING EVIDENCE TO ACTION: The results of this study indicate that EBP attributes and competencies can be improved and sustained by attending an intensive 5-day EBP immersion, regardless of clinicians' prior educational preparation.

Air Quality in Association With Rural Coal Mining and Combustion in New South Wales Australia.

PURPOSE: Rural areas may face under-recognized threats to air quality. We tested 2 hypotheses that 1) rural areas in New South Wales, Australia, would have better air quality than metropolitan Sydney, and that 2) the rural Upper Hunter region characterized by coal mining and coal combustion would have worse air quality than other rural areas of the state. METHODS: We analyzed 2017 daily mean values for New South Wales, Australia, for particulate matter (PM2.5 and PM10), sulfur dioxide (SO2 ), nitric oxide (NO), nitrogen dioxide (NO2 ), and NOx (sum of NO and NO2 ). Forty-six air monitoring stations were grouped into 6 rural and urban regional areas. Linear regression models examined pollution levels in association with rural and urban regions and meteorological covariates. RESULTS: Findings show that daily mean pollutant levels in the rural Upper Hunter were the highest of all regions, and were significantly higher than metropolitan Sydney, with and without control for weather conditions, for every pollutant. For example, daily mean PM2.5 was 8.64 µg/m3 in the rural Upper Hunter, compared to 7.23 µg/m3 in metropolitan Sydney. CONCLUSIONS: Results highlight the need to consider both urban and rural sources of pollution in air quality studies, and appropriate policy steps to address likely rural air pollution from coal mining.

Pediatric Nurses' Knowledge, Values, and Implementation of Evidence-based Practice and Use of Two Patient Safety Goals.

PURPOSE: To describe knowledge, values, and implementation of evidence-based practice (EBP) and use of two National Patient Safety Goals-Central Line Associated Blood Stream Infections (CLABSI) and Surgical Site Infections (SSI)-between nurses working in Magnet® versus non-Magnet® designated hospitals. BACKGROUND: There is a gap in the literature concerning nurses' understanding of EBP and how EBP guidelines are used in practice and if guidelines are being used as intended. The Conceptual Model of Nursing and Health Policy was used to guide the study. METHODS: A descriptive survey methodology using three instruments was delivered electronically to members of the Society of Pediatric Nurses-the Quick-EBP-VIK, the Use of Evidence-based Practice Questionnaire, and a Background Data Sheet. RESULTS: Results revealed statistically significant differences between the Magnet and non-Magnet participants only for the Quick-EBP-VIK value domain; nurses from Magnet hospitals had a higher value for EBP compared with nurses from non-Magnet hospitals, nurses from both groups had a moderate amount of knowledge about EBP, and very few nurses indicated they were implementing EBP. There were no differences in CLABSI and SSI prevention care for patients in acute care hospitals in the United States by nurses working in Magnet versus non Magnet designated hospitals. CONCLUSION: The findings of this study have implications for practice, education, policy, and research. A disconnect between the use of policy and implementation of EBP has been identified. Specifically, nurses need to understand how EBP is embedded in hospital and organizational policy.

Measuring Nurses' Value, Implementation, and Knowledge of Evidence-Based Practice: Further Psychometric Testing of the Quick-EBP-VIK Survey.

BACKGROUND: The Quick-EBP-VIK is a new instrument for measuring nurses' value, implementation, and knowledge of EBP. Psychometric testing was conducted in two parts. Part 1 describes the tool development and validity testing which resulted in the development of a 25-item survey after receiving ≥0.80 Item-Level Content Validity Index for both clarity and relevance. Part 2 describes psychometric testing was necessary to assess additional types of validity and reliability. AIM: The purpose of this paper is to further describe the psychometric testing of the Quick-EBP-VIK survey instrument. METHODS: This descriptive study was designed to assess test-retest reliability, internal consistency and construct validity via a web-based survey. The survey instrument was e-mailed to all nurses at the study hospital. Nurses who responded to the first survey (Wave 1) received another e-mail invitation to complete the survey instrument again (Wave 2) for the purpose of assessing the test-retest reliability of the instrument. RESULTS: A total of 1,177 deliverable e-mails were sent to all nursing staff at one free standing pediatric hospital with Magnet® designation in the northeast. A total of 382 nurses returned completed surveys, indicating a 32.5% response rate for Wave 1. A total of 131 nurses responded to Wave 2 indicating a response rate of 34.3%. The intraclass correlation coefficients for the items included in the final instrument ranged from 0.43 to 0.80 and were deemed sufficient. These represent a sufficient intraclass correlation coefficient. The Cronbach's Alpha values for each of the three domains are all higher than 0.7 indicating that the items of each of the measurement dimension are internally consistent. However, the composite reliability of the third domain was slightly lower than 0.7 when using Raykov's Rho. LINKING EVIDENCE TO ACTION: The Quick-EBP-VIK instrument has gone through rigorous comprehensive testing and has demonstrated good psychometric properties.

Nurses' Use of Evidence-Based Practice in Clinical Practice After Attending a Formal Evidence-Based Practice Course: A Quality Improvement Evaluation.

This quality improvement project explored whether participation in an evidence-based practice (EBP) course influenced the use of EBP in day-to-day nursing practice. Data from two focus groups highlighted the impact of the EBP course, areas for further development, and potential barriers to the utilization of EBP. The authors found that educational offerings that remove barriers to EBP (knowledge and time) improve nurses' utilization of EBP. Ongoing professional development support is needed to foster the use of EBP in practice.

High efficiency ex vivo cloning of antigen-specific human effector T cells.

While cloned T cells are valuable tools for the exploration of immune responses against viruses and tumours, current cloning methods do not allow inferences to be made about the function and phenotype of a clone's in vivo precursor, nor can precise cloning efficiencies be calculated. Additionally, there is currently no general method for cloning antigen-specific effector T cells directly from peripheral blood mononuclear cells, without the need for prior expansion in vitro. Here we describe an efficient method for cloning effector T cells ex vivo. Functional T cells are detected using optimised interferon gamma capture following stimulation with viral or tumour cell-derived antigen. In combination with multiple phenotypic markers, single effector T cells are sorted using a flow cytometer directly into multi-well plates, and cloned using standard, non antigen-specific expansion methods. We provide examples of this novel technology to generate antigen-reactive clones from healthy donors using Epstein-Barr virus and cytomegalovirus as representative viral antigen sources, and from two melanoma patients using autologous melanoma cells. Cloning efficiency, clonality, and retention/loss of function are described. Ex vivo effector cell cloning provides a rapid and effective method of deriving antigen-specific T cells clones with traceable in vivo precursor function and phenotype.

Melanomas of unknown primary have a mutation profile consistent with cutaneous sun-exposed melanoma.

Melanoma of unknown primary (MUP) is an uncommon phenomenon whereby patients present with metastatic disease without an evident primary site. To determine their likely site of origin, we combined exome sequencing from 33 MUPs to assess the total rate of somatic mutations and degree of UV mutagenesis. An independent cohort of 91 archival MUPs was also screened for 46 hot spot mutations highly prevalent in melanoma including BRAF, NRAS, KIT, GNAQ, and GNA11. Results showed that the majority of MUPs exhibited high somatic mutation rates, high ratios of C>T/G>A transitions, and a high rate of BRAF (45 of 101, 45%) and NRAS (32 of 101, 32%) mutations, collectively indicating a mutation profile consistent with cutaneous sun-exposed melanomas. These data suggest that a significant proportion of MUPs arise from regressed or unrecognized primary cutaneous melanomas or arise de novo in lymph nodes from nevus cells that have migrated from the skin.

Open release of male mosquitoes infected with a wolbachia biopesticide: field performance and infection containment.

BACKGROUND: Lymphatic filariasis (LF) is a globally significant disease, with 1.3 billion persons in 83 countries at risk. A coordinated effort of administering annual macrofilaricidal prophylactics to the entire at-risk population has succeeded in impacting and eliminating LF transmission in multiple regions. However, some areas in the South Pacific are predicted to persist as transmission sites, due in part to the biology of the mosquito vector, which has led to a call for additional tools to augment drug treatments. Autocidal strategies against mosquitoes are resurging in the effort against invasive mosquitoes and vector borne disease, with examples that include field trials of genetically modified mosquitoes and Wolbachia population replacement. However, critical questions must be addressed in anticipation of full field trials, including assessments of field competitiveness of transfected males and the risk of unintended population replacement. METHODOLOGY/PRINCIPAL FINDINGS: We report the outcome of field experiments testing a strategy that employs Wolbachia as a biopesticide. The strategy is based upon Wolbachia-induced conditional sterility, known as cytoplasmic incompatibility, and the repeated release of incompatible males to suppress a population. A criticism of the Wolbachia biopesticide approach is that unintended female release or horizontal Wolbachia transmission can result in population replacement instead of suppression. We present the outcome of laboratory and field experiments assessing the competitiveness of transfected males and their ability to transmit Wolbachia via horizontal transmission. CONCLUSIONS/SIGNIFICANCE: The results demonstrate that Wolbachia-transfected Aedes polynesiensis males are competitive under field conditions during a thirty-week open release period, as indicated by mark, release, recapture and brood-hatch failure among females at the release site. Experiments demonstrate the males to be 'dead end hosts' for Wolbachia and that methods were adequate to prevent population replacement at the field site. The findings encourage the continued development and extension of a Wolbachia autocidal approach to additional medically important mosquito species.

A high-throughput panel for identifying clinically relevant mutation profiles in melanoma.

Success with molecular-based targeted drugs in the treatment of cancer has ignited extensive research efforts within the field of personalized therapeutics. However, successful application of such therapies is dependent on the presence or absence of mutations within the patient's tumor that can confer clinical efficacy or drug resistance. Building on these findings, we developed a high-throughput mutation panel for the identification of frequently occurring and clinically relevant mutations in melanoma. An extensive literature search and interrogation of the Catalogue of Somatic Mutations in Cancer database identified more than 1,000 melanoma mutations. Applying a filtering strategy to focus on mutations amenable to the development of targeted drugs, we initially screened 120 known mutations in 271 samples using the Sequenom MassARRAY system. A total of 252 mutations were detected in 17 genes, the highest frequency occurred in BRAF (n = 154, 57%), NRAS (n = 55, 20%), CDK4 (n = 8, 3%), PTK2B (n = 7, 2.5%), and ERBB4 (n = 5, 2%). Based on this initial discovery screen, a total of 46 assays interrogating 39 mutations in 20 genes were designed to develop a melanoma-specific panel. These assays were distributed in multiplexes over 8 wells using strict assay design parameters optimized for sensitive mutation detection. The final melanoma-specific mutation panel is a cost effective, sensitive, high-throughput approach for identifying mutations of clinical relevance to molecular-based therapeutics for the treatment of melanoma. When used in a clinical research setting, the panel may rapidly and accurately identify potentially effective treatment strategies using novel or existing molecularly targeted drugs.

Monitoring temporal abundance and spatial distribution of Aedes polynesiensis using BG-Sentinel traps in neighboring habitats on Raiatea, Society Archipelago, French Polynesia.

Adult numbers and sizes of mosquitoes were monitored for 2 yr in neighboring habitats on the western coast of Raiatea (Society Archipelago) in anticipation of testing new vector control technologies. Aedes polynesiensis Marks females comprised the overwhelming majority (approximately 99%) of the three species of mosquitoes captured in Biogent Sentinel traps placed at fixed sites on three small satellite islands (motus) of the western lagoon and on the shoreline of Raiatea. Aedes polynesiensis males, Aedes aegypti (L.), and Culex quinquefasciatus Say rarely were collected. Numbers of Ae. polynesiensis females per collection differed among trapping dates and locations, with the majority of females captured on two motus, Horea and Toamaro. Shoreline and Horea females had significantly longer mean wing lengths than females from Tiano and Toamaro. Thus, wing lengths were influenced more by local developmental conditions than overall numbers of adults. Significantly more females were captured during the wet season than the dry season. Nonetheless, at least on the two highly productive motus, dry-season females had larger wing lengths than their wet season counterparts. Local weather patterns predicted about half the variation in mosquito numbers. Differences in vector abundance observed when comparing neighboring motus are likely because of differences in human activity and mosquito suppression.