Pediatric Sedation Unit: A Safe, Effective, and Satisfactory Alternative to Outpatient Pediatric Urological Procedures Under Anesthesia.

INTRODUCTION: The operating room is an increasingly expensive and limited resource. The aim of this study was to evaluate the efficacy, safety, cost, and parental satisfaction of transitioning minor pediatric urology procedures from an operating room setting to a pediatric sedation unit. METHODS: Minor urological procedures were transitioned from the operating room to the pediatric sedation unit if they could be completed in 20 minutes using minimal instrumentation. Information regarding patient demographics, procedure characteristics, rates of success and complications, and cost were collected from urology procedures performed in the pediatric sedation unit between August 2019 and September 2021. Patient demographics and cost data from the most common urology procedures performed in the pediatric sedation unit were compared to data from historical controls of cases occurring in the operating room. Parent surveys were performed following the completion of procedures in the pediatric sedation unit. RESULTS: A total of 103 patients, ranging from 6-207 months old (mean 72 months), underwent procedures in the pediatric sedation unit. The most common procedures were lysis of adhesions and meatotomy. All procedures were successfully completed with procedural sedation, and no procedure was complicated by serious sedation adverse events. The cost reduction for lysis of adhesions in the pediatric sedation unit was 53.5% compared to the operating room, and meatotomy was 27.9%, leading to approximately $57,000 cost savings per year. Fifty families completed a follow-up satisfaction survey, and 83% of parents were satisfied with the care their family received. CONCLUSIONS: The pediatric sedation unit can provide a successful and cost-efficient alternative to the operating room while preserving safety and high rates of parental satisfaction.

Mood-altering drugs in the trauma population: hidden dangers, deadly combinations.

Depression is on the rise, and as a result, there is an increased use of psychotropic medications. Also, nonreversible anticoagulants have entered the market and are increasing in use. In combination, these developments have created new risk factors for trauma patients. Our study examined the occurrence of trauma patients who present with a history of psychotropic medication, and we also sought to determine the rate of psychotropic medication and blood thinner use in the older adults. Because these drugs may play a role in causing injury and worsening outcomes, prescribers need to be aware of the patients' medication history and the potential risks.

The clinical nurse specialist as change agent: reducing employee injury and related costs.

PURPOSE: The purpose of this study was, first, to examine the role of the clinical nurse specialist (CNS) as it relates to the implementation of a CNS-initiated Safe Movement Program and, second, to report findings from a CNS-initiated safe movement program (SMP) in reducing healthcare workers' injuries and related costs. DESIGN: A longitudinal preimplementation and postimplementation study design was used. SETTING: Healthcare workers in a 156-bed, extended-care facility (nursing home) participated in the study. SAMPLE: Participants at the onset of the study included 52 healthcare workers who participated in the study preimplementation and postimplementation of the SMP. Attrition resulted in a final sample of 46. METHODS: Data were collected on healthcare workers' perceptions of injuries as well as existing incident reports and workers' compensation records preimplementation and postimplementation of the study. FINDINGS: Outcomes included major reduction in healthcare worker injuries and related workers' compensation cost savings. The number of healthcare workers who thought an injury occurred as a result of lifting or transferring a resident was reduced by 75%, and perceptions of lifting and transfer injuries resulting in a back strain were reduced by 80%. The number of times in a month healthcare workers felt lifting or transferring a resident was "too much" for them was reduced by 73%. Workers' compensation insurance was reduced by 93%. CONCLUSIONS: A CNS-initiated SMP reduces injuries and costs and may recoup the cost of the program in 5 years. IMPLICATIONS: Job-related musculoskeletal injuries are a critical problem. As the healthcare workforce continues to age, a comprehensive SMP needs to be implemented to ensure safety of employees in the clinical practice setting. The program may pay for itself in 5 years.

Emergency department visits for suicidality in three hospitals.

The purposes of this study were to describe suicidal persons who come to the emergency department (ED) and to examine the relationship between clinical and health service characteristics and decisions regarding post-ED care. Data were collected from three hospital EDs by means of a retrospective review of records. During the 1-month study period, 163 ED visits were for suicidal ideation (f = 110) or behavior (f = 53). The mean age of the patients was 36.5 years (range = 5-87 years); 51% were female patients. Clinical decisions about post-ED care tended to be cautious, regardless of a patient's level of suicidality, with 71% of patients either transferred for psychiatric evaluation or admitted to the psychiatric unit. Emergency department staff tended to be slightly more conservative than mental health professionals, but the difference in their decisions about disposition was not significant.

The Shorter PROMIS Questionnaire: further validation of a tool for simultaneous assessment of multiple addictive behaviours.

There is both a theoretical and clinical need to develop a questionnaire that assesses a range of addictive behaviours. The Shorter PROMIS Questionnaire (SPQ) is a 16-scale self-report instrument assessing the use of nicotine, recreational drugs, prescription drugs, gambling, sex, caffeine, food bingeing, food starving, exercise, shopping, work, relationships dominant and submissive, and compulsive helping dominant and submissive. Clinical cut-off scores using the 90th percentile were derived from a normative group of 508 individuals. These cut-offs correctly identified 78-100% of cases within clinical criterion groups of specific disorders. The clinical sample also completed other validated scales assessing gambling, eating, alcohol, and drug use. Correlations were typically.7 with relevant SPQ scales. The SPQ food, drug, and alcohol scales were at least equivalent to validated comparison scales in the strength of their relationship to relevant clinical criterion groups. Internal consistency was high for all scales, and test-retest reliability was generally good. This clinically useful instrument provides a broad assessment of addictive problems, thereby benefiting both the treatment provider and the client.

A comparison of imputation techniques for handling missing data.

Researchers are commonly faced with the problem of missing data. This article presents theoretical and empirical information for the selection and application of approaches for handling missing data on a single variable. An actual data set of 492 cases with no missing values was used to create a simulated yet realistic data set with missing at random (MAR) data. The authors compare and contrast five approaches (listwise deletion, mean substitution, simple regression, regression with an error term, and the expectation maximization [EM] algorithm) for dealing with missing data, and compare the effects of each method on descriptive statistics and correlation coefficients for the imputed data (n = 96) and the entire sample (n = 492) when imputed data are inculded. All methods had limitations, although our findings suggest that mean substitution was the least effective and that regression with an error term and the EM algorithm produced estimates closest to those of the original variables.