Development of a culturally targeted chatbot to inform living kidney donor candidates of African ancestry about APOL1 genetic testing: a mixed methods study.

Clinical chatbots are increasingly used to help integrate genetic testing into clinical contexts, but no chatbot exists for Apolipoprotein L1 (APOL1) genetic testing of living kidney donor (LKD) candidates of African ancestry. Our study aimed to culturally adapt and assess perceptions of the Gia® chatbot to help integrate APOL1 testing into LKD evaluation. Ten focus groups and post-focus group surveys were conducted with 54 LKDs, community members, and kidney transplant recipients of African ancestry. Data were analyzed through thematic analysis and descriptive statistics. Key themes about making Gia culturally targeted included ensuring: (1) transparency by providing Black LKDs' testimonials, explaining patient privacy and confidentiality protections, and explaining how genetic testing can help LKD evaluation; (2) content is informative by educating Black LKDs about APOL1 testing instead of aiming to convince them to undergo testing, presenting statistics, and describing how genetic discrimination is legally prevented; and (3) content avoids stigma about living donation in the Black community. Most agreed Gia was neutral and unbiased (82%), trustworthy (82%), and words, phrases, and expressions were familiar to the intended audience (85%). Our culturally adapted APOL1 Gia chatbot was well regarded. Future research should assess how this chatbot could supplement provider discussion prior to genetic testing to scale APOL1 counseling and testing for LKD candidate clinical evaluation.

Ethical and Psychosocial Factors in the Decision-Making and Informed Consent Process for Upper Extremity Vascularized Composite Allotransplantation: A Mixed-Methods Study.

Although upper extremity (UE) vascularized composite allotransplantation (VCA) aims to improve quality of life, relatively few have been performed worldwide to support evidence-based treatment and informed decision-making. Methods: We qualitatively examined factors contributing to anticipated and actual decision-making about UE VCA and perceptions of the elements of informed consent among people with UE amputations, and UE VCA candidates, participants, and recipients through in-depth interviews. Thematic analysis was used to analyze qualitative data. Results: Fifty individuals participated; most were male (78%) and had a mean age of 45 y and a unilateral amputation (84%). One-third (35%) were "a lot" or "completely" willing to pursue UE VCA. UE VCA decision-making themes included the utility of UE VCA, psychosocial impact of UE VCA and amputation on individuals' lives, altruism, and anticipated burden of UE VCA on lifestyle. Most respondents who underwent UE VCA evaluation (n = 8/10) perceived having no reasonable treatment alternatives. Generally, respondents (n = 50) recognized the potential for familial, societal, cultural, medical, and self-driven pressures to pursue UE VCA among individuals with amputations. Some (n = 9/50, 18%) reported personally feeling "a little," "somewhat," "a lot," or "completely" pressured to pursue UE VCA. Respondents recommended that individuals be informed about the option of UE VCA near the amputation date. Conclusions: Our study identified psychosocial and other factors affecting decision-making about UE VCA, which should be addressed to enhance informed consent. Study participants' perceptions and preferences about UE VCA suggest re-examination of assumptions guiding the UE VCA clinical evaluation process.

Patient definitions of transplant success in upper extremity vascularized composite allotransplantation: A mixed-methods study.

Objective: Upper extremity vascularized composite allotransplantation is an innovative treatment option for people with upper extremity amputations. Limited patient-relevant long-term outcomes data about transplant success may impede patients' informed treatment decision-making. We assessed perceptions of what constitutes upper extremity vascularized composite allotransplantation success among individuals with upper extremity amputations. Methods: This multisite study entailed interviews and focus groups with individuals with upper extremity amputations and upper extremity vascularized composite allotransplantation candidates, participants, and recipients. We examined perceptions of transplant success and preferences for five upper extremity vascularized composite allotransplantation outcomes. Qualitative data were analyzed using thematic analysis; and quantitative data were analyzed using descriptive statistics. Results: In all, 50 individuals participated in interviews (61.7% participation rate), and 37 participated in nine focus groups (75.5% participation rate). Most were White (72%, 73%), had a mean age of 45 and 48 years, and had a unilateral amputation (84%, 59%), respectively. Participants conceptualized upper extremity vascularized composite allotransplantation success as transplant outcomes: (1) restoring function and sensation to enable new activities; (2) accepting the transplanted limb into one's identity and appearance; (3) not having transplant rejection; (4) attaining greater quality of life compared to prosthetics; and (5) ensuring benefits outweigh risks. Participants rated their most important upper extremity vascularized composite allotransplantation outcomes as follows: not having transplant rejection, not developing health complications, grasping objects, feeling touch and temperature, and accepting the upper extremity vascularized composite allotransplantation into your identity. Conclusion: Individuals with upper extremity amputations maintain several conceptions of vascularized composite allotransplantation success, spanning functional, psychosocial, clinical, and quality of life outcomes. Providers should address patients' conceptions of success to improve informed consent discussions and outcomes reporting for upper extremity vascularized composite allotransplantation.

Patient preferences of patient selection criteria for upper extremity vascularized composite allotransplantation: A qualitative study.

Background: Upper extremity vascularized composite allotransplantation is a life-enhancing reconstructive treatment option that aims to improve recipients' quality of life and maximize function. This study assessed upper extremity vascularized composite allotransplantation patient selection criteria perceptions among individuals with upper extremity limb loss. The perceptions of individuals with upper extremity limb loss on patient selection criteria may enable vascularized composite allotransplantation centers to improve criteria to avoid mismatched expectations about the posttransplant vascularized composite allotransplantation experience and outcomes. Realistic patient expectations may increase patient adherence, improve outcomes, and reduce vascularized composite allotransplantation graft loss. Methods: We conducted in-depth interviews with civilian and military service members with upper extremity limb loss and upper extremity vascularized composite allotransplantation candidates, participants, and recipients from three US institutions. Interviews assessed perceptions of patient selection criteria for suitability as a candidate for upper extremity vascularized composite allotransplantation. Thematic analysis was used to analyze qualitative data. Results: A total of 50 individuals participated (66% participation rate). Most participants were male (78%), White (72%), with a unilateral limb loss (84%), and a mean age of 45 years. Six themes emerged regarding upper extremity vascularized composite allotransplantation patient selection criteria, including support for candidates who: (1) are of younger age, (2) are in good physical health, (3) have mental stability, (4) are willing to "put in the work," (5) have specific amputation characteristics, and (6) have sufficient social support. Patients had preferences about selecting candidates with unilateral versus bilateral limb loss. Conclusions: Our findings suggest that numerous factors, including medical, social, and psychological characteristics, inform patients' perceptions of patient selection criteria for upper extremity vascularized composite allotransplantation. Patient perceptions of patient selection criteria should inform the development of validated screening measures that optimize patient outcomes.

Implementation of a culturally competent APOL1 genetic testing programme into living donor evaluation: A two-site, non-randomised, pre-post trial design.

INTRODUCTION: While living donor (LD) kidney transplantation is the optimal treatment for patients with kidney failure, LDs assume a higher risk of future kidney failure themselves. LDs of African ancestry have an even greater risk of kidney failure post-donation than White LDs. Because evidence suggests that Apolipoprotein L1 (APOL1) risk variants contribute to this greater risk, transplant nephrologists are increasingly using APOL1 genetic testing to evaluate LD candidates of African ancestry. However, nephrologists do not consistently perform genetic counselling with LD candidates about APOL1 due to a lack of knowledge and skill in counselling. Without proper counselling, APOL1 testing will magnify LD candidates' decisional conflict about donating, jeopardising their informed consent. Given cultural concerns about genetic testing among people of African ancestry, protecting LD candidates' safety is essential to improve informed decisions about donating. Clinical 'chatbots', mobile apps that provide genetic information to patients, can improve informed treatment decisions. No chatbot on APOL1 is available and no nephrologist training programmes are available to provide culturally competent counselling to LDs about APOL1. Given the shortage of genetic counsellors, increasing nephrologists' genetic literacy is critical to integrating genetic testing into practice. METHODS AND ANALYSIS: Using a non-randomised, pre-post trial design in two transplant centres (Chicago, IL, and Washington, DC), we will evaluate the effectiveness of culturally competent APOL1 testing, chatbot and counselling on LD candidates' decisional conflict about donating, preparedness for decision-making, willingness to donate and satisfaction with informed consent and longitudinally evaluate the implementation of this intervention into clinical practice using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. ETHICS AND DISSEMINATION: This study will create a model for APOL1 testing of LDs of African ancestry, which can be implemented nationally via implementation science approaches. APOL1 will serve as a model for integrating culturally competent genetic testing into transplant and other practices to improve informed consent. This study involves human participants and was approved by Northwestern University IRB (STU00214038). Participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04910867. Registered 8 May 2021, https://register. CLINICALTRIALS: gov/prs/app/action/SelectProtocol?sid=S000AWZ6&selectaction=Edit&uid=U0001PPF&ts=7&cx=-8jv7m2 ClinicalTrials.gov Identifier: NCT04999436. Registered 5 November 2021, https://register. CLINICALTRIALS: gov/prs/app/action/SelectProtocol?sid=S000AYWW&selectaction=Edit&uid=U0001PPF&ts=11&cx=9tny7v.

A Patient-Centered Website (Within Reach) to Foster Informed Decision-making About Upper Extremity Vascularized Composite Allotransplantation: Development and Usability Study.

BACKGROUND: Upper extremity (UE) vascularized composite allotransplantation (VCA; hand transplantation) is a reconstructive treatment option for patients with UE loss. Approximately 37 UE VCAs have been performed in the United States to date; thus, little is known about long-term psychosocial outcomes and whether the benefits outweigh the risks. To make an informed treatment decision, patients must understand the procedure, risks, and potential benefits of UE VCA. However, few educational resources are publicly available providing unbiased, comprehensive information about UE VCA. OBJECTIVE: This paper described the development of a neutral, and accessible, educational website supporting informed decision-making about UE VCA as a treatment option for individuals with UE amputations. METHODS: Website content development was informed by 9 focus groups conducted with individuals with UE amputations at 3 study sites. After initial website development, we conducted usability testing to identify ways to improve navigability, design, content, comprehension, and cultural sensitivity. Participants were administered the After-Scenario Questionnaire to assess user performance after completing navigational tasks, System Usability Scale to measure the perceived usability of the website, and Net Promoter Score to measure user satisfaction. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using rapid thematic analysis. RESULTS: A total of 44 individuals with UE amputations participated in focus groups (n=37, 84%) and usability testing (n=14, 32%). Most participants in the focus groups and usability testing were male (24/37, 65% and 11/14, 79%, respectively) and White (27/37, 73% and 9/14, 64%, respectively), had unilateral limb loss (22/37, 59% and 12/14, 86%, respectively), and had mean ages of 48 (SD 9.2) and 50 (SD 12.0) years, respectively. Focus group results are organized into accessibility, website design, website development, website tone and values, sitemap, terminology, images and videos, and tables and graphics. Usability testing revealed that participants had a positive impression of the website. The mean After-Scenario Questionnaire score of 1.3 to 2.3 across task scenarios indicated high satisfaction with website usability, the mean System Usability Scale score of 88.9 indicated user satisfaction with website usability, and the mean Net Promoter Score of 9.6 indicated that users were enthusiastic and would likely refer individuals to the website. CONCLUSIONS: The findings suggest that our educational website, Within Reach, provides neutral, patient-centered information and may be a useful resource about UE VCA for individuals with UE amputations, their families, and health care professionals. Health care professionals may inform UE VCA candidates about Within Reach to supplement current VCA education processes. Within Reach serves as a resource about treatment options for patients preparing for scheduled or recovering from traumatic UE amputations. Future research should assess whether Within Reach improves knowledge about UE VCA and enhances informed decision-making about UE VCA as a treatment option.

Information needs and development of a question prompt sheet for upper extremity vascularized composite allotransplantation: A mixed methods study.

Background: People with upper extremity (UE) amputations report receiving insufficient information about treatment options. Furthermore, patients commonly report not knowing what questions to ask providers. A question prompt sheet (QPS), or list of questions, can support patient-centered care by empowering patients to ask questions important to them, promoting patient-provider communication, and increasing patient knowledge. This study assessed information needs among people with UE amputations about UE vascularized composite allotransplantation (VCA) and developed a UE VCA-QPS. Methods: This multi-site, cross-sectional, mixed-methods study involved in-depth and semi-structured interviews with people with UE amputations to assess information needs and develop a UE VCA-QPS. Qualitative data were analyzed by thematic analysis; quantitative data were analyzed by descriptive statistics. The initial UE VCA-QPS included 130 items across 18 topics. Results: Eighty-nine people with UE amputations participated. Most were male (73%), had a mean age of 46 years, and had a unilateral (84%) and below-elbow amputation (56%). Participants desired information about UE VCA eligibility, evaluation process, surgery, risks, rehabilitation, and functional outcomes. After refinement, the final UE VCA-QPS included 35 items, across 9 topics. All items were written at a ≤ 6th grade reading level. Most semi-structured interview participants (86%) reported being 'completely' or 'very' likely to use a UE VCA-QPS. Conclusion: People with UE amputations have extensive information needs about UE VCA. The UE VCA-QPS aims to address patients' information needs and foster patient-centered care. Future research should assess whether the UE VCA-QPS facilitates patient-provider discussion and informed decision-making for UE VCA.

Emergency care nurses: certification, empowerment, and work-related variables.

INTRODUCTION: The value of specialty certification has been of interest to the profession and has been related to a number of key variables. The specific aims of this study were to determine differences between certified and noncertified ED nurses in perceptions of structural empowerment, anticipated turnover, intent to leave the current position, and intent to leave the nursing profession. In addition we explored differences in the key variables based on position (staff or manager) and background variables (eg, age, ethnicity, etc). Participants also were asked to indicate reasons why they intended to leave their current position and the nursing profession. METHODS: In this descriptive quantitative design, data were collected via a Web-based survey of the Emergency Nurses Association membership. There were 2,633 participants who completed the surveys; 1,525 of the participants were staff nurses and 2,237 worked full time in the emergency department. Differences in empowerment, anticipated turnover, or intent to leave current position or the profession were determined based on specialty certification among the total sample and the subsamples of staff nurses and full-time employees. RESULTS: There were differences based on certification status on several dimensions of empowerment, in all of the samples. There were no significant differences in anticipated turnover, or intent to leave position or profession based on certification status. DISCUSSION: The study adds to our understanding of the value of specialty certification among ED nurses. Additional study is warranted to determine the benefits of specialty certification to additional organizational, professional, and clinical patient outcomes.

Nurse Practitioner Delphi Study: competencies for practice in emergency care.

INTRODUCTION: The Emergency Nurses Association (ENA) convened a Nurse Practitioner (NP) Validation Work Team and conducted a Delphi study to verify and gain consensus on professional and clinical competencies for NPs in emergency care. This document describes entry-level competencies for NPs practicing in emergency care, regardless of setting. METHODS: A Delphi study was conducted from September 2007 to May 2008 with a national sample of credentialed NPs in emergency care. Using online questionnaires, three rounds were sent to the NPs to reach group consensus. Participants were asked to rate the importance and frequency of performance for each competency as well as list competencies they felt were not addressed in the questionnaires. RESULTS: The list of competencies was reduced from 111 to 83. In 2008, a Consensus Panel Meeting was convened to validate the Delphi study findings and gain consensus from a multidisciplinary group of stakeholders. Several organizations participated in the meeting (ie, AAEM, AANP, AACN, ACEP, ACNP, ANA, ANCC, BCEN, CCNE, NCSBN, and NONPF). The stakeholders approved a list of 60 entry-level competencies. DISCUSSION: There are implications for NPs in the following areas: 1) education, for use in academic settings as a foundation for curricula; 2) practice, emphasizing the unique aspects of practice for the NP in emergency care; and 3) research, including the development of advanced competencies for NPs in emergency care.

Violence against nurses working in US emergency departments.

UNLABELLED: The objective of this study was to investigate emergency nurses experiences and perceptions of violence from patients and visitors in US emergency departments (EDs). BACKGROUND: The ED is a particularly vulnerable setting for workplace violence, and because of a lack of standardized measurement and reporting mechanisms for violence in healthcare settings, data are scarce. METHODS: Registered nurses members (n=3,465) of the Emergency Nurses Association participated in this cross-sectional study by completing a 69-item survey. RESULTS: Approximately 25% of respondents reported experiencing physical violence more than 20 times in the past 3 years, and almost 20% reported experiencing verbal abuse more than 200 times during the same period. Respondents who experienced frequent physical violence and/or frequent verbal abuse indicated fear of retaliation and lack of support from hospital administration and ED management as barriers to reporting workplace violence. CONCLUSION: Violence against ED nurses in highly prevalent. Precipitating factors to violent incidents identified by respondents is consistent with the research literature; however, there is considerable potential to mitigate these factors. Commitment from hospital administrators, ED managers, and hospitals security is necessary to facilitate improvement and ensure a safer workplace for ED nurses.

Violence against nurses working in US emergency departments.

OBJECTIVE: The objective of this study was to investigate emergency nurses' experiences and perceptions of violence from patients and visitors in US emergency departments (EDs). BACKGROUND: The ED is a particularly vulnerable setting for workplace violence, and because of a lack of standardized measurement and reporting mechanisms for violence in healthcare settings, data are scarce. METHODS: Registered nurse members (n = 3,465) of the Emergency Nurses Association participated in this cross-sectional study by completing a 69-item survey. RESULTS: Approximately 25% of respondents reported experiencing physical violence more than 20 times in the past 3 years, and almost 20% reported experiencing verbal abuse more than 200 times during the same period. Respondents who experienced frequent physical violence and/or frequent verbal abuse indicated fear of retaliation and lack of support from hospital administration and ED management as barriers to reporting workplace violence. CONCLUSION: Violence against ED nurses is highly prevalent. Precipitating factors to violent incidents identified by respondents is consistent with the research literature; however, there is considerable potential to mitigate these factors. Commitment from hospital administrators, ED managers, and hospital security is necessary to facilitate improvement and ensure a safer workplace for ED nurses.

Barriers to emergency departments' adherence to four medication safety-related Joint Commission National Patient Safety Goals.

BACKGROUND: Medication errors are a serious public health threat, causing patient injury and death and sharply increasing health care costs. Serious preventable errors are most likely to occur in areas of increased complexity and technology, such as the emergency department (ED). Although The Joint Commission in 2002 approved the first set of National Patient Safety Goals (NPSGs) to decrease the occurrence of health care errors, the literature suggests that the goals are not fully implemented. In 2006, the Emergency Nurses Association (ENA) conducted a national, multisite survey (1) to describe barriers to full implementation of the 2006 NPSGs related to medication safety (then known as Goals 1, 2, 3, and 8) as reported by ED registered nurses (ED nurses) and (2) to investigate factors related to those barriers. METHODS: ED nurses (n = 2,220), managers (n = 129), and site coordinators (n = 126) representing 131 EDs completed surveys concerning NPSG implementation, policies, and barriers. Nonparametric statistical methods were used to analyze the data. RESULTS: ED nurses frequently reported barriers to adherence to NPSGs. Patient safety education was not related to NPSG adherence. A complex work environment, such as that associated with residents in training, mixed-shift hours, and state designation as a trauma center, was associated with reduced NPSG adherence. DISCUSSION: The low response rate (4.6%) to this study inherently limits the overall generalizability of the findings to the greater population of EDs. Yet, the findings suggest that substantial barriers remain to ED adherence to the NPSGs related to medication safety. Efforts to reduce the barriers should focus on system changes that facilitate adherence. Health care providers and their organizations must commit to and enforce a zero-tolerance policy for preventable medication errors.

Designing ergonomic interventions for EMS workers: concept generation of patient-handling devices.

Fire service personnel and private ambulance paramedics suffer musculoskeletal injuries as they lift and carry patients while performing emergency medical services (EMS). Engineering changes, such as the design of new EMS patient-handling devices, offer a potential intervention opportunity for combating this problem. The purpose of this qualitative descriptive study was to generate beginning ideas for the design of new EMS patient-handling devices that were framed within the contextual reality of the end user firefighter/paramedics. Guided by an ecological model of musculoskeletal injuries in the fire service, focus groups were conducted with 25 firefighter/paramedics from 13 suburban fire departments. Based on their availability, participants were assigned to one of three groups with each group focusing on a different EMS patient-handling scenario. Each group participated in two focus group sessions: one session to brainstorm ideas for devices and a second session to validate sketches of their design ideas. The sketches were professionally drawn by an industrial designer who attended all focus group sessions. Sketches, photos, videotapes, and written transcripts were content analyzed to describe the phenomena of interest. The ideas centered on EMS devices for lateral transfers, bed-to-stairchair transfers, and stair descent transport, and served as the starting point for the development of EMS devices in subsequent phases of a mixed method research study. The outcomes of this study were an improved understanding of the contextual issues that need to be considered in designing EMS patient handling devices and a set of industrial design sketches that served as a starting point for subsequent development of the devices. End user acceptance criteria for the devices included: affordability, portability/compactness, durability, operability including being quickly ready for use, and cleanability.

Designing ergonomic interventions for EMS workers - part II: lateral transfers.

The objective of the current work was to test ergonomic interventions aimed at reducing the low back musculoskeletal loads experienced by firefighters/paramedics (FFPs) providing emergency medical services (EMS) when performing lateral transfers between a bed and a stretcher or between a stretcher and a hospital gurney. The interventions, developed using focus groups, were a bridgeboard to reduce the frictional force resisting the lateral sliding of the patient, the use of rods along each side of the patient to facilitate the grasping and handling of the bedsheet on which the patient is typically transferred, and a single rod that, when rolled in the bedsheet, resulted in the task being changed from a lifting task to a pulling task. Eleven two-person teams laterally transferred a 75 kg dummy with each intervention between a bed and simulated stretcher. Two roles were defined. For the two-sided transfers, the FFP roles were termed "stretcher-side" and "bed-side." Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant along with spine kinematic data. Additionally, kinetic data were obtained for the FFP in the stretcher-side role. Trunk flexion moments and Erector Spinae activity were reduced for the FFP in the stretcher-side role when using the bridgeboard and the single rod both individually and in combination. The single rod reduced the Erector Spinae activity in the FFP who typically would have been on the bed. For FFPs in both roles the single rod increased Latissimus Dorsi activation relative to the standard bedsheet transfer condition, although, this effect was moderated when the single rod was used in combination with the bridgeboard. Ratings of perceived exertion also supported the use of the single rod relative to the corresponding control condition.

Designing ergonomic interventions for EMS workers, Part I: transporting patients down the stairs.

The objective of the current work was to test ergonomic interventions aimed at reducing the magnitude of trunk muscle exertions in firefighters/paramedics (FFPs) providing emergency medical services (EMS) when transporting patients down the stairs. The interventions, developed using focus groups, were a footstrap to prevent the patient from sliding down on the backboard, a change in the handle configuration on the stairchair, and 2 devices, the "backboard wheeler" and a tank tread-like device (descent control system, DCS) for a stretcher, that change the backboard and stretcher carrying tasks into rolling and sliding tasks. Eleven two-person teams transported a 75 kg dummy with each intervention and its corresponding control condition down a flight of steps. Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant. Results showed that the backboard footstrap reduced the erector spinae (ERS) activity for the FFP in the "leader" role by 15 percent, on average. The change in handle configuration on the stairchair had no effect on the variables measured. The backboard wheeler reduced the ERS activity bilaterally in the FFP in the leader role and unilaterally for the FFP in the "follower" role, by 28 and 24 percent, respectively. The DCS reduced the 90th percentile ERS activity for both FFPs from 26 to 16 percent MVC, but increased the latissimus dorsi activity in the follower from 11 to 15 percent MVC. The DCS was the only intervention tested that resulted in a reduced rating of perceived exertion relative to the corresponding control condition. In summary, the hypotheses that the proposed interventions could reduce trunk muscle loading were supported for 3 of the 4 transport interventions tested.

Designing ergonomic interventions for emergency medical services workers--part III: Bed to stairchair transfers.

The objective of the current work was to test interventions aimed at reducing the low-back musculoskeletal loads experienced by firefighters/paramedics (FFPs) providing emergency medical services (EMS) that involve transferring a patient between a bed and a stairchair. The interventions, developed or selected using focus groups, were a prototype Drew People Movertrade mark, and a Transfer Sling. These interventions changed the coupling between the EMS worker and the patient. They were compared with an under-axilla lift. Eleven FFP teams transferred a 75kg dummy between a bed and a stairchair. Both interventions were tested using two-person transfers. In addition, the Transfer Sling was tested using a one-person transfer. Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant along with spine kinematic data. Additionally, ground reaction force data obtained from two forceplates were acquired for one member of each FFP team that was used to estimate directional spine moments using a 3D linked-segment model. In the two-person transfers, there was 19 degrees less trunk flexion (p=0.002) for the FFP on the patient's left side and a trend towards less motion for the FFP on the patient's right side (p=0.079) when using the interventions. Both FFPs showed reductions in the ipsilateral Erector Spinae activity using the Drew People Mover and the Transfer Sling that averaged approximately 9% MVC, which corresponds to a 21% decrease in the muscle activation levels. While the overall EMG was greater when performing a single-FFP transfer, the Transfer Sling reduced the bilateral Erector Spinae activity by approximately 20%. During the two-person transfers, the FFP on the forceplate to the right side of the patient showed a reduction in the forward bending moment using the Drew People Mover relative to the Sling and under-axilla conditions. During the single-person transfers, only the twisting moment was significantly reduced through use of the Transfer Sling. These objective measures, when combined with the subjective ratings of perceived exertion and the verbal feedback lead us to recommend the use of these interventions for bed to stairchair transfers.

Research education needs of pediatric emergency nurses.

INTRODUCTION: Evidence-based practice in the emergency care of children is critical. The Pediatric Emergency Care Applied Research Network (PECARN) was developed to increase pediatric research; however, participation by emergency nurses has been limited. To identify research needs in order to increase research involvement, the Emergency Nurses Association (ENA) conducted a research needs assessment with nurses in PECARN emergency departments. METHODS: A self-administered needs assessment questionnaire was completed by 216 ED managers and nurses in 26 PECARN emergency departments between August and November of 2004. The questionnaires included items about research education, knowledge, and experience, as well as barriers to and resources for conducting research. Descriptive statistics were used to analyze the data. RESULTS: The primary barriers to nurses' research involvement included limited research knowledge and experience, limited awareness and availability of research resources, lack of dedicated time, and limited recognition for research contributions. However, the nurses reported moderate to extensive interest in research continuing education and desired moderate to extensive involvement in pediatric research. DISCUSSION: The nurses worked in research institutions with increased access to subjects and collaborative opportunities, indicating strong potential for nurses' research involvement. However, few institutions had practice models that included research recognition and dedicated research time. Furthermore, limited knowledge, experience, and awareness of research resources added to the barriers that reduced research involvement. To begin addressing the barriers, ENA developed a research curriculum based on the continuing education needs and interests identified by the nurses.

Residents' access to ethics consultations: knowledge, use, and perceptions.

PURPOSE: To examine residents' levels of awareness, use, and perceptions of the ethics consultation service at Loyola University Medical Center, a large Midwestern academic teaching hospital. METHOD: In 2001-2002, the authors conducted a cross-sectional survey and semistructured interviews about knowledge and use of the ethics consultation service among all 229 internal medicine, surgery, anesthesiology, pediatrics, and medicine-pediatrics residents. Chi-square and t tests were used to compare categorical and continuous variables. RESULTS: In all, 135 (59%) of the residents responded, and of these 22 (16%) completed an interview. Most survey respondents (76%) reported awareness of the ethics consultation service, although only 28 (21%) indicated they knew how to request one. Most respondents (89%) had never personally requested an ethics consultation. Thirteen residents (10%) had wanted to call an ethics consultation, but decided not to request one. Residents reported barriers to requesting an ethics consultation were the attending physician's opposition (46%), lack of awareness of the ethics consultation service (15%), and negative perceptions of ethics consultations (15%). CONCLUSION: Several barriers hindered residents' use of ethics consultation services. Health care institutions should systematically educate employees about the availability and use of ethics consultation services. Institutions should establish mechanisms to give health care professionals in subordinate roles within the medical hierarchy a safe way to access and use the service.