Translating evidence-based nursing clinical handover practice in an acute care setting: A quasi-experimental study.

Effective transfer of information during the nursing handover contributes to patient safety. This study aimed to translate the best practice nursing shift handover recommendations in an acute care setting using the Ottawa Model for Research Use and to explore its effect on patient adverse outcomes (falls, pressure injuries, and medication errors). Using a quasi-experimental design, the study was conducted in four internal medicine wards in a major tertiary hospital. A total of 88 nurses and 110 patients participated in 152 handover observations. The findings showed clinically important increases in percentages and odds of nurses' compliance with shift handover recommendations after the intervention. The patient adverse outcomes after the intervention were compared to the corresponding period of previous year. A reduction was observed for all adverse patient outcomes with incident rate ratios of 0.762 (p = 0.027) for falls, 0.624 for pressure injuries (p = 0.010), and 0.782 for medication errors (p = 0.023). Replicating this study's methodology across multiple clinical settings will increase the generalizability of findings and provide further evidence to inform nursing practice and policy.

Risk factors associated with higher pain levels among pediatric burn patients: a retrospective cohort study.

INTRODUCTION: There is an absence of evidence regarding predictors of moderate to severe pain in children undergoing acute burn treatment. This investigation aimed to determine if relationships existed between patient and clinical characteristics, and pain at first dressing change for children with acute burn injuries. METHODS: A retrospective cohort investigation was conducted using clinical data from pediatric burn patients treated at the Queensland Children's Hospital, Brisbane, Australia. Data extracted included patient and burn characteristics, first aid, and follow-up care. Observational pain scores were categorized into three groups (mild, moderate, and severe pain), and bivariate and multivariable relationships were examined using proportional odds ordinal logistic regression. Data from 2013 pediatric burns patients were extracted from the database. RESULTS: Factors associated with increased odds of procedural pain included: hand burns (OR 1.7, 95% CI 1.3 to 2.1, p<0.001), foot burns (OR 1.5, 95% CI 1.1 to 2.1, p<0.01), baseline pain (OR 5.5, 95% CI 2.8 to 10.8, p<0.001), deep dermal partial-thickness injuries (OR 7.9, 95% CI 4.0 to 15.6, p<0.001), increased burn size (OR 1.1, 95% CI 1.0 to 1.2, p<0.01), four or more anatomical regions burned (OR 3.6, 95% CI 1.5 to 8.6, p<0.01), initial treatment at a non-burns center (OR 1.8, 95% CI 1.4 to 2.3, p<0.001), and time to hospital presentation (OR 0.9, 95% CI 0.8 to 0.9, p<0.001). These burn characteristics are associated with increased odds of moderate to severe procedural pain during a child's first dressings change. DISCUSSION: It is recommended that patients presenting with one or more of the aforementioned factors are identified before their first dressing change, so additional pain control methods can be implemented.

Differential growth patterns of the abdominal aorta and vertebrae during childhood.

The adult vertebral level of the splanchnic branches of the abdominal aorta relies on a complex series of fusion and regression steps during embryological development, such that variation is common. Little is known however regarding the anatomy of the abdominal aorta in children. This study aimed to investigate the spatial relationship between the abdominal aorta and the vertebral column during childhood development to inform clinical management of pediatric patients. Retrospective multislice computed tomography abdominopelvic angiograms of children aged neonate to 19 years (n = 232) were used to examine vertebral levels of the celiac trunk (CoT), superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and aortic bifurcation (AB) using multiplanar formatting views in OsiriX. The abdominal aorta length, AB angle, and displacement of the aorta from the midline were quantified with the effect of age and sex analyzed using multinomial logistic regression and general linear models. The most frequent origins of CoT, SMA, IMA, and AB were T12, L1, L3, and L4, respectively, with significant variation in vertebral level for each vessel. SMA level was significantly more proximal with age, and CoT and AB demonstrated marked sex differences in vertebral level. As the age of the child increased, AB angle decreased, aortic displacement increased, and the length of the abdominal aorta increased at a slower velocity to the vertebral column (P < 0.001). Our study highlights the variation of the location and geometry of the abdominal aorta in children; this knowledge will positively impact pediatric surgical approaches and endovascular procedures. Clin. Anat. 32:783-793, 2019. © 2019 Wiley Periodicals, Inc.

Assessing the fusion of the ischiopubic synchondrosis using predictive modeling.

Flaring of the ischiopubic synchondrosis at the time of fusion is a common clinical observation in pediatrics and represents a normal physiological process in skeletal maturation. When presenting unilaterally, this flaring can mimic a range of serious pathological conditions such as osteomyelitis, osteal tumors, and traumatic injury. An improved understanding of ischiopubic synchondrosis fusion is therefore critical to avoid potential misdiagnosis. Retrospective multi-slice computed tomography pelvic scans of Australian individuals aged neonate to 24 years (n = 184) were assessed using a novel five stage morphological classification system of the maturation and fusion of the ischiopubic synchondrosis. Maturation scoring was conducted using both multiplanar formatting views and volume-rendered reconstructions in OsiriX™. Maturational stage was strongly related to age (P < 0.001) with fusion of the ischiopubic synchondrosis observed between the ages of 4 and 9 years in females and 7 and 13 years for males. The highest probability of fusion in our Queensland Australian population based on multinomial regression predictive modeling was between 7 and 10 years of age. We documented three variants of fusion: pubic and ischial outgrowths, appearance of a secondary ossification center, and a fusiform-shaped enlargement. This study provides the first predictive modeling of the timing of fusion of the ischiopubic synchondrosis using a reliable morphological classification system. The significant variation in timing and progression of fusion of the ischiopubic synchondrosis reported in this study, will aid in minimizing misdiagnosis and unnecessary treatment in children presenting with asymmetrical or delayed ischiopubic synchondrosis anomalies. Clin. Anat. 32:851-859, 2019. © 2019 Wiley Periodicals, Inc.