Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: A systematic review and meta-analysis

BackgroundMicroorganisms can intraluminally access a central venous catheter via the catheter hub. The catheter hub should be appropriately disinfected to prevent central line-associated bloodstream infections (CLABSIs). However, compliance with the time-consuming manual disinfection process is low. An alternative is the use of an antiseptic barrier cap, which cleans the catheter hub by continuous passive disinfection.ObjectiveTo compare the effects of antiseptic barrier cap use and manual disinfection on the incidence of CLABSIs.DesignSystematic review and meta-analysis.MethodsWe systematically searched Embase, Medline Ovid, Web-of-science, CINAHL EBSCO, Cochrane Library, PubMed Publisher and Google Scholar until May 10, 2016. The primary outcome, reduction in CLABSIs per 1000 catheter-days, expressed as an incidence rate ratio (IRR), was analyzed with a random effects meta-analysis. Studies were included if 1) conducted in a hospital setting, 2) used antiseptic barrier caps on hubs of central lines with access to the bloodstream and 3) reported the number of CLABSIs per 1000 catheter-days when using the barrier cap and when using manual disinfection.ResultsA total of 1537 articles were identified as potentially relevant and after exclusion of duplicates, 953 articles were screened based on title and abstract; 18 articles were read full text. Eventually, nine studies were included in the systematic review, and seven of these nine in the random effects meta-analysis. The pooled IRR showed that use of the antiseptic barrier cap was effective in reducing CLABSIs (IRR = 0.59, 95% CI = 0.45–0.77, P < 0.001).ConclusionsUse of an antiseptic barrier cap is associated with a lower incidence CLABSIs and is an intervention worth adding to central-line maintenance bundles.     

The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial

BackgroundPressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare.ObjectivesTo evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care.DesignCost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial.SettingsEight tertiary hospitals in Australia.ParticipantsAdult patients receiving either a patient-centred pressure ulcer prevention care bundle (n = 799) or standard care (n = 799).MethodsDirect costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n = 317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28 days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015).ResultsThe care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be −$2320 (95%CI −$3900, −$1175) per patient, suggesting the care bundle was not a cost-effective use of resources.ConclusionsA pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient education may promote best practice nursing care but may not be cost-effective in preventing hospital acquired pressure ulcer.     

Effects of a nurse-led transitional care program on clinical outcomes,health-related knowledge,physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial

BackgroundCoronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.ObjectivesTo examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.DesignRandomized controlled trial.MethodsThe Omaha system and Pender’s health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n = 100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n = 99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.ResultsCompared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t = 5.762, P = 0.000; diastolic blood pressure, t = 4.250, P = 0.000; fasting blood glucose, t = 2.249, P = 0.027; total cholesterol, t = 4.362, P = 0.000; triglyceride, t = 3.147, P = 0.002; low density lipoprotein cholesterol, t = 2.399, P = 0.018; and body mass index, t = 3.166, P = 0.002), higher knowledge scores for coronary artery disease (total knowledge score, t = −7.099, P = 0.000), better physical health status (t = −2.503, P = 0.014) and mental health status (t = −2.950, P = 0.004).ConclusionsThis study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender’s health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.     

Screening for diabetic kidney disease in primary care for the underinsured: A quality improvement initiative

PurposeScreening rates for DKD in primary care are low, even though diabetes accounts for 44% of all new kidney disease cases. The purpose of this project was to determine if a primary care team for the underinsured improved screening and diagnosis of diabetic kidney disease (DKD) after initiating a quality improvement (QI) process.MethodsA chart audit with feedback, provider education of clinical practice guidelines, and strategies from TeamSTEPPS™ were implemented with the inter-professional primary care team.ResultsPre/post-intervention chart audit analysis showed the frequency of ordering microalbumin increased from 50.3% (n = 148) to 75% (n = 148), and diagnosing DKD rose from 3.3% (n = 10) to 10.7% (n = 21) over three months (P = .000).ConclusionImplementing a QI process in underinsured primary care centers improved the compliance of proper screening and diagnosing DKD AND introduced inter-professional practice competencies and teamwork strategies not previously recognized at the centers.     

Nurse workload and inexperienced medical staff members are associated with seasonal peaks in severe adverse events in the adult medical intensive care unit: A seven-year prospective study

ObjectiveOur purpose was to identify potential organizational factors that contributed to life-threatening adverse events in adult intensive care unit.MethodsA prospective, observational, dynamic cohort study was carried out from January 2006 to December 2013 in a 20-bed adult medical intensive care unit. All patients admitted to the intensive care unit and who experienced one or more selected life-threatening adverse events (mainly unexpected cardiac arrest, unplanned extubation, reintubation after planned extubation, and readmission within 48 h of intensive care unit discharge) were included in the analysis. Negative binomial regression was used to model how human resources, work organization, and intensive care activity influenced the monthly rate of selected severe adverse events. Data were collected from local and national databases.ResultsOverall, 638 severe adverse events involving 498 patients were recorded. Adverse events increased seasonally in May, November and December (p < .001 vs other months). The proportion of inexperienced nurses and doctors’ working hours could not explain these seasonal peaks of adverse events. Multivariate analysis identified bed-to-nurse ratio and the arrival of inexperienced residents or senior registrars as being independently associated with the rate of adverse events (incidence risk ratio = 1.36 (95% confidence interval, 1.05–1.75), and 1.07 (95% confidence interval, 1.01–1.13), respectively; p = .01 in both cases). According to this model, a one-unit increase in the day–night shifts carried out by each nurse per month tended to reduce the rate of adverse events (incidence risk ratio = 0.60 (95% confidence interval, 0.36–1.01), p = .05). Severity at intensive care unit admission did not influence the rate of adverse events (incidence risk ratio = 1.02 (95% confidence interval, 1.00–1.04), p = .12).ConclusionsResults identify nurse workload and the arrival of inexperienced residents or senior registrars as risk factors for the occurrence of life-threatening adverse events in the adult medical intensive care unit. Limiting fluctuations in bed-to-nurse ratio and providing inexperienced medical staff members with sufficient supervision may decrease severe adverse events in critically ill patients.     

The effect of oral care using honey as an additional topical agent on oral health status of intubated patients in the intensive care unit

BackgroundPatients using endotracheal tubes are at high risk of oral health status dysfunction due to impaired natural airway defence, oral flora composition changes and protective substances of the teeth, medication causing xerostomia. Oral care has not been enough to manage oral mucosal dryness, so an additional topical agent is needed to protect oral mucosa to maintain oral health. Honey is one of the recommended topical agents.ObjectiveThis study aims to identify the effect of oral care with honey as topical agents on the oral health status of patients using endotracheal tube in the Intensive Care Unit.MethodsThis was an experimental study with a randomized pretest and posttest design. The sample was adult intubated patients, consisting of 36 patients. The data were analysed using the parametric test, and dependent and independent t-test.ResultsThe oral health score in the control group was found to be pre & post mean score11.94 and 13.28 (p = .004) respectively, while in the intervention group 11.89 and 8.33 (p < .001). Mean differences in both groups were 4.95 (p < .001) and the BOAS subscale differences were seen on the lips, gums & mucosa, and tongue (p < .05).ConclusionOral care with honey as a topical agent can improve the oral health status of intubated patients on the lips, gum, mucosa, and tongue subscale. Therefore, honey as an additional topical agent can be a moisturizer to maintain the oral mucosa for intubated patients in the Intensive Care Unit. Furthermore, good mucosal health will help prevent the infection and colonization of microorganisms.     

Audit for quality of care and fate of maternal critical cases at Women's Health Hospital

Maternal deaths remain high, numbers at the facility level are relatively low.AimTo evaluate effect of management guidelines on occurrence of maternal near miss in Women's Health Hospital.DesignA cross-sectional study.SettingICU of Women's Health Hospital's at Assiut Main University Hospital and Al-fayoum University Hospital.SubjectsConvenient sample of 93 maternal near-miss cases including (Pregnancy or postpartum complications).Toolaudit the applied critical care for severe condition related to obstetric complications and consist of three parts: Patient's demographic data, Audit of critical care and “Maternal near-miss” Fate. Data collected during a period of 1/3/2015 to 30/8/2015 for management guidelines and maternal outcomes.ResultsA statistical significant differences between the medical management and occurrence of sever maternal complications such as (severe postpartum hemorrhage, severe pre-eclampsia, Sepsis or severe systemic infection, uterine hemorrhage, ruptured uterus) (P = 0.000, P = 0.031, P = 0.036, P = 0.052, P = 0.012 respectively).ConclusionsThe maternal management guidelines was a successful tool in recording the gap between the current received management and standards management guidelines in ICU. Also they measure the effect of current management in ICU on maternal mortality and morbidity.     

Protective isolation precautions for the prevention of nosocomial colonisation and infection in burn patients: A systematic review and meta-analysis

ObjectivesTo assess the impact of protective isolation precautions on nosocomial colonisation and infection rates in burn patients.Research methodologyA systematic review and meta-analysis were performed of studies identified through Pubmed and Web of Science. Only articles in English were considered. The Downs and Black tool was used to evaluate their methodological quality. Random-effects meta-analysis obtained pooled risk ratios (RRs) and 95% confidence intervals (CIs) of nosocomial colonisation and infection rates.ResultsFive eligible before-after studies were identified, encompassing a total of 3033 patients (1192 in the experimental group; 1841 in the control group). Varying protective isolation precautions were investigated, resulting in high clinical heterogeneity. Quality assessment revealed overall poor methodological quality. Protective isolation significantly reduces combined colonisation and infection rates compared to baseline care (RR 0.52, 95% CI 0.40–0.69; P < 0.0001). Subgroup analyses indicated significant reductions in both nosocomial colonisation (RR 0.65, 95% CI 0.51–0.83; P = 0.02) and infection rates (RR 0.53, 95% CI 0.49–0.58; P < 0.0001).ConclusionsProtective isolation precautions appear to decrease the risk of colonization and infection in burn patients. Because of the absence of higher quality study designs, clinical heterogeneity and the small number of studies involved, these results must be interpreted cautiously.     

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial

BackgroundUp to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients’ sleep quality. An effective educational programme was important to improve patients’ sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan.ObjectivesTo examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure.Designrandomised controlled trial.Participants and settingEighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n = 43) or the control group (n = 41).MethodsPatients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients’ enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression.ResultsThe intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p < .001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p > .05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β = −2.22, p < .001), daytime sleepiness (β = −4.23, p < .001), anxiety (β = −1.94, p < .001), and depression (β = −3.05, p < .001) after 12 weeks of the intervention.ConclusionThis study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.     

Barriers and facilitators in providing oral care to nursing home residents,from the perspective of care aides: A systematic review and meta-analysis

BackgroundOral health of nursing home residents is generally poor, with severe consequences for residents’ general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents.MethodsWe systematically searched the databases MEDLINE, Embase, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence.ResultsWe included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care = 45% (15%–77%); care providers’ lack of knowledge, education or training in providing oral care = 24% (7%–47%); general difficulties in providing oral care = 26% (19%–33%); lack of time = 31% (17%–47%); general dislike of oral care = 19% (8%–33%); and lack of staff = 22% (13%–31%).ConclusionsWe found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents’ responsive behaviors and to improve care aides’ oral care knowledge are especially needed.     

Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational,multicenter, cross-sectional study

ObjectivesTo investigate if burnout in the Intensive Care Unit (ICU) is influenced by aspects of personality, religiosity and job satisfaction.Research methodologyCross-sectional study, designed to assess burnout in the ICU and to investigate possible determinants. Three different questionnaires were used: the Malach Burnout Inventory, the Eysenck Personality Questionnaire and the Spiritual/Religious Attitudes Questionnaire. Predicting factors for high burnout were identified by multivariate logistic regression analysis.Setting/ParticipantsThis national study was addressed to physicians and nurses working full-time in 18 Greek ICU departments from June to December 2015.ResultsThe participation rate was 67.9% (n = 149) and 65% (n = 320) for ICU physicians and nurses, respectively). High job satisfaction was recorded in both doctors (80.8%) and nurses (63.4%). Burnout was observed in 32.8% of the study participants, higher in nurses compared to doctors (p < 0.001). Multivariate analysis revealed that neuroticism was a positive and extraversion a negative predictor of exhaustion (OR 5.1, 95%CI 2.7–9.7, p < 0.001 and OR 0.49, 95%CI 0.28–0.87, p = 0.014, respectively). Moreover, three other factors were identified: Job satisfaction (OR 0.26, 95%CI 0.14–0.48, p < 0.001), satisfaction with current End-of-Life care (OR 0.41, 95%CI 0.23–0.76, p = 0.005) and isolation feelings after decisions to forego life sustaining treatments (OR 3.48, 95%CI 1.25–9.65, p = 0.017).ConclusionsPersonality traits, job satisfaction and the way End-of-Life care is practiced influence burnout in the ICU.     

Comparison of open and closed suction on safety,efficacy and nursing time in a paediatric intensive care unit

BackgroundEndotracheal suctioning (ETS) is one of the most common procedures performed in the paediatric intensive care. The two methods of endotracheal suctioning used are known as open and closed suction, but neither method has been shown to be the superior suction method in the Paediatric Intensive Care Unit (PICU).PurposeThe primary purpose was to compare open and closed suction methods from a physiological, safety and staff resource perspective.MethodsAll paediatric intensive care patients with an endotracheal tube were included. Between June and September 2011 alternative months were nominated as open or closed suction months. Data were prospectively collected including suction events, staff involved, time taken, use of saline, and change from pre-suction baseline in heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO₂). Blocked or dislodged ETTs were recorded as adverse events.FindingsClosed suction was performed more often per day (7.2 vs 6.0, p < 0.01), used significantly less nursing time (23 vs 38 min, p < 0.01) and had equivalent rates of adverse events compared to open suction (5 vs 3, p < 0.23). Saline lavage usage was significantly higher in the open suction group (18% vs 40%). Open suction demonstrated a greater reduction in SpO₂ and nearly three times the incidence of increases in HR and MAP compared to closed suction. Reductions in MAP or HR were comparable across the two methods.ConclusionsIn conclusion, CS could be performed with less staffing time and number of nurses, less physiological disturbances to our patients and no significant increases in adverse events.     

Feeding Tubes and Health Costs Postinsertion in Nursing Home Residents With Advanced Dementia

ContextThe best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs.ObjectivesTo estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization.MethodsMedicare claims (1999–2009) and Minimum Data Set data (1999–2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design.ResultsMatched residents with (n = 1924, 68.9% female, 28.8% African American, average age 83.1 years) and without (weighted n = 1924, unique n = 4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9% 180 day mortality among those with a feeding tube vs. 49.8% among those without a feeding tube, P = 0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95% CI of difference = $1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95% CI of difference = 0.34, 0.92 days).ConclusionIn an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.     

Incidencia de flebitis secundaria por catéter venoso de acceso periférico e impacto de un protocolo de manejo

ObjectiveTo assess the impact on the incidence of PPIVC by implementing a catheter management protocol and to determine risk factors for PPIVC development in hospitalized patients.MethodA total of 3978 episodes of venous catheterization were prospectively included from September 2002 to December 2007. A catheter management protocol was implemented during this period of time. The incidence and variables associated to the occurrence of PPIVC were determined.ResultsThe incidence of PPIVC from 2002 to 2007 was 4.8%, 4.3%, 3.6%, 2.5%, 1.3% and 1.8% (p<0.001). Perfusion of amiodarone [adjusted OR (AOR) 25.97; 95% CI=7.29 – 92.55, p=0.0001] and cefotaxime (AOR 2.90; 95% CI=1.29 – 6.52, p=0.01) and the shift when the catheters were placed (AOR for morning vs. night shift 0.60; 95% CI=0.35 – 1.02, p=0.063) were independently associated to the development of PPIVC. A history of phlebitis was the only factor independently associated to phlebitis due to peripherally inserted central venous catheters (AOR 3.24; CI at 95% CI= 1.05 – 9.98, p=0.04).ConclusionsA catheter management protocol decreases the incidence of PPIVC in hospitalized patients. The risk of PPIVC increases for peripherally inserted central venous catheters when the patients have a history of phlebitis and for peripheral venous catheters when amiodarone or cefotaxime are infused. Catheterization of peripheral veins performed during morning shifts is associated with a lower incidence of PPIVC when compared with night shift catheterizations.     

The Glu298ASP polymorphism of the endothelial nitric oxide synthase gene is associated with premature ST elevation myocardial infarction in Mexican population

BackgroundThe polymorphism Glu298Asp of endothelial nitric oxide (eNOS) gene has been associated with hypertension and coronary artery disease in several populations worldwide, but results are still controversial. We examined the possible association of the Glu298Asp with premature ST elevation myocardial infarction (STEAMI) in young Mexican population.MethodsIn a case–control study 180 unrelated patients with STEAMI ≤ 45 years who were admitted to a cardiovascular intense care unit and 180 apparently healthy controls matched by age and gender were recruited from January 2006 to June 2009. The polymorphism Glu298Asp was determined in all participants by a polymerase chain-reaction-restriction fragment length polymorphism assay (PCR-RFLP).ResultsThere was a significant difference in the genotype distribution between 2 groups (P = 0.001). The allele Asp occurred more frequently in the patients group (P = 0.001). There were independent factors for STEAMI: the Asp allele (OR 2.2, 95% CI 1.1–3.5, P = 0.03), smoking (OR 5.0, 95% CI 3.1–8.2, P < 0.001), hypertension (OR 2.0, 95% CI 1.0–3.5, P = 0.03), family history of cardiovascular disease, (OR 3.7, 95% CI 2.0–4.6, P = 0.02), and dyslipidemia (OR 3.4, 95% CI 2.0–6.3, P = 0.02).ConclusionsThe Asp allele from the Gu298Asp polymorphism represents an independent risk factor for premature STEAMI in Mexican Mestizo population.     

Rehabilitation of 190 non-ambulatory children with cerebral palsy in structures of care or in liberal sector

AimsTo describe the rehabilitation of non-ambulatory children with cerebral palsy and to explore adjustability on their individual needs.Material and methodData described are extracted from an on-going national cohort study, following during 10 years 385 children with cerebral palsy, aged from 4 to 10, Gross Motor Function Classification System IV and V. We analysed data from the first 190 patients (mean age 6 years 10 months (SD 2.0), 111 boys), focusing on physiotherapy, ergotherapy, psychomotility and speech therapy in medico-social and liberal sectors.ResultsIn medico-social sector, duration of paramedical care is significantly more important than in liberal sector (structure of care: median = 4.25 h/week, liberal sector: median = 2.00 h/week) (P < 0.0001). More than 4 different types of care per week are given in medico-social sector, while in liberal sector children benefit from only 2 different types of care a week. In investigators opinion, rehabilitation in structures of care is 71.65% adapted as opposed to 18.75% in the liberal sector (P < 0.001). Children level V have less time of rehabilitation than the others (P = 0.0424).InterpretationRehabilitation of children with cerebral palsy who are not able to walk, with an objective to improve quality of life, is truly multidisciplinary and suitable in medico-social sector.     

The impact of general practice nursing care on patient satisfaction and enablement in Australia: A mixed methods study

BackgroundThe numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablementMethodsA mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models.ResultsData from 678 completed patient surveys (response rate = 42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR = 2.50, 95% CI: 1.43–4.35) and more enabled (OR = 2.55, 95% CI: 1.45–4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR = 2.31, 95% CI: 1.33–4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR = 1.76, 95% CI: 1.09–2.82) and more enabled (OR = 2.56, 95% CI: 1.40–4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR = 2.64, 95% CI: 1.32–5.30) were more enabled than those receiving preventive health care.ConclusionsThis study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.     

Overcoming nursing barriers to intensive care unit early mobilisation: A quality improvement project

ObjectivesTo increase adherence with intensive care unit mobility by developing and implementing a mobility training program that addresses nursing barriers to early mobilisation.DesignAn intensive care unit mobility training program was developed, implemented and evaluated with a pre-test, immediate post-test and eight-week post-test. Patient mobility was tracked before and after training.SettingA ten bed cardiac intensive care unit.Main outcome measuresThe training program’s efficacy was measured by comparing pre-test, immediate post-test and 8-week post-test scores. Patient mobilisation rates before and after training were compared. Protocol compliance was measured in the post training group.ResultsNursing knowledge increased from pre-test to immediate post-test (p < 0.0001) and pre-test to 8-week post-test (p< 0.0001). Mean test scores decreased by seven points from immediate post-test (80 ± 12) to 8-week post-test (73 ± 14). Fear significantly decreased from pre-test to immediate post-test (p = 0.03), but not from pre-test to 8-week post-test (p = 0.06) or immediate post-test to 8-week post-test (p = 0.46). Post training patient mobility rates increased although not significantly (p = 0.07). Post training protocol compliance was 78%.ConclusionThe project successfully increased adherence with intensive care unit mobility and indicates that a training program could improve adoption of early mobility.