COSIMO – patients with active cancer changing to rivaroxaban for the treatment and prevention of recurrent venous thromboembolism: a non-interventional study

Background

Around 20% of venous thromboembolism (VTE) cases occur in patients with cancer. Current guidelines recommend low molecular weight heparin (LMWH) as the preferred anticoagulant for VTE treatment. However, some guidelines state that vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) are acceptable alternatives for long-term therapy in some patients if LMWHs are not available. LMWHs and VKAs have a number of drawbacks that can increase the burden on patients. DOACs, such as rivaroxaban, can ameliorate some burdens and may offer an opportunity to increase patient satisfaction and health-related quality of life (HRQoL). The Cancer-associated thrOmboSIs – patient-reported outcoMes with rivarOxaban (COSIMO) study is designed to provide real-world information on treatment satisfaction in patients with active cancer who switch from LMWH or VKA to rivaroxaban for the treatment of acute VTE or to prevent recurrent VTE.

Methods

COSIMO is a prospective, non-interventional, single-arm cohort study that aims to recruit 500 patients in Europe, Canada and Australia. Adults with active cancer who are switching to rivaroxaban having received LMWH/VKA for the treatment and secondary prevention of recurrent VTE for at least the previous 4 weeks are eligible. Patients will be followed for 6 months. The primary outcome is treatment satisfaction assessed as change in the Anti-Clot Treatment Scale (ACTS) Burdens score at week 4 after enrolment compared with baseline. Secondary outcomes include treatment preferences, measured using a discrete choice experiment, change in ACTS Burdens score at months 3 and 6, and change in HRQoL (assessed using the Functional Assessment of Chronic Illness Therapy – Fatigue questionnaire). COSIMO will collect data on patients’ medical history, patterns of anticoagulant use and incidence of bleeding and thromboembolic events. Study recruitment started in autumn 2016.

Conclusions

COSIMO will provide information on outcomes associated with switching from LMWH or VKA therapy to rivaroxaban for the treatment or secondary prevention of cancer-associated thrombosis in a real-life setting. The key goal is to assess whether there is a change in patient-reported treatment satisfaction. In addition, COSIMO will facilitate the evaluation of the safety and effectiveness of rivaroxaban in preventing recurrent VTE in this patient population.

Trial registration

NCT02742623. Registered 19 April 2016.

     

What are the criteria for evaluation and prevention of venous thromboembolism?

Venous thromboembolism occurs frequently in both medical and surgical units. Although we possess the therapeutic means to prevent this condition, the question is how to assess the benefit induced by a treatment in relation to the haemorrhagic risk? The primary evaluation criteria and the evaluation method must be correctly chosen. While phlebography is the reference method for diagnosing deep venous thrombosis, the limitations associated with this method have led to the promotion of other diagnostic techniques, and clinical criteria or composite criteria are increasingly used. These different approaches--with their respective advantages and limitations--will be developed.     

Colonization of the medial lumen is a risk factor for catheter-related bloodstream infection

Objective To analyze the colonization of each lumen and the risk factors for triple-lumen central venous catheter-related bloodstream infection (CRBI). Design and setting Prospective, observational study in the medical–surgical intensive care unit (ICU) of a teaching hospital.Patients A total of 120 patients requiring the insertion of a triple-lumen catheter.Interventions Cultures of the catheter.Measurements and results The catheters were removed when CRBI was suspected or at discharge from ICU. At the removal time, blood cultures, a swab of the insertion site and a culture of the catheter tip were performed. Furthermore, we made quantitative cultures of the proximal, medial and distal lumen. We diagnosed CRBI in six patients (3.35 CRBI/1,000 days at risk), and we observed that in these patients colonization of the medial lumen was more frequent (5/6) than in patients without CRBI (9/114; p = 0.0001). The logistic regression analysis showed that colonization of the medial lumen was an independent risk factor for CRBI (OR 28.1, 95% CI 2.2–364.9).Conclusions Colonization of the medial lumen is an independent risk factor for triple-lumen catheter-related bloodstream infection, possibly due to the absence of use of this lumen.This study was presented, in part, at the 15th Annual Congress of the European Society of Intensive Care Medicine, Barcelona, Spain, September 2002.     

Correlation between “malfunctioning events” and catheter-related infections in pediatric cancer patients bearing tunneled indwelling central venous catheter: results of a prospective observational study

Aim of the study To evaluate the possible link between malfunctioning events and catheter related infections in indwelling central venous devices in children with cancer.Patients and methods Prospective observation of 418 devices inserted in 2 Italian tertiary care pediatric cancer centers. The presence of a relationship was identified if a malfunctioning event was followed by a catheter related infection within 10 days, or vice versa.Results The 418 catheters were followed for a period of 107,012 days. Among the malfunctioning events 2 out of 141 (1%) were followed by a catheter related infection while among infectious episodes 3 out of 93 (3%) were followed by a malfunctioning event.Conclusions Malfunctioning events followed by catheter related infections and catheter related infections followed by malfunctioning are both rare events in children with cancer.     

The effects of patient–professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study

BackgroundSelf-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients’ health outcome. Contemporary pain management theories and models also suggest that a good patient–professional partnership enhances patients’ ability to self-manage their condition.Objectives(1) To investigate whether there is a reciprocal relationship between self-management of chronic back pain and health-related quality of life (HRQoL); (2) to examine the impact of a good patient–professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain.Design and settingThis quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient–professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients’ health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients’ life situation. Patients were recruited following initial consultation and followed up three months later.ParticipantsA total of 147 patients (65% female) with a mean age of 48 years (standard deviation (SD): 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief.MethodsSelf-reported measures of HRQoL, patient–professional partnerships and self-management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling.ResultsThere was no association between patients’ self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (−0.38, p < 0.01). A patient–professional partnership was not found to be beneficial for patients’ HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (−19.09, p < 0.01).ConclusionsThis study suggests that the increase in patients’ self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient–professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain.     

Australian graduating nurses’ knowledge,intentions and beliefs on infection prevention and control: a cross-sectional study

Background

In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts.

Methods

A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored.

Results

349 students from six universities completed the study. 59.8% (95% CI 58.8–60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p?<?0.001). No association was found between self-reported compliance with IPC activities and gender or age. Certain infection control issues were correlated with the percentage of correctly answered transmission-based precaution questions. The participants were most likely to seek infection control information from an infection control professional.

Conclusion

Knowledge on transmission-based precautions was substandard. As transmission-based precautions are the foundation of IPC for serious organisms and infections, education institutions should reflect on the content and style of educational delivery on this topic.

     

Patient–ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study

Objective   To determine the prevalence of patient–ventilator asynchrony in patients receiving non-invasive ventilation (NIV) for acute respiratory failure. Design   Prospective multicenter observation study. Setting   Intensive care units in three university hospitals. Methods  Patients consecutively admitted to ICU were included. NIV, performed with an ICU ventilator, was set by the clinician. Airway pressure, flow, and surface diaphragmatic electromyography were recorded continuously for 30 min. Asynchrony events and the asynchrony index (AI) were determined from visual inspection of the recordings and clinical observation. Results  A total of 60 patients were included, 55% of whom were hypercapnic. Auto-triggering was present in 8 (13%) patients, double triggering in 9 (15%), ineffective breaths in 8 (13%), premature cycling 7 (12%) and late cycling in 14 (23%). An AI > 10%, indicating severe asynchrony, was present in 26 patients (43%), whose median (25–75 IQR) AI was 26 (15–54%). A significant correlation was found between the magnitude of leaks and the number of ineffective breaths and severity of delayed cycling. Multivariate analysis indicated that the level of pressure support and the magnitude of leaks were weakly, albeit significantly, associated with an AI > 10%. Patient comfort scale was higher in pts with an AI < 10%. Conclusion  Patient–ventilator asynchrony is common in patients receiving NIV for acute respiratory failure. Our results suggest that leaks play a major role in generating patient–ventilator asynchrony and discomfort, and point the way to further research to determine if ventilator functions designed to cope with leaks can reduce asynchrony in the clinical setting. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. This study was presented in abstract form at the 2008 Annual Meeting of the American Thoracic Society.     

Low and “supranormal” central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study

Purpose  

To characterize incidence of low, normal and “supranormal” central venous oxygen saturation (ScvO₂) and the relation to markers of tissue hypoxia, course and outcome in cardiac surgery patients.     

Silver nanoparticles and polymeric medical devices: a new approach to prevention of infection?

OBJECTIVES: Implantable devices are major risk factors for hospital-acquired infection. Biomaterials coated with silver oxide or silver alloy have all been used in attempts to reduce infection, in most cases with controversial or disappointing clinical results. We have developed a completely new approach using supercritical carbon dioxide to impregnate silicone with nanoparticulate silver metal. This study aimed to evaluate the impregnated polymer for antimicrobial activity. METHODS: After impregnation the nature of the impregnation was determined by transmission electron microscopy. Two series of polymer discs were then tested, one washed in deionized water and the other unwashed. In each series, half of the discs were coated with a plasma protein conditioning film. The serial plate transfer test was used as a screen for persisting activity. Bacterial adherence to the polymers and the rate of kill, and effect on planktonic bacteria were measured by chemiluminescence and viable counts. Release rates of silver ions from the polymers in the presence and absence of plasma was measured using inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: Tests for antimicrobial activity under various conditions showed mixed results, explained by the modes and rates of release of silver ions. While washing removed much of the initial activity there was continued release of silver ions. Unexpectedly, this was not blocked by conditioning film. CONCLUSIONS: The methodology allows for the first time silver impregnation (as opposed to coating) of medical polymers and promises to lead to an antimicrobial biomaterial whose activity is not restricted by increasing antibiotic resistance.     

Efficacy of venlafaxine for the relief of taxane and oxaliplatin-induced acute neurotoxicity: a single-center retrospective case–control study

Background

Oxaliplatin and taxane-induced neurosensory toxicity is dose-limiting and mostly presents with acute symptoms that affect the activities of daily living and overall quality of life. The objective of the present study is to assess the relief of acute neuropathy with venlafaxine treatment during the chemotherapy period.

Patients and methods

In this retrospective case–control study, from January 2010 to February 2015, patients who experienced treatment with oxaliplatin and taxane-induced acute neurotoxicity were evaluated according to the NCI-CTCAE v. 4.03 grading scale. Neurotoxicity was evaluated using a numeric rating scale (NRS) for pain intensity and experienced relief under the treatment of venlafaxine and using a neuropathic pain symptom inventory scale (NPSI) for the style of complaints. Patients who were diagnosed as mildly depressed according to the HOST anxiety and depression scale and who had grade 1 to 3 sensory neurotoxicity based on the NCI-CTCAE v. 4.03 grading scale, and who also reported ≥4/10 on a NRS were eligible. The primary end point was the rate of more than 75 % symptomatic relief under venlafaxine treatment.

Results

Two hundred six patients were included (82 % female, median age: 52.7 years). Most patients had breast, gynecologic, and colon cancer (93.4 %). Ninety-one patients who received venlafaxine and 115 patients as the control group were assessed for neurotoxicity every 3 weeks. Based on the NRS, a rate of more than 75 % symptomatic relief was 53.5, 58.3, and45.2 % in venlafaxine arm versus 0, 0, and 0 % in the control arm in the first, second, and third visits, respectively. Side-effects of venlafaxine (n?=?7) were grade 1–2 nausea/vomiting (3.2 %) and asthenia/somnolence (3.2 %) without grade 3–4 events.

Conclusion

Venlafaxine has a significant clinical activity against taxane-oxaliplatin-induced acute neurosensory toxicity.

     

Variability in alignment of central venous pressure transducer to physiologic reference point in the intensive care unit–A descriptive and correlational study

BackgroundThe phlebostatic axis is the most commonly used anatomical external reference point for central venous pressure measurements. Deviation in the central venous pressure transducer alignment from the phlebostatic axis causes inadequate pressure readings, which may affect treatment decisions for critically ill patients in intensive care units.AimThe primary aim of the study was to assess the variability in central venous pressure transducer levelling in the intensive care unit. We also assessed whether patient characteristics impacted on central venous pressure transducer alignment deviation.MethodsA sample of 61 critical care nurses was recruited and asked to place a transducer at the appropriate level for central venous pressure measurement. The measurements were performed in the intensive care unit on critically ill patients in supine and Fowler's positions. The variability among the participants using eyeball levelling and a laser levelling device was calculated in both sessions and adjusted for patient characteristics.ResultsA significant variation was found among critical care nurses in the horizontal levelling of the pressure transducer placement when measuring central venous pressure in the intensive care unit. Using a laser levelling device did not reduce the deviation from the phlebostatic axis. Patient characteristics had little impact on the deviation in the measurements.ConclusionThe anatomical external landmark for the phlebostatic axis varied between critical care nurses, as the variation in the central venous pressure transducer placement was not reduced with a laser levelling device. Standardisation of a zero-level for vascular pressures should be considered to reduce the variability in vascular pressure readings in the intensive care unit to improve patient treatment decisions. Further studies are needed to evaluate critical care nurses' knowledge and use of central venous pressure monitoring and whether assistive tools and/or routines can improve the accuracy in vascular pressure measurements in intensive care units.     

TEG® and RapidTEG® are unreliable for detecting warfarin-coagulopathy: a prospective cohort study

Background

Thromboelastography^® (TEG) utilizes kaolin, an intrinsic pathway activator, to assess clotting function. Recent published studies suggest that TEG results are commonly normal in patients receiving warfarin, despite an increased International Normalized Ratio (INR). Because RapidTEG? includes tissue factor, an extrinsic pathway activator, as well as kaolin, we hypothesized that RapidTEG would be more sensitive in detecting a warfarin-effect.

Methods

Included in this prospective study were 22 consecutive patients undergoing elective cardioversion and receiving warfarin. Prior to cardioversion, blood was collected to assess INR, Prothrombin Time, TEG, and RapidTEG.

Results

INR Results: 2.8?±?0.5 (1.6 to 4.2). Prothrombin Time Results: 19.1?±?2.2 (13.9. to 24.3). TEG Results (Reference Range): R-Time: 8.3?±?2.7 (2–8); K-Time: 2.1?±?1.4 (1–3); Angle: 62.5?±?10.3 (55–78); MA: 63.2?±?10.3 (51–69); G: 9.4?±?3.5 (4.6-10.9); R-Time within normal range: 10 (45.5%) with INR 2.9?±?0.3; Correlation coefficients for INR and each of the 5 TEG variables were insignificant (P?>?0.05). RapidTEG Results (Reference Range): ACT: 132?±?58 (86–118); K-Time: 1.2?±?0.5 (1–2); Angle: 75.4?±?5.2 (64–80); MA: 63.4?±?5.1 (52–71); G: 8.9?±?2.0 (5.0-11.6); ACT within normal range: 9 (40.9%) with INR 2.7?±?0.5; Correlation coefficients for INR and each of the 5 RapidTEG variables were insignificant (P?>?0.05).

Conclusions

TEG, using kaolin activation, and RapidTEG, with kaolin and tissue factor activation, were normal in a substantial percent of warfarin patients, despite an increased INR. The false-negative rate for detecting warfarin coagulopathy with either test is unacceptable. The lack of correlation between INR and all TEG and RapidTEG components further indicates that these methodologies are insensitive to warfarin effects. Findings suggest that intrinsic pathway activation may mitigate detection of an extrinsic pathway coagulopathy.     

The effect of a more community-oriented curriculum on nursing students’ intervention choice in community care: A quasi-experimental cohort study

AimThe aim of this study is to investigate the effect of a more ‘community-oriented’ baccalaureate nursing curriculum on students’ intervention choice in community care.BackgroundFollowing a healthcare shift with increased chronic diseases in an ageing patient population receiving care at home, nursing education is revising its curricula with new themes (e.g., self-management) on community care. Although it seems obvious that students incorporate these themes in their nursing care interventions, this is unclear. This study investigates the effect of a redesigned curriculum on students’ care intervention choice in community nursing.DesignA quasi-experimental quantitative study.MethodsThis study with an historic control group (n = 328; study cohorts graduating in 2016 and 2017; response rate 83 %) and an intervention group n = 152; graduating in 2018; response rate 80 %) was performed at a University of Applied Sciences in the Netherlands. The intervention group experienced a curriculum-redesign containing five new themes related to community care (e.g., enhancing self-management, collaboration with the patients’ social network, shared decision making, using health technology and care allocation). The primary outcome 'intervention choice in community nursing’ was assessed with a specially developed vignette instrument ‘Assessment of Intervention choice in Community Nursing’ (AICN). Through multiple regression analyses we investigated the effect of the curriculum-redesign on students’ intervention choice (more ‘traditional’ interventions versus interventions related to the five new themes). The control and intervention groups were compared on the number of interventions per theme and on the number of students choosing a theme, with a chi-square or T-test.ResultsStudents who studied under the more community-oriented curriculum chose interventions related to the new themes significantly more often, F(1461) = 14.827, p = <0.001, R² = .031. However, more traditional interventions are still favourite (although less in the intervention group): 74.5 % of the chosen interventions in the historic control group had no relation with the new curriculum-themes, vs. 71.3 % in the intervention group; p = .055).ConclusionsStudents who experienced a more ‘community-oriented’ curriculum were more likely, albeit to a limited extent, to choose the new community care themes in their caregiving. Seeing this shift in choices as a step in the right direction, it can be expected that the community care field in the longer term will benefit from these better skilled graduates.     

Design of a cluster-randomized controlled trial of a diabetes prevention program within African–American churches: The Fit Body and Soul study

Evidence from varied community settings has shown that the Group Lifestyle Balance (GLB) Program and other adaptations of the Diabetes Prevention Program (DPP) intervention are effective in lowering diabetes risk. Most DPP data originated from studies of pre-diabetic whites, with only sparse evidence of the effect of DPP in African Americans (AAs) in community settings. This paper describes the design, methods, baseline characteristics and cost effective measures, of a single-blinded, cluster-randomized trial of a faith-based adaptation of the GLB program, Fit Body and Soul (FBAS). The major aims are to test efficacy and cost utility of FBAS in twenty AA churches. Randomization occurred at the church level and 604 AA overweight/obese (BMI ≥ 25 kg/m²) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program. FBAS is a group-based, multi-level intervention delivered by trained church health advisors (health professionals from within the church), with the goal of ≥ 7% weight loss, achieved through increasing physical activity, healthy eating and behavior modification. The primary outcome is weight change at 12 weeks post intervention. Secondary outcomes include hemoglobin A1C, fasting plasma glucose, waist circumference, blood pressure, physical activity level, quality of life measures, and cost-effectiveness. FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation. Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial. The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination.     

Appraising clinical guidelines and the development of criteria–a pilot study

In the past few years there has been a remarkable rise in the publication of clinical practice guidelines in the UK. Guidelines are being produced for many conditions from a variety of sources. Increasingly, health care practitioners are encouraged to use guidelines to promote the quality and cost-effectiveness of the care they provide. Yet important questions remain unanswered. How do we judge the quality of guidelines? What criteria should we use to make that judgement? Following a national workshop, a joint programme was set up to research and develop methods for evaluating clinical practice guidelines. This paper presents the results of a pilot study on the appraisal of a number of UK published guidelines using a multidisciplinary review panel. If the introduction of guidelines is to improve the quality of care, users must be able to judge the rigour with which the guidelines have been produced. The results of this study suggest that UK guidelines are deficient in the information necessary to make this assessment. The development process of the guidelines needs to be made more transparent and more amenable to scrutiny for appraisal.     

Baseline characteristics of the Indian cohort from the IMPROVE™ study: a multinational,observational study of biphasic insulin aspart 30 treatment for type 2 diabetes

Introduction  The IMPROVE™ study is an openlabel, nonrandomized, observational study aimed at determining the safety and efficacy of biphasic insulin aspart 30 (BIAsp 30) treatment in subjects with type 2 diabetes from 11 countries. Here, we report the baseline data of the Indian cohort. Methods  All subjects with type 2 diabetes requiring insulin and considered suitable for BIAsp 30 therapy based on their physician’s clinical judgment were eligible to enter the study. The data recorded at baseline included demographic characteristics, detailed medical histories, physician-cited reasons for starting BIAsp 30 treatment, and the chosen dosage regimens. Results  The Indian cohort included 17,995 subjects with diabetes. Poor glycemic control (glycated hemoglobin [HbA_1c], 8.7%–9.6%) was observed at baseline in all four geographical zones (North, South, East, and West) and prestudy treatment groups (no therapy, only oral antidiabetic drug [OAD], OAD ± insulin, and OAD ± insulin ± BIAsp 30). Prevalence of both micro- and macrovascular complications was high, also reflecting poor glycemic control. Improving HbA_1c and fasting and postprandial blood glucose levels were the most common reasons for starting BIAsp 30 therapy. The subjects were prescribed a mean BIAsp 30 dose of approximately 24 IU, and a twice-daily regimen was employed in almost 80% of subjects. Conclusion  The baseline results of the IMPROVE study Indian cohort confirm the poor glycemic control and the delayed initiation and/or inadequacy of treatment in subjects with type 2 diabetes. These results also highlight the need for timely and appropriately intensive insulin-based therapy.     

Patients’ perceptions of having a central venous catheter or a totally implantable subcutaneous port system–results from a randomised study in acute leukaemia

Goals of work  The selection process of type of central venous access device (CVAD) in patients with acute leukaemia (AL) is generally based on appropriate catheter capacity/function and risk of complications in relation to the planned length of therapy. Advantages and disadvantages of the CVAD from the patient’s perspective should also be important parts in the selection of type of device. Perceptions on having a CVAD were thus analysed in a series of adult patients with AL included in a prospective randomised study evaluating the use of a double lumen totally implantable subcutaneous port system (PORT) or a double lumen central venous catheter (CVC) regarding survival time and complication rate. Materials and methods  Perceptions were registered in 32 patients (median age 68 years, range 24–83 years) on three occasions (T1; the day after placement, T2; 3 weeks after placement and T3 after 12 weeks and/or when the CVAD was removed) with the use of two study specific questionnaires. Main results  Overall, many patients reported minor catheter related discomfort, feelings of anxiety and restrictions. Half of the patients (6/11) who experienced a local bleeding after CVAD insertion described the placement procedure as unpleasant. More patients in the CVC group compared with the PORT group stated that they thought of having a CVAD (T3; p = 0.02) and that the CVAD interfered when dressing themselves (T2; p = 0.02 and T3; 0.04) or taking a shower (T3; p = 0.009). Conclusion  Our findings support the view that the PORT is less restrictive in daily life than the CVC.     

Factors influencing the optimal selection of central venous access devices: A qualitative study of health care team members’ perspectives

ObjectiveThis study aimed to explore health care team members’ understanding of the factors influencing the optimal selection of central venous access devices (CVADs).MethodsThe data of the study was collected using semi-structured interviews. Twenty-six hospital medical staff (four hospital manager, 15 head nurses, 7 nurse) with experience in peripheral or central catheterization from four regions (Northern China, Southern China, Northwest China, and Qinghai-Tibet China) in China were interviewed between June and October 2021. Content analysis was used to analyze the data.ResultsThe results revealed five themes and 14 sub-themes. Patients: concerns, resources, requirements, and evaluation (security concerns, support resources, life requirements, evaluation among patients); nurses: awareness, knowledge, and popularizing methods (awareness of intravenous therapy, understanding of professional knowledge, forms of popularizing methods); doctors: support and involvement (support for decision-making, involvement in intravenous work); hospital managers: authority, quality control and continuing education (management of catheterization authority, quality control of intravenous infusion, investment in continuing education) and environment: differences and commonalities (differences in social support, and current commonalities).ConclusionNurses and other healthcare team members’ understanding, selection, use, and recommendation of CVADs have an indirect effect on patients’ decision-making. Therefore, hospital managers and government departments can indirectly strengthen medical team cooperation and improve learning education in order to improve the safety of patients receiving intravenous infusions.     

Effect of language and country of birth on the consent process and medical suitability of potential organ donors; a linked-data cohort study 2010–2015

PurposeAustralia has unmet need for transplantation. We sought to assess the impact of cultural and linguistic diversity (CALD) on family consent and medical suitability for organ donation.MethodCohort study of New South Wales donor referrals, 2010–2015. Logistic regression estimated effects of primary language other than English and birthplace outside Australia (odds ratios OR, with 95% confidence intervals, 95%CI). Outcomes were whether families were asked for consent to donation, provided consent for donation, and whether the referral was medically suitable for donation.ResultsOf 2977 organ donor referrals, a similar proportion of families had consent for donation was sought between non-English speakers and English speakers (p = .07), and between overseas-born compared to Australian-born referrals (p = .3). However, consent was less likely to be given for both non-English speakers than English speakers (OR 0.44, 95%CI:0.29–0.67), and those overseas-born than Australian-born (OR 0.54, 95%CI:0.41–0.72). For referrals both overseas-born and non-English speaking, families were both less likely to be asked for consent (OR 0.67; 95%CI:0.49–0.91) or give consent (OR 0.24; 95%CI0.16–0.37). There was no difference in medical suitability between English speakers and non-English speakers (p = .6), or between Australian-born and overseas-born referrals (p = .6).ConclusionIntervention to improve consent rates from CALD families may increase donation.