Pediatric Nursing Comes Full Circle

Role Play is an issues-related forum to engender dialogue about the roles assumed by nurses who care for children and their families.     

Encouraging family engagement in the rehabilitation process: a rehabilitation provider's development of support strategies for family members of people with traumatic brain injury

Purpose: After a moderate to severe traumatic brain injury, it is widely recommended that family members be actively engaged in the client's rehabilitation journey because evidence suggests that this is associated with better outcomes. The ability of family members to fully engage in rehabilitation may be hindered by the barriers (logistical and psychological) they encounter. However, rehabilitation services can facilitate family engagement through a person-centred approach that provides support to remove barriers. Limited published guidance exists regarding practical and effective methods for delivering such support. This paper describes how one rehabilitation service has developed an eight-tiered approach. Key messages and implications: Family support is provided by explicit structuring of services to include (i) early engagement, (ii) meeting cultural needs, (iii) keeping families together, (iv) actively listening, (v) active involvement, (vi) education, (vii) skills training, and (viii) support for community re-integration. Implementation of these support strategies are individualised based on the expressed needs of each family. Families report a high level of satisfaction with the service. Conclusion: A practice-based quality improvement model identified challenges, implemented changes, and observed/evaluated the results to successfully develop a multifaceted strategy for supporting families, thereby encouraging their engagement in rehabilitation. Ongoing refinements and evaluation are planned. [Box: see text].     

Frequency and specificity of the Trima Accel "verify WBCs" advisory: considerations for product management

BACKGROUND: The Trima Accel displays a “verify WBCs” message if the plateletpheresis product (PLT) may not be leukoreduced (LR). Most blood banks require sensitive white blood cell (WBC) testing of these PLTs by flow or Nageotte. We evaluated how often these PLTs were non‐LR by European or US Food and Drug Administration (FDA) criteria and whether sensitive WBC testing is necessary. STUDY DESIGN AND METHODS: Phase 1 reviewed the frequency of this message with various procedure types and the flow WBC results for PLTs with or without the message. Phase 2 assessed how many FDA LR failures were detectable by a hematology analyzer. In Phase 3, PLTs were managed by hematology analyzer results. RESULTS: In Phase 1, 3.8% of PLT‐only and 11.1% of PLT‐plasma collections had the “verify WBCs” message. Only 1% of “verify” PLTs contained more than 1 × 10⁶ WBCs and only 0.5% were FDA LR failures. In Phase 2, 10 of 670 “verify” PLTs and one nonflagged PLT were FDA LR failures. Six of 11 LR failures had hematology analyzer WBC concentrations of 0.4 × 10⁹/L or higher. In Phase 3, “verify” PLTs were allowed in inventory if hematology analyzer WBC concentration was below 0.4 × 10⁹/L; inventory quality control showed no FDA LR failures by flow. Trima Version 6.0 software lowered the “verify” message frequency in PLT‐plasma procedures but not in PLT‐only procedures. CONCLUSION: Four percent of Trima PLT collections have the “verify WBCs” message but almost all of these are LR by European and FDA criteria. Fifty percent of FDA LR failures were detectable by a hematology analyzer. Sensitive WBC testing of all “verify WBCs” PLTs may not be necessary to satisfy LR quality assurance requirements.     

Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review

BackgroundSystematic literature reviews identify, select, appraise, and synthesize relevant literature on a particular topic. Typically, these reviews examine primary studies based on similar methods, e.g., experimental trials. In contrast, interest in a new form of review, known as mixed studies review (MSR), which includes qualitative, quantitative, and mixed methods studies, is growing. In MSRs, reviewers appraise studies that use different methods allowing them to obtain in-depth answers to complex research questions. However, appraising the quality of studies with different methods remains challenging. To facilitate systematic MSRs, a pilot Mixed Methods Appraisal Tool (MMAT) has been developed at McGill University (a checklist and a tutorial), which can be used to concurrently appraise the methodological quality of qualitative, quantitative, and mixed methods studies.ObjectivesThe purpose of the present study is to test the reliability and efficiency of a pilot version of the MMAT.MethodsThe Center for Participatory Research at McGill conducted a systematic MSR on the benefits of Participatory Research (PR). Thirty-two PR evaluation studies were appraised by two independent reviewers using the pilot MMAT. Among these, 11 (34%) involved nurses as researchers or research partners. Appraisal time was measured to assess efficiency. Inter-rater reliability was assessed by calculating a kappa statistic based on dichotomized responses for each criterion. An appraisal score was determined for each study, which allowed the calculation of an overall intra-class correlation.ResultsOn average, it took 14 min to appraise a study (excluding the initial reading of articles). Agreement between reviewers was moderate to perfect with regards to MMAT criteria, and substantial with respect to the overall quality score of appraised studies.ConclusionThe MMAT is unique, thus the reliability of the pilot MMAT is promising, and encourages further development.     

Syndemic effect of mental illness and substance use on viral suppression among recently-incarcerated,HIV-infected individuals in the CARE+ Corrections study

Few studies on HIV-related syndemics of co-occurring and mutually reinforcing psychosocial conditions have assessed clinical outcomes in criminal justice (CJ)-involved populations. Baseline data from the CARE+ Corrections study were used to quantify co-occurring mental illness and substance use and examine syndemic effects on viral suppression among 106 CJ-involved HIV-infected individuals. Ninety-one (86%) reported a mental illness diagnosis, 30 (28%) reported hazardous alcohol use, and 61 (58%) were drug dependent. Eighteen (17%) experienced all three conditions. Drug dependence was clustered with mental illness (prevalence odds ratio [POR] 3.20, 95% CI 1.01–10.14) and hazardous alcohol use (POR 2.61, 95% CI 1.03–6.56). The association between syndemic score, representing the number of conditions reported by each individual, and viral suppression was not statistically significant, although 86% of participants with none of these conditions were virally suppressed, compared to 56% of those with all three (p?=?0.56). Mental illness and substance use were concentrated in this sample, indicating a need for integrated care services.     

Reducing the risk of HIV transmission among men who have sex with men: A feasibility study of the motivational interviewing counseling method

HIV prevalence among Chinese men who have sex with men has rapidly increased in recent years. In this randomized, controlled study, we tested the feasibility and efficacy of motivational interviewing to reduce high‐risk sexual behaviors among this population in Changsha, China. Eighty men who have sex with men were randomly assigned to either the intervention group, in which participants received a three‐session motivational interviewing intervention over 4 weeks, or the control group, in which participants received usual counseling from peer educators. High‐risk behavior indicators and HIV knowledge level were evaluated at baseline and 3 months after the intervention. Motivational interviewing significantly improved consistent anal condom use. However, there was no significant change in consistent condom use for oral sex or in the number of sexual partners over time. HIV knowledge scores improved equally in both groups. This study demonstrated that an intervention using motivational interviewing is feasible and results in increased condom use during anal sex for Chinese men who have sex with men. However, further work must be done to increase the use of condoms during oral sexual encounters.     

Optimal duration of antimicrobial therapy for uncomplicated Gram-negative bloodstream infections

Purpose

Optimal antimicrobial treatment duration for Gram-negative bloodstream infection (BSI) remains unclear. This retrospective cohort study examined effectiveness of short (7–10 days) and long (>10 days) courses of antimicrobial therapy for uncomplicated Gram-negative BSI.

Methods

Hospitalized adults with uncomplicated Gram-negative BSI at Palmetto Health hospitals in Columbia SC, USA from January 1, 2010 to December 31, 2013 were identified. Multivariate Cox proportional hazards regression with propensity score adjustment was used to examine risk of treatment failure in the two groups.

Results

During the study period, 117 and 294 patients received short and long courses of antimicrobial therapy for uncomplicated Gram-negative BSI, respectively. Overall, the median age was 67 years, 258 (63%) were women, 282 (69%) had urinary source of infection, and 271 (66%) had BSI due to Escherichia coli. The median duration of antimicrobial therapy was 8.5 and 13.3 days in the short and long treatment groups, respectively. After adjustment for the propensity to use a short course of therapy, risk of treatment failure was higher in patients receiving short compared to long courses of antimicrobial agents (HR 2.60, 95% CI: 1.20–5.53, p = 0.02). Other risk factors for treatment failure included liver cirrhosis (HR 5.83, 95% CI: 1.89–15.02, p = 0.004) and immune compromised status (HR 4.30, 95% CI: 1.57–10.80, p = 0.006). Definitive antimicrobial therapy with intravenous or highly bioavailable oral agents was associated with reduced risk of treatment failure (HR 0.33, 95% CI: 0.14–0.73, p = 0.006).

Conclusions

The current results support common clinical practice of 2 weeks of antimicrobial therapy for uncomplicated Gram-negative BSI.

     

Racial and Ethnic Disparities in Genetic Testing at a Hereditary Breast and Ovarian Cancer Center

BackgroundPrior studies suggest that referral to genetic counseling and completion of genetic testing vary by race/ethnicity; however, the data are limited.ObjectiveWe sought to evaluate patterns of genetic testing and clinical outcomes across race/ethnicity at a hereditary breast and ovarian cancer center.DesignThe medical records for all patients undergoing genetic assessment at a hereditary breast and ovarian cancer center were reviewed and stratified by self-reported race/ethnicity (non-Hispanic White, Hispanic, non-Hispanic Black, and Asian).ParticipantsA total of 1666 patients met inclusion criteria (non-Hispanic Whites, 1367; Hispanics, 85, non-Hispanic Blacks, 101; Asians, 113).Main MeasuresDemographics, patient characteristics, and referral patterns for patients who underwent genetic testing were analyzed using Kruskal-Wallis tests, chi-square test, or Fisher’s exact tests, stratifying by self-reported race/ethnicity. Pathogenic mutations and variants of unknown significance (VUS) were reviewed. Outcomes of patients with genetic mutations and personal history of breast and/or gynecologic malignancies were compared.Key ResultsNon-Hispanic Whites were more likely to be referred due to family cancer history compared to all other ethnicities while Non-Hispanic Blacks, Hispanics, and Asians were more likely to be referred due to personal history of cancer (p < 0.001). Non-Hispanic Blacks and Hispanics were more likely to have advanced-stage cancer at the time of genetic testing (p < 0.02). Rates of mutations did not differ by race/ethnicity when Ashkenazi Jewish patients were excluded (p = 0.08). Among patients found to have a BRCA1/2 mutation, Non-Hispanic Whites were more likely to undergo cancer screening and risk-reducing surgery compared with all other ethnicities (p = 0.04).ConclusionsMinority patients were more likely to utilize genetic services following a cancer diagnosis and less likely due to family cancer history, suggesting a missed opportunity for mutation detection and cancer prevention in this population. Efforts to eradicate racial/ethnic disparities in early access to genetic testing and guided cancer prevention strategies are essential.Electronic supplementary materialThe online version of this article (10.1007/s11606-020-06064-x) contains supplementary material, which is available to authorized users.