Friday, June 23, 2006

New Evidence-Based Knowledge Portal

"The Evidence Based Knowledge Portal, developed by the Eskind Biomedical Library at Vanderbilt with grant funding (NLM grant number 5R01LM007849), includes tutorials addressing facets of statistical analysis and critiquing the medical literature as
well as virtual practice cases that allow users to explore principles of EBM (e.g. number needed to treat, selection bias) in the context of a clinical scenario. Cases include pre-and post- tests to allow users to gauge their knowledge and progress."

You will need to do a very quick registration in order to obtain a free password and you will also need to download Macromedia flash player if you don't already have it. This is a very user friendly tutorial resource that demystifies lots of research concepts such as the advantages and disadvantages of cohort studies and positive and negative predictive values. The virtual practice cases allow you to utilize and reinforce some of your new principles of research. In addition, this portal offers
a Evidence Summary Generator which allows you to create summaries of articles and evidence in a template format.

The Evidence Based Knowledge Portal at Vanderbilt University welcomes your comments/suggestions

Monday, June 19, 2006

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Friday, June 16, 2006

CHF Team at St. Joseph Hospital, Orange, California

Posted by Julie Smith for Judy Rousch
Pictured above are some of the CHF team

The CMS (which stands for Centers for Medicare and Medicaid Services) Demonstration Project, encourages evidence- based care to patients with these diagnoses:
· Community Acquired Pneumonia (CAP)
· Congestive Heart Failure (CHF)
· Acute Myocardial Infarction (AMI)
· Coronary Artery Bypass Grafts (CABG), and
· Total Joint Replacement (TJR).
Our hospital is required to collect data from patient charts, collated by an outside company, reviewed, and compared to hospitals nationwide. This data is publicly available The current data retrieval required for three of the above diagnosis is:
· One of the current goals of the TJR part of data collection is to ensure that the last dose of antibiotics is administered within 24 hours of the incision “close time”.
· For CAP, the goal is an antibiotic started within 4 hours of arrival, O2 sat or ABG within the first 24 hours of admission, Pneumococcal and Influenza vaccines as appropriate and smoking cessation counseling as appropriate.
· With CHF, the hospital must show that LVF is assessment is documented, detailed discharge instructions are given to the patient and charted. ACE/ARB medication is prescribed for an ejection fraction of <40%, and smoking cessation counseling is begun and charted.
As you can see, this requires a lot of time and effort to ensure these steps are taken both with patient care as well as the actual data retrieval. The team has developed tools for the patient care nurse to use to insure that her patient is receiving these evidence-based recommendations and that the hospital is compliant in providing these services to our patients. For further information or to access help for your patient, contact any member of the 4E/W team, Megan Whalen, the Heart Failure Clinic Nurse Practioner, at extension 8858, Trish Cruz, the Quality Management RN- ext. 8208, or access the Clinical Practice Guidelines for the CHF patient posted in third and fourth floor nursing units, or the CHF Resource Binder. Some of the questions that might come up are:
· What happens when they are confused and disoriented?
· Include family or caregivers
· What if the patient is a DNAR?
· Much of the teaching can be considered palliative care. For example fluid and sodium diet restrictions enable the patient to breathe easier.
· What if they are discharged to a SNF?
· Include the written DC instructions in the envelope to go to the SNF. Sometimes the SNF staff doesn’t know how to care for CHF patients.
· What if the doctor hasn’t ordered an ACEI or ARB for EF<40%
· Call the physician and ask for the medication or the contraindication
· What happens when my patient refuses?
· Document that the patient refuses
· What happens if the doctor doesn’t list the discharge medications and doses?
· Call the physician and ask. If you can’t determine what meds the patient is on, how is the patient supposed to be able to?

Wednesday, June 14, 2006

Julie's June picks from the literature

Some of these recent nursing articles really caught my eye. SJH/CHOC staff can obtain these online or request them from Burlew Medical Library. Nurses who are not at SJH/CHOC should check with their own medical libraries.

1. Delgado-Passler P. McCaffrey R. The influences of postdischarge management by nurse practitioners on hospital readmission for heart failure. Journal of the American Academy of Nurse Practitioners. 2006 Apr; 18(4): 154-60. (17 ref) 2

2. Gardner MR. Deatrick JA. Understanding interventions and outcomes in mothers of infants. Issues in Comprehensive Pediatric Nursing. 2006 Jan-Mar; 29(1): 25-44. (86 ref)

3. Karkkainen O. Bondas T. Eriksson K. Documentation of individualized patient care: a qualitative metasynthesis. Nursing Ethics. 2005 Mar; 12(2): 123-32. (32 ref)

4. Kehl-Pruett W. Deep vein thrombosis in hospitalized patients: a review of evidence-based guidelines for prevention. DCCN: Dimensions of Critical Care Nursing. 2006 Mar-Apr; 25(2): 53-61. (28 ref)

5. Whall AL. Sinclair M. Parahoo K. A philosophic analysis of evidence-based nursing: recurrent themes, metanarratives, and exemplar cases. Nursing Outlook. 2006 Jan-Feb; 54(1): 30-5. (47 ref)

6. Harrington L. Implementing a hospital-based nursing research program in 30 days. Nurse Leader. 2006 Feb; 4(1): 37-42, 55. (8 ref)

Friday, June 09, 2006

Nursing Literature Mapping: from Med-Surg to Transcultural Nursing and more

The first ever online-only supplement to the Journal of the Medical Library Association (JMLA) has been published freely on PubMed Central. This online symposium deals entirely with the Mapping the Literature of Nursing Symposium.

Friday, June 02, 2006

Nursing Wiki

NursingWiki is a free multilingual wiki-project for health care and nursing information, that anyone can edit. Since May 2006, 68 free licensed articles in english language have been created. Anyone can contribute his/her knowledge in updating pages – the first steps are very simple! Wiki is the shortened form of the hawaiian adjective "wiki wiki", which describes something as "quick" or "fast". A wiki is a website which allows users to easily and quickly edit, add and remove content; it is therefore an effective tool for collaborative writing. There is a section on "Nursing Research" under construction in this Nursing Wiki. Feel free to contribute content to the Nursing Wiki. This blog is linked with the other nursing related blogs.

Nursing study finds that music relieves symptoms and eases depression in chronic pain patients

siedliecki s.l. & good m. (2006) Journal of Advanced Nursing54(5), 553–562

Effect of music on power, pain, depression and disability
Aim. This paper reports a study testing the effect of music on power, pain, depression and disability, and comparing the effects of researcher-provided music (standard music) with subject-preferred music (patterning music).

Background. Chronic non-malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated.

Method. A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21–65 years with chronic non-malignant pain. They were randomly assigned to a standard music group (n = 22), patterning music group (n = 18) or control group (n = 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II).

Results. The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported.

Conclusion. Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.

Journal of Advanced Nursing Table of Contents