Looking for the Best WOW: Understanding the Nurses' Needs.

The effective use of nurses' time for providing increasingly safe, efficient, and patient-centered care is a major concern for healthcare managers as well as for nurses themselves. Different solutions have been used aimed at improving those times by providing nurses with mobile and 'on wheels' alternatives for bedside care. Nevertheless, the selection of solutions is still a complicated organizational decision. This paper describes the evaluation of ergonomic characteristics of five local mobile carts for the bedside nursing care at Hospital Italiano de Buenos Aires. Cornell University's checklist was used for data collection according to five domains: car handling, work surface and data load, documents and screen reading, storage and dimensions, and energy and cleaning. Considering the scarcity of literature on needs for WOWs assessment, the findings of this paper represent a valuable approach to the requirements of nurses in real work environments and a support for decision-making based on nursing observations.

BarCode Medication Administration in ICU: Learning from Our Nurses.

Errors during drug administration stage represent a significant percentage of adverse events associated with health care. Its prevalence is higher in critical care units, due to vulnerable patient population, characteristics of intensive care as well as complexity of pharmacotherapy. Errors can occur at any stage of the medication cycle although they often occur during administration, so nurses' role in prevention is essential. The bar code medication administration (BCMA) technology increases patient safety by instituting control time, but a poorly designed system or a faulty implementation can lead to low utilization in future. This paper describes implementation, evaluation, detection of problems and search for their possible solutions of a BCMA system in the intensive care unit at Hospital Italiano de Buenos Aires.

Post-Implementation Study of a Nursing e-Chart: How Nurses Use Their Time.

Nursing documentation is a significant component of electronic health records nevertheless integrating a new chart into nursing activities required multiples strategies to ensure adherence. Current literature demonstrates that nurses spend part of their time performing activities no related with patients' direct care and sometimes even does not fall under their purview. Thus it is important to quantify the effect that a new system could have in the proportion of time dedicated to documentation. The objective of this work was to determine the time dedicated to different activities including those related to electronic documentation after the implementation of a renewed nurse chart in an Electronic Health Record at Hospital Italiano de Buenos Aires. An observational, cross sectional and work sampling study was performed. During the study 2396 observations were made in 3 wards. Nurses' activities included 36.09% of direct care, 28.9% of indirect care, 0.67% support tasks, 22.99% non related to patient tasks, 11.32% personal activities and documenting on EHR 17.43%. The comparison with the previous study shows indirect care activities decreased 12.28% and non-related to patients increased 11.85%. The results demonstrate that the new nurses' e-chart did not increase documentation time.

User-Centered Design Practices to Redesign a Nursing e-Chart in Line with the Nursing Process.

Regarding the user-centered design (UCD) practices carried out at Hospital Italiano of Buenos Aires, nursing e-chart user interface was redesigned in order to improve records' quality of nursing process based on an adapted Virginia Henderson theoretical model and patient safety standards to fulfil Joint Commission accreditation requirements. UCD practices were applied as standardized and recommended for electronic medical records usability evaluation. Implementation of these practices yielded a series of prototypes in 5 iterative cycles of incremental improvements to achieve goals of usability which were used and perceived as satisfactory by general care nurses. Nurses' involvement allowed balance between their needs and institution requirements.

Computerization of a Nursing Chart According to the Nursing Process.

The benefits associated with the computerization of clinical records are known since a long time ago. Documentation evolution from paper to electronic format aims to always improve communication, reduce errors and facilitate continuity of care. Ideally when improvements to nursing records are contemplated, they should consider the nurses needs, new functionality workflow impacts and correspondence with representation models of standardized data that are specific to their domains practices. The aim of this study was to describe the development and implementation of computerized nursing record at Hospital Italiano de Buenos Aires.

Changing Educational Paths in an Informatics Course According to the Needs and Expectations of Nursing Degree Students.

Informatics education in the nursing career varies in each curriculum, and directly impact in training and future development of nurses in the professional field. While the proposed curriculum is based on essential minimum content for professional training, it was necessary to update it according to current technological development, considering the different profiles of students and practice settings, labor and academia. The pedagogical proposals were redesigned in two informatics courses of a Bachelor of Science in Nursing (BSN) at Hospital Italiano de Buenos Aires. We adapted the curricula tailored on prior knowledge, educational path and needs of the students identified and made explicit by them at the beginning of the courses. At the end of the courses, the students surveyed said that the changes were appropriate.

Evaluating the Feasibility of Using Mobile Devices for Nurse Documentation.

The use of electronic health records (EHR) has changed the quality of clinical documentation and improved quality of patient assistance, allowing better communication between health professionals and increased data recording that helps the nursing assistance process. The use of mobile devices for compiling data at the assistance moment has increased, and more studies have demonstrated its usefulness. The aim of this study was to evaluate the use of mobile devices in the nursing staff of the Hospital Italiano de Buenos Aires, in a pilot test to measure their use and user satisfaction.

Pre-Implementation Study of a Nursing e-Chart: How Nurses Use Their Time.

In clinical practice, nurses perform different activities that exceed direct care of patients, and influence workload and time administration among different tasks. When implementing changes in an electronic nursing record, it is important to measure how it affects the time committed to documentation. The objective of this study was to determine the time dedicated to different activities, including those related to electronic documentation prior to implementing a redesigned nurse chart in an Electronic Health Record at the Hospital Italiano de Buenos Aires. An observational work sampling study was performed. Nursing activities observed were categorized as direct care, indirect care, support, non-patient related, and personal activities. During the study, 74 nurses were observed and 2,418 observations were made in the Intensive Care Unit (32.22%), the Intermediate Care Unit (29.57%), and the General Care Unit (38.21%). Nurses' activities included 37.40% of direct care, 41.18% of indirect care, 0.43% support tasks, 11.14% non-related to patient tasks, and 9.77% personal activities. The results allow for the estimation of the impact of a nursing e-chart on nurses' activities, workflow and patient care.

User-centered design to develop clinical applications. Literature review.

User-centered design is mentioned by Norman as "the need for a design that uses the natural properties of the individuals, exploiting the relationships and constraints and focusing on the needs and interests of the user, in order to make the final products usable and understandable". This is also important in health developments. The objective of this paper is to search and analyze articles in the healthcare field where user-centered design principles have been applied. We describe findings in this topic from articles published between January 1995 and September 2014.

Nurses' expectations and perceptions of a redesigned Electronic Health Record.

When a new Electronic Health Record is implemented or modifications are made, the full acceptance by end users depends on their expectations and perceptions about the possible benefits and the potential impacts on care quality. The redesign of an electronic nurse chart should consider the inherent characteristics of nurses' practice and the variables that may influence the implementation and use of the new chart. In this study, a qualitative method evaluated nurses' expectations and perceptions about the implementation impacts of a redesigned nurse chart in an electronic health record at Hospital Italiano de Buenos Aires. Seventy-four nurses participated in three operative groups. Following ground theory, three analytic dimensions were found: impact at work, communication and chart quality. In addition, time was a recurrent topic. Nurses found it difficult to think positively if reduction in time of documentation was not assured.

Biopsia incisional o escisional en lesiones pigmentadas. Esperiencia en 193 casos de melanoma in situ / Incisional versus excisional biopsy in pigmented lesions. Experience in 193 cases of melanoma in situ

La biopsia escisional (BE) es considerada de elección por las guíasnacionales e internacionales (GI) de manejo del melanoma cutáneo (MM). En cambio, la biopsia incisional (BI), es discutida por su eventual influencia pronóstica y/o terapéutica. Objetivos: Describir el tipo de biopsia (BE-BI) empleada en lesiones sospechosas deMM según especialista actuante y frecuencia con que se cumplieron las GI. Estimar concordancia entre el diagnóstico histológico inicial (DHI) y el diagnóstico histológico definitivo (DHD) según el tipo de biopsia empleada. Diseño: Descriptivo y retrospectivo de corte transversal.Materiales y Métodos: Entre junio de 1992 y diciembre de 2008 se trataron 705 pacientes con MM en la práctica privada, actualmente Unidad de Oncología Cutánea del Instituto Alexander Fleming de la Ciudad de Buenos Aires. Para el análisis se incluyeron 193 casos con DHI y/o DHD de MM in situ. Resultados: fueron derivados a nuestro centro 131/193 (68%) casos con biopsia previa, en 115/131 (88%) efectuada por dermatólogos y en 16/131 (12%) por cirujanos. En cambio 62/193(32%) consultaron directamente o fueron derivados sin biopsia previa. Predominó la BI: 110/193 (57%). Los dermatólogos emplearon BI en103/110 (93.6%). En 52/193 (27%) pacientes, no se siguieron las GI.En 13/110 (11.8% IC95% 6.7-19.7%) de las BI no hubo concordancia entre DHI y DHD. En 9/110 (8.2%) el DHI de MM in situ se modificó a MM invasor.Conclusiones: según esta experiencia, en nuestro medio la mayoría de MM in situson diagnosticados por dermatólogos, por medio de BI. En 27% de casos no se respetaron las GI y la discordancia diagnóstica en BI fue 11.8%.Consideramos necesario ajustar la indicación de BI a las GI para disminuir diagnósticos incorrectos, pero priorizamos efectuar la biopsia en forma inmediata, aún como BI, en el mismo consultorio dermatológico, en presencia de una lesión sospechosa demelanoma...

Aftosis recurrente / Relapsing aphthous ulcers

La aftosis recurrente o estomatitis aftosa recurrente es una de las patologías más frecuentes de la mucosa oral. Aunque sus características clínicas están bien definidas, la etiología específica y la patogenia de este trastorno no han sido dilucidadas. Clínicamente pueden distinguirse dos formas de aftosis recurrente, que varían de un polo de elevada frecuencia y menor severidad conocido como aftosis simple, a uno infrecuente y de mayor severidad asociado o no a patologías sistémicas, que se denomina aftosis compleja. El tratamiento es inespecífico y en ocasiones frustrante, a pesar de la multiplicidad de agentes tópicos y sistémicos descriptos. La presencia de aftas orales recurrentes exige realizar un diagnóstico adecuado y una clasificación clínica apropiada que permitan excluir la enfermedad de Behçet e identificar factores predisponentes y eventuales patologías sistémicas asociadas. Son necesarios más estudios para poder comprender el origen de este trastorno y optimizar su terapeútica.

Relapsing aphthous ulcers or relapsing aphthous stomatitis is one of themost frequent disorders of the oral mucosa. Although their clinical characteristics are well defi ned, the specifi c etiology and pathogenesis of this disorder have not been established. Clinically it is possible to determine two forms of relapsing aphthous ulcers,varying from one pole of high frequency and low severity known as simple aphthosis to another more rare and severe, which may or may not be associated to systemic pathologies, and is called complex aphthosis.Treatment although not specifi c is at times frustrating despite many topical and systemic options.The presence of relapsing oral aphthous ulcers demands an adequate diagnosis and clinical classifi cation in order to rule out Behcet`s disease, as well as the identifi cation of possible predisposing factors and associated systemic diseases. Further studies are required to understand the origin of this disorder and optimize its treatment.

Successful transplantation of donor organs from a hemlock poisoning victim.

BACKGROUND: The poison hemlock plant (Conium maculatum) has been a known poison since early in human history, most notably as the agent used for the execution/suicide of Socrates in ancient Greece. No experience has been reported regarding the suitability of a hemlock victim's organs for transplantation. METHODS AND RESULTS: This report documents successful transplantation of the liver, kidney, and pancreas from a 14-year-old girl who died of anoxic encephalopathy from asphyxia after the accidental ingestion of fresh hemlock while on a nature hike. Predonation laboratory values were not remarkable, and liver and kidney biopsy results were normal. All organs in the three recipients had immediate function, and no recipient had any clinical evidence of transmitted toxin. All recipients are well, with functioning transplants at greater than 6 months after transplantation. CONCLUSIONS: Poison hemlock intoxication does not seem to be a contraindication to organ donation.

Los resultados de trasplante renal de donante vivo en Puerto Rico / The results of renal transplantation of alive donors in Puerto Rico

El Programa de Trasplante de Puerto Rico comenzó en 1977, primero adscrito al Hospital de la Administración de Veteranos y más recientemente al Hospital Auxilio Mutuo. Este estudio informa nuestros resultados con 168 trasplantes llevados a cabo desde 1977. Tenemos datos completos de 103 trasplantes de donador vivo llevados a cabo en el Programa entre enero de 1977 y junio de 1984. La mayor parte de los pacientes eran varones, entre las edades de 21 a 50 años y de raza blanca. La evaluación de los donadores fue extremadamente estricta con criterios de exclusión muy rígidos. La técnica quirúrgica y el manejo post-trasplante has sido standard con la excepción de que en 1980 se alteró el régimen inmunosupresor para añadir suero antilinfocítico en la terapia de rechazo y a la vez disminuir drásticamente los requisitos de cortico-esteroides. Los resultados de sobrevida de paciente a 3 años plazo para toda la serie es de 92%, pero después de 1980, y quizás como reflejo de los cambios en inmunosupresión, aumentó la sobrevida a 98%. La sobrevida del injerto se ha mantenido estable entre 77 y 82% a 3 años plazo. La mayor parte de las muertes han sido secundarias a sepsis, casi todas relacionadas al manejo del rechazo. Todas las pérdidas de riñón fueron secundarias a rechazo. Informamos una tasa relativamente baja de complicaciones urológicas y técnicas. También informamos una alta prevalencia de hongos cutáneos y, sin embargo, una incidencia casi ausente de hongos sistémicos. Correlacionamos estos resultados con factores relevantes, con atención a detalles técnicos y médicos