A multicenter randomized placebo-controlled trial of intravenous thyroxine for heart-eligible brain-dead organ donors.

BACKGROUND: Brain death frequently induces hemodynamic instability and cardiac stunning. Impairments in cardiac performance are major contributors to hearts from otherwise eligible organ donors not being transplanted. Deficiencies in pituitary hormones (including thyroid-stimulating hormone) may contribute to hemodynamic instability, and replacement of thyroid hormone has been proposed as a means of improving stability and increasing hearts available for transplantation. Intravenous thyroxine is commonly used in donor management. However, small controlled trials have not been able to demonstrate efficacy. METHODS: This multicenter study will involve organ procurement organizations (OPOs) across the country. A total of 800 heart-eligible brain-dead organ donors who require vasopressor support will be randomly assigned to intravenous thyroxine for at least 12 h or saline placebo. The primary study hypotheses are that thyroxine treatment will result in a higher proportion of hearts transplanted and that these hearts will have non-inferior function to hearts not treated with thyroxine. Additional outcome measures are the time to achieve hemodynamic stability (weaning off vasopressors) and improvement in cardiac ejection fraction on echocardiography. DISCUSSION: This will be the largest randomized controlled study to evaluate the efficacy of thyroid hormone treatment in organ donor management. By collaborating across multiple OPOs, it will be able to enroll an adequate number of donors and be powered to definitively answer the critical question of whether intravenous thyroxine treatment increases hearts transplanted and/or provides hemodynamic benefits for donor management. TRIAL REGISTRATION: ClinicalTrials.gov NCT04415658 . Registered on June 4, 2020.

Gaps in communication between cancer patients and healthcare providers: symptom distress and patients' intentions to disclose.

PURPOSE: Good communication between patients and healthcare professionals (HCPs) is an important contributor to patient well-being. Few studies have focused on the gaps in communication between patients and HCPs about symptoms. This study examined patients' perspectives on symptom distress, intention to discuss symptoms, and actual symptom discussion in medical oncology visits. METHODS: This was a cross-sectional descriptive study. Ninety-four patients provided demographic and clinical information and completed the Memorial Symptom Assessment Scale. Patients also answered questions about their plans for communication-and after the visit, their actual communication-with their medical team about their symptoms. RESULTS: Patients reported many symptoms by questionnaire; however, they did not plan to discuss-nor actually discussed-most of their symptoms with their HCPs. For all symptoms, fewer than 42% of patients with the symptom intended to discuss it (except for lack of energy and pain) and less than 50% actually discussed the symptom. For bothersome symptoms, less than 42% of those with the symptom intended to discuss it (except for lack of energy) and less than 40% actually discussed the symptom. Psychological symptoms were endorsed by 24-41% of patients, depending on the symptom; however, of those endorsing a symptom, most did not discuss it with an HCP. CONCLUSIONS: Results of this study support the perception of communication gaps between patients and HCPs about symptoms. Better understanding of these gaps is needed to ensure that patient-centered care is delivered and that patients' symptoms can be appropriately managed in oncology clinics.

Anatomy of Inpatient Falls: Examining Fall Events Captured by Depth-Sensor Technology.

BACKGROUND: Sensor technology offers a new way to identify patient movement, detect falls, and automatically alert health care staff when falls occur. The information gained from analyzing actual fall events can be beneficial in developing individualized fall prevention strategies, informing nursing staff about the nature of falls, and identifying opportunities to make the patient care environment safer. METHODS: A six-month performance improvement pilot was conducted at Barnes-Jewish Hospital (St. Louis) to assess the ability of a depth-sensor system to capture inpatient fall events within patient hospital rooms. Depth sensors were installed on two inpatient medicine units with a history of high fall rates. The depth sensors captured actual fall events on video. Video clips were reviewed and analyzed to identify the characteristics of patient falls, staff response times, and environmental conditions contributing to falls. RESULTS: A total of 16 falls involving 13 patients were recorded by depth sensors. Six of the 13 patients who fell were classified as high risk on the basis of the hospital's fall rating tool. Common contributing factors included difficulty rising from their bed, weakened lower extremities, and unsteady or slow gait. Eleven of the falls involved patients reaching for objects in their path in an effort to achieve stability. Nurses had less than two minutes from the time a patient began to exit a bed to the time a fall occurred. Patients expressed few complaints with depth sensors installed in rooms. CONCLUSION: Fall-detection sensor systems offer valuable data for analyzing the nature of patient falls, with the potential promise of prescribing specific fall interventions for patients and to identify staff development opportunities. Hospitals should understand these devices' benefits and limitations and how they affect nursing practice.

A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit.

BACKGROUND: Although most intensive care patients are at risk for pressure ulcers, not all experience such ulcers. OBJECTIVE: To examine a model of variables related to extrinsic and intrinsic pressure on skin and underlying tissues, oxygenation, perfusion, and baseline comorbid conditions to identify risk factors associated with pressure ulcers in critically ill adults. METHOD: A retrospective chart review was conducted on patients identified by weekly rounds from January 2010 through October 2010 to determine the prevalence of pressure ulcers. Variables were analyzed via bivariate analysis and logistic regression for unit-acquired pressure ulcers. RESULTS: Data on 345 patients with 436 intensive care admissions were reviewed. Variables were significant in each model category at P < .05. In the regression analysis of first admission only (n = 306), the model was significant (P < .001) and yielded correct classification of 86.3% of patients. For all intensive care admissions (n = 391), the model was significant (P < .001) and yielded correct classification of 83.9% of patients. In both models, 4 of the same variables were significant: any transport off the unit, number of days to bed change, systolic blood pressure less than 90 mm Hg, and use of more than 1 vasopressor. History of pulmonary disease and presence of a feeding tube were also significant in regression analyses. CONCLUSIONS: Several variables within the model of pressure, oxygenation, and perfusion were significantly associated with development of pressure ulcers.

Compassion fatigue among pediatric healthcare providers.

BACKGROUND: Compassion fatigue is a term used to describe the unique stressors affecting people in caregiving professions. PURPOSE: For nurses and other direct care providers, the impact of compassion fatigue may result in stress-related symptoms, job dissatisfaction, decreased productivity, decreased patient satisfaction scores, safety issues, and job turnover. Those who care for seriously ill children and their families are at increased risk for compassion fatigue. Constant exposure to children who are suffering, in combination with work place stressors and personal issues, may contribute to the development of compassion fatigue. METHODS: The Professional Quality of Life Scale Version 5 was used to determine the risk for compassion fatigue among 296 direct care providers at St. Louis Children's Hospital. RESULTS: Compassion satisfaction, burnout, and secondary traumatic stress scores did not differ by age, work category, level of education, or work experience. There were, however, significant differences in scores as a function of nursing unit. Nurses who work in the pediatric intensive care unit reported lower compassion satisfaction scores, and higher burnout and secondary traumatic stress scores. CLINICAL IMPLICATIONS: Results demonstrated the risk for compassion fatigue and provided data necessary to support development of a compassion fatigue program for direct care providers.

An instructional DVD fall-prevention program for patients with cancer and family caregivers.

PURPOSE/OBJECTIVES: Determine the efficacy of a fall-prevention skills training program for patients with cancer and family caregivers. DESIGN: Randomized, controlled trial with repeated measures and postintervention measure of fall occurrence. SETTING: A comprehensive cancer center in the midwestern United States. SAMPLE: 132 patient and family caregiver dyads. METHODS: Dyads were randomly assigned to one of two groups: a control group that received standard fall-prevention education or a treatment group that received standard education and a fall-prevention DVD program to view at home. Participants completed surveys at baseline, one week, one month, and three months. Follow-up phone calls were made at three months. MAIN RESEARCH VARIABLES: Fall occurrence, perceptions of fall risks, and fall-prevention knowledge. FINDINGS: Patients in the treatment group were significantly more likely to report not falling at three months than patients in the control group. The number of falls was lower for the treatment group. The difference was not statistically significant. Dyads in the treatment group showed significantly greater improvement over time in fall risk awareness and fall-prevention knowledge. CONCLUSIONS: Mobility skills training is a promising educational intervention for reducing fall occurrences in the home for patients with cancer. IMPLICATIONS FOR NURSING: Efforts are needed for improving the knowledge and skills of cancer survivors and their family members in recognizing patient fall risks, making home adjustments, and performing mobility skills competently.