Development and Validation of a Fall Prevention Efficiency Scale.

OBJECTIVES: Fall TIPS (Tailoring Interventions for Patient Safety) is an evidence-based fall prevention program that led to a 25% reduction in falls in hospitalized adults. Because it would be helpful to assess nurses' perceptions of burdens imposed on them by using Fall TIPS or other fall prevention program, we conducted a study to learn benefits and burdens. METHODS: A 3-phase mixed-method study was conducted at 3 hospitals in Massachusetts and 3 in New York: (1) initial qualitative, elicited and categorized nurses' views of time spent implementing Fall TIPS; (2) second qualitative, used nurses' quotes to develop items, research team inputs for refinement and organization, and clinical nurses' evaluation and suggestions to develop the prototype scale; and (3) quantitative, evaluated psychometric properties. RESULTS: Four "time" themes emerged: (1) efficiency, (2) inefficiency, (3) balances out, and (4) valued. A 20-item prototype Fall Prevention Efficiency Scale was developed, administered to 383 clinical nurses, and reduced to 13 items. Individual items demonstrated robust stability with Pearson correlations of 0.349 to 0.550 and paired t tests of 0.155 to 1.636. Four factors explained 74.3% variance and provided empirical support for the scale's conceptual basis. The scale achieved excellent internal consistency values (0.82-0.92) when examined with the test, validation, and paired (both test and retest) samples. CONCLUSIONS: This new scale assess nurses' perceptions of how a fall prevention program affects their efficiency, which impacts the likelihood of use. Learning nurses' beliefs about time wasted when implementing new programs allows hospitals to correct problems that squander time.

Use of a perceived efficacy tool to evaluate the FallTIPS program.

BACKGROUND/OBJECTIVES: To assess nurses' opinions of the efficacy of using the FallTIPS (Tailoring Interventions for Patient Safety) fall prevention program. DESIGN: Survey research. SETTING: Seven adult acute-care hospitals in 2 hospital centers located in Boston and NYC. PARTICIPANTS: A total of 298 medical-surgical nurses on 14 randomly selected units. INTERVENTION: Three-step FallTIPS fall prevention program that had been in use as a clinical program for a minimum of 2 years in each hospital. MEASUREMENTS: Fall Prevention Efficiency Scale (FPES), range 13-52; four-factorilly derived subscales: valued, efficiency, balances out and inefficiency; and 13 psychometrically validated individual items. RESULTS: Nurses perceived the FallTIPS fall prevention program to be efficacious. The FPES mean score of 38.55 (SD = 5.05) and median of 39 were well above the lowest possible score of 13 and scale midpoint of 32.5. Most nurses (N = 270, 90.6%) scored above 33. There were no differences in FPES scores between nurses who had only used FallTIPS and nurses who had previously used a different fall prevention program. CONCLUSION: The nurses who used FallTIPS perceived that efficiencies in patient care compensated for the time spent on FallTIPS. Nurses valued the program and findings confirmed the importance of patient and family engagement with staff in the fall prevention process. Regardless of the fall prevention program used, organizations should examine staff perceptions of their fall prevention program because programs that are not perceived as being useful, efficient, and valuable will lead to nonadherence over time and then will not reduce falls and injuries. The recently developed FPES used in this study is a brief tool available for organizations to assess nurses' perceptions of the efficacy of their fall prevention program. Additional FPES research is needed with larger and more diverse samples.

Proliferating trichilemmal tumour of the eyelid in a 7-year-old girl.

Proliferating trichilemmal tumours (PTTs) are rare cutaneous adnexal tumours derived from the hair shaft outer root sheath. We are reporting the first case of PTT in a young child. In this case, a 7-year-old girl presented with trichilemmal keratinisation consistent with PTT. The patient was monitored with no signs of recurrence. PTT is a rare tumour occurring primarily in adults and we present this case so that young patients with PTT can be diagnosed and treated appropriately with a painless, mobile, rapidly growing mass on the right upper eyelid. CT imaging showed well-circumscribed, heterogenous mass measuring 1.6 cm with fluid-filled appearance and no tissue invasion. Surgical excision was performed and pathology revealed an unencapsulated, well-demarcated tumour.

Intratracheal parathyroid gland: an unexpected diagnosis.

Ectopic or supernumerary parathyroid tissue has been generally described in the literature in cases found during workup for parathyroid adenoma. We present two unique cases of intratracheal parathyroid gland, a rare occurrence that has not yet been described in the literature. In both cases, the masses were found incidentally and showed no clinical or laboratory evidence of hyperparathyroidism. In both cases, surveillance was chosen as the method of treatment. We present this case series to increase awareness of this potential diagnosis.

Classification of Injurious Fall Severity in Hospitalized Adults.

BACKGROUND: Many hospital systems in the United States report injurious inpatient falls using the National Database of Nursing Quality Indicators categories: None, Minor, Moderate, Major, and Death. The Major category is imprecise, including injuries ranging from a wrist fracture to potentially fatal subdural hematoma. The purpose of this project was to refine the Major injury classification to derive a valid and reliable categorization of the types and severities of Major inpatient fall-related injuries. METHODS: Based on published literature and ranking of injurious fall incident reports (n = 85) from a large Academic Medical Center, we divided the National Database of Nursing Quality Indicators Major category into three subcategories: Major A-injuries that caused temporary functional impairment (eg, wrist fracture), major facial injury without internal injury (eg, nasal bone fracture), or disruption of a surgical wound; Major B-injuries that caused long-term functional impairment or had the potential risk of increased mortality (eg, multiple rib fractures); and Major C-injuries that had a well-established risk of mortality (eg, hip fracture). Based on the literature and expert opinion, our research team reached consensus on an administration manual to promote accurate classification of Major injuries into one of the three subcategories. RESULTS: The team tested and validated each of the categories which resulted in excellent interrater reliability (kappa = .96). Of the Major injuries, the distribution of Major A, B, and C was 40.3%, 16.1%, and 43.6%, respectively. CONCLUSIONS: These subcategories enhance the National Database of Nursing Quality Indicators categorization. Using the administration manual, trained personnel can classify injurious fall severity with excellent reliability.

Acquires Anterior Thoracic Lung Herniation and Repair: A Rare Case and Discussion.

We report a case of acquired anterior thoracic lung herniation in a 63-yeal-old female. This painful herniation developed four years after uncomplicated video-assisted thoracic surgery for lung cancer resection and adjuvant radiation for concomitant breast cancer. The herniation site was remote from all prior incisions, and demonstrated intercostal muscle denervation and radiation fibrosis. The 8 cm x 10 cm chest wall defect was reconstructed with inlay PROCEED mesh and reinforced with a pedicled latissimus dorsi flap. Five months postoperatively the patient had complete resolution of symptoms, no evidence of herniation, and a stable wound.

IV 3000 Dressing for Fingertip Injury: Management and Discussion.

An active, right hand dominant. 86-year-old male presented with transverse amputation of the right ring finger just distal to the DIP joint. Conservative management was recommended in order to preserve digit length, mobility, and the DIP joint. The IV3000 semipermeable dressing was utilized as the primary treatment. The clear adhesive dressing has a high moisture vapor transmission rate that facilitates creation of a suitable wound microenvironment. The digit showed significant epithelialization and mobility at two weeks post-injury and was healed with full range of motion at both the DIP and PIP joints by week six. There were no complications from use of the IV3000 dressing, and both healing time and pain during dressing change are improved over alternative dressings like gauze.

Unilateral Forehead Paralysis Following Operative Repair of Facial Trauma: A Case Study and Review of the Literature.

The temporal branch of the facial nerve is a commonly injured nerve during facial trauma due to its superficial course over the zygomatic arch, and is a commonly damaged nerve during facial surgery. We report a case of trauma to the left temporal fossa, and subsequent unilateral forehead paralysis. Early exploration revealed external suture compression as the origin of his paralysis. Removal of the suture led to complete resolution of the neurological deficit. The differential diagnosis did not include the possibility of the compression of the nerve by a suture, however the decision for early exploration led to a full recovery.

Bone marrow osteoblast vulnerability to chemotherapy.

Osteoblasts are a major component of the bone marrow microenvironment, which provide support for hematopoietic cell development. Functional disruption of any element of the bone marrow niche, including osteoblasts, can potentially impair hematopoiesis. We have studied the effect of two widely used drugs with different mechanisms of action, etoposide (VP16) and melphalan, on murine osteoblasts at distinct stages of maturation. VP16 and melphalan delayed maturation of preosteoblasts and altered CXCL12 protein levels, a key regulator of hematopoietic cell homing to the bone marrow. Sublethal concentrations of VP16 and melphalan also decreased the levels of several transcripts which contribute to the composition of the extracellular matrix (ECM) including osteopontin (OPN), osteocalcin (OCN), and collagen 1A1 (Col1a1). The impact of chemotherapy on message and protein levels for some targets was not always aligned, suggesting differential responses at the transcription and translation or protein stability levels. As one of the main functions of a mature osteoblast is to synthesize ECM of a defined composition, disruption of the ratio of its components may be one mechanism by which chemotherapy affects the ability of osteoblasts to support hematopoietic recovery coincident with altered marrow architecture. Collectively, these observations suggest that the osteoblast compartment of the marrow hematopoietic niche is vulnerable to functional dysregulation by damage imposed by agents frequently used in clinical settings. Understanding the mechanistic underpinning of chemotherapy-induced changes on the hematopoietic support capacity of the marrow microenvironment may contribute to improved strategies to optimize patient recovery post-transplantation.