Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals.

OBJECTIVE: Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs). METHODS: A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented. RESULTS: The pooled mean CLABSI rate (No. of infections per 1000 days with a central catheter) was 1.28 before the bundle and 0.96 after the bundle (repeated measures general linear model; F1,58 = 6.973; P = .01; partial η(2) = .11). From 14 months before to 14 months after the bundle was implemented, the mean number of CLABSIs per LTACH decreased by 4.5 (95% CI, 1.85-7.15). Time series modeling showed a significant decrease in the mean hospital CLABSI rate after the bundle was implemented (-0.511 CLABSI/1000 catheter days, SE = 0.050), indicating an immediate effect of the bundle. The mean hospital CLABSI rate was decreasing slightly before the bundle was implemented and continued to decrease at a reduced rate after the bundle was implemented. CONCLUSION: The bundle resulted in a significant and sustained reduction in CLABSI rates in 30 LTACHs for 14 months. These results encourage the development and implementation of similar bundles as effective strategies for infection reduction in LTACHs.

Long-term acute care hospitals have low impact on medicare readmissions to short-term acute care hospitals.

The relative contribution of long-term acute care hospital (LTACH) to short-term acute care hospital (STACH) Medicare patient readmissions is important because of the high acuity of LTACH patients. A retrospective cohort study was conducted to determine the magnitude of LTACH Medicare heart failure (HF) and pneumonia (PN) inpatient readmissions to STACHs within 30 days of LTACH admission and the relative contribution of LTACH patient readmissions to each STACH's total readmissions. Seventy-five for-profit LTACHs and their associated host or primary referral STACHs were studied. An average of 8% HF and 8% PN LTACH Medicare inpatients were readmitted to host or primary referral STACHs within 30 days of admission, representing 0.4% and 0.8% of the total number of HF and PN Medicare patients, respectively, readmitted to the STACHs in fiscal year 2010. The low rates of readmission from LTACHs to STACHs suggest an appropriate level of care for the LTACHs studied.

A preconception care program for women in a college setting.

Preconception healthcare is a way to enhance positive pregnancy outcomes by encouraging women to engage in healthy lifestyles before they become pregnant. Because approximately 50% of pregnancies are unplanned, fetal development may be affected before a woman receives prenatal care. Young women are especially vulnerable to poor outcomes due to risky behaviors. Education about preconception health is not common practice. This article describes a peer education preconception health program for college women that provided a basis for an expanded program with larger, more diverse populations. Nursing students as peer educators presented the program to over 100 young women using the mnemonic REFRAMED PLUS to address eight preconception risk areas and reproductive life planning. Materials to augment the program, developed by peer educators, included a brochure on preconception health, a risk assessment tool, a DVD with stories of young women who experienced unplanned pregnancies, and a Reproductive Life Plan book. Peer educators administered a pretest, showed the DVD, guided discussions, assessed each woman's health risks and administered a posttest. The risk assessment revealed that young women have several preconception health risks. Following the preconception program, posttest scores indicated increased knowledge of preconception health. For preconception healthcare to be successful, preconception risk assessments, education and counseling must be addressed by nurses every time a young woman receives care. When possible, peer educators should be used to disseminate the message to all women of childbearing age.

Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial.

OBJECTIVES: This article describes results of a randomized controlled trial comparing a time-limited early-stage memory loss (ESML) support group program conducted by a local Alzheimer's Association chapter to a wait-list (WL) control condition. METHODS: One hundred and forty-two dyads were randomized in blocks to ESML (n = 96) or WL (n = 46). Mean age of participants was 74.9 years, and mean Mini-Mental State Examination was 23.4. The primary outcome was participant's quality of life; secondary outcomes included mood, family communication, and perceived stress. RESULTS: On the intent-to-treat (ITT) pre-post analysis, significant differences were seen in participant quality of life (p < .001), depression (p < .01), and family communication (p < .05). Within the care partner groups, there was no significant difference between ESML and WL in the ITT analysis. A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems (p < .05), improved family communication (p < .05), self-efficacy (p < .01), Medical Outcomes Study short form (SF-36) role-emotional (p < .05), SF-36 social functioning (p < .05), and SF-36 mental health components (p < .01) in improvers. DISCUSSION: These results support the efficacy of ESML support groups for individuals with dementia.

Auricular chondropathy in rats at a contract research toxicology laboratory.

ABSTRACT The veterinary staff at WIL Research Laboratories, LLC, was asked to assess and characterize a condition of swollen and reddened ears that had been observed in some of the rats in our facility. When all of the Crl:CD(SD) rats in the facility were examined in August of 2004, August of 2005, and February of 2007, the incidences were 0.25%, 0.18%, and 0.19%, respectively. The overall incidence was 0.21%, with a total of 51 of 24677 animals affected. Only bilaterally affected animals were considered positive. Incidence was strongly correlated with the presence of an ear tag. All but one of the affected animals had an ear tag present. Severe auricular chondropathy was diagnosed on microscopic exam.

Effectiveness of support groups for people with mild to moderate Alzheimer's disease: an evaluative survey.

Support groups can provide a forum for socialization and learning for people with mild to moderate Alzheimer's disease. The aim of this study was to evaluate the effectiveness of these groups based on participant feedback. A survey questionnaire was administered to 70 support group participants with Alzheimer's disease from 8 well-established groups across the United States. Participants reported on the educational value, positive socialization, and improved ability to cope with symptoms and to accept the diagnosis as a result of participating in a support group. These reported outcomes suggest the importance of creating more sensitive measures to better evaluate the effectiveness of support groups and other educational or social support programs for persons with dementia.

Causes of errors in the electrocardiographic diagnosis of atrial fibrillation by physicians.

BACKGROUND: The emphasis of most large studies has been placed on the treatment and prevention of atrial fibrillation (AF) and its complications. Little is known about the accuracy of physicians in the electrocardiographic (ECG) diagnosis of AF and the possible causes of the diagnostic errors. METHODS: Over a period of 10 months, a total of 35508 ECGs (28356 patients) were overread in a 385-bed community hospital within 24 hours of the initial reading. Corrected ECGs were returned to the patient file. The gold standard for the final diagnosis was based on the consensus by the cardiologist readers. RESULTS: In all, 35508 ECGs were reviewed. A total of 2809 cases of AF were studied. Incorrect diagnoses related to AF were found in 219 cases. Type I errors (overdiagnosis) occurred in 137 cases. Rhythms with irregular R-R intervals (sinus rhythm with premature atrial contractions and atrial tachycardia or flutter with variable atrioventricular conduction) were misdiagnosed as AF. The presence of low-amplitude atrial activity and/or baseline artifact significantly increased the likelihood of the erroneous diagnosis, whereas ventricular rates of 130 beats/min did not influence the rate of error. Type II errors (missed AF) occurred in 82 cases where AF was either missed or confused with atrial tachycardia/flutter. Finally, ventricular pacing significantly increased the likelihood of type II errors. CONCLUSIONS: In our institution, about 900 ECGs are read each week and 5 of them carry a wrong interpretation related to AF. More attention to common sources of errors as reinforced by an ongoing quality improvement program may reduce the rate of mistakes and thus prevent serious consequences.