Can text messaging be used as an effective method for collecting quality and detailed evaluation data from students on clinical placements?

BACKGROUND: Collecting timely evaluation from students on their clinical placements for quality assurance purposes is challenging. Prompt responses can help placement organisers improve the experience for the next cohort of students. AIMS: This paper examines the success and limitations of using text messages to collect anonymous, instant, and detailed evaluation from students on clinical placements. METHOD: Second year medical students attending 9 placements were sent a series of 5 evaluation statements immediately after their placement. RESULTS: The response rate for the first question was 55.73% (n = 124) falling to 46.16% for the completion of all 5 questions. The number of words used in the free text responses ranged from 1 to 95. The median value for words used per text was 10 when asked to make positive comments and 7 when asked to identify negative issues. CONCLUSION: Text messaging is an effective method of collecting good quality and timely evaluation from students on placements. The quality of information received provided placement organisers with sufficient information to respond to issues in a timely manner. The method is limited by the number of questions that can realistically be asked. The concerns that students would be unwilling to engage with this method seems unfounded.

Nursing professorate in America: projected retirements and replacements.

New paradigms are emerging in higher education, and institutions are facing financial shortfalls. Faculty retirements and resignations may have an impact on the quality of education across disciplines. Will adequate numbers of doctorally prepared replacements be entering nursing education to meet projected retirements and resignations? A national study was conducted of National League for Nursing-accredited baccalaureate and higher degree nursing programs with 296 (58%) responding. The purpose was to determine faculty profiles, policies related to retirement, and projected replacements. Projected retirements and resignations over the years 1992 to 2006 are estimated to be approximately one third of the current faculty work force. Numbers of anticipated graduates at the master's level seem to be adequate. However, doctorally prepared candidates will most certainly not fill all the gaps that will exist in nursing education. Implications call for an examination of clinical teaching practices to ensure continued quality nursing education. An examination of faculty retirement policies and plans is warranted.

Deaths caused by physical restraints.

A retrospective analysis of 122 deaths caused by vest and strap restraints found that most victims were women (78%) and a median age of 81. Victims were found suspended from chairs (42%) or beds (58%); 83% were in nursing homes. Detailed analysis of 19 cases showed that all were demented, 13 had impulsive or involuntary movements, and 14 had recently tried to escape from a restraint or been found in a dangerous position while restrained. Restraints are an underrecognized, underreported, avoidable, and proximate cause of at least 1 of every 1,000 nursing home deaths.

State regulations governing infection control issues in long-term care.

OBJECTIVE: To examine states' regulations governing infections and infection control in long-term-care institutions. DESIGN: Collection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid. MAIN OUTCOME MEASURES: Rules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)-infected patients, and (6) infection control were compared. RESULTS: There were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge. CONCLUSION: Uniform federal standards for long-term care would probably provide a better and more economical way to ensure quality of care in these institutions.

Integrating HIV/AIDS policies and curricular content into baccalaureate nursing programs.

A model used by one school of nursing to implement HIV/AIDS policies, sequenced instructional opportunities, and a research-based evaluation process is described. In the evaluation phase, a study was undertaken to measure students' retention of HIV/AIDS knowledge and their application of universal precautions (U.P.). Findings revealed that 59% of junior baccalaureate nursing students and 75% of seniors retained knowledge about HIV/AIDS and U.P. Seniors indicated that in their role as nursing student or technician/extern, supplies and equipment were readily available and that they had sufficient time to implement U.P. However, only 64% admitted to following correct procedures, even though 96% acknowledged feeling confident in their ability to do so. Knowledge about HIV/AIDS and consistent application of U.P. protects nursing students, prevents legal problems, and promotes the quality of patient care.

Occurrence of adverse effects and high amantadine concentrations with influenza prophylaxis in the nursing home.

Amantadine, in a dose of 100 mg/day, is recommended for influenza prevention in older nursing home residents. We studied an influenza prevention protocol in a 98-bed community nursing home (96% female; mean age = 87.4 years). Fifty-five residents received amantadine when influenza A was confirmed. Although no further influenza cases were diagnosed, 22% experienced adverse events. Dose in mg/kg/day was significantly higher in the group experiencing adverse events (2.24 +/- 0.98 vs 1.76 +/- 0.35; P less than .01). Amantadine concentrations in 32 residents ranged from 128-5,810 ng/mL. Six residents had amantadine concentrations greater than 1,000 ng/mL. Seventy-eight percent would have qualified for further dose reduction on the basis of estimated creatinine clearance. The results suggest that adverse events may be an important problem with the 100 mg/day dose, and this dose may be excessive for influenza prophylaxis in many nursing home residents.

Circadian hematologic time structure in the elderly.

Twenty-three clinically healthy, diurnally active elderly subjects, 71 +/- 5 years of age were studied over a 24-hr span (six samples). Complete blood counts and differential counts were done (Ortho ELT-8, Wright stained smears). The circadian rhythm parameters of the hematologic variables in the elderly subjects were compared with reference values obtained from a larger group of clinically healthy young adult and adult subjects studied independently. The data were analyzed by cosinor and the Bingham test. Circadian rhythms in the number of circulating formed elements in the peripheral blood persist in the aged. In comparison with the young adult, the elderly subjects show differences in the timing (phase advance) of the circadian rhythms in circulating neutrophil leukocytes and lymphocytes, a decrease in the circadian amplitude of circulating platelets, a decrease in circadian rhythm adjusted mean (mesor) in the red cell count, and in the neutrophil band forms.

An approach to the management of medical problems in demented patients.

The appropriate management of medical problems in demented patients plays an important role in maximizing their quality of life. Demented patients present medical problems differently and require treatment strategies that incorporate the strengths and weaknesses of the patients and their caregivers. The goals for treatment must be developed and followed in balance with any plans to limit the treatment because of the dementia.

Chronobiology of serum iron concentration in subjects of different ages at different geographic locations.

The circadian rhythm in serum iron concentration was studied in 61 elderly men (74 +/- 6 years of age) and 93 women (78 +/- 8 years of age) in Bucharest, Romania, in 81 clinically healthy boys and 103 girls (11 +/- 1.5 years of age) in Tîrgoviste, Romania, in 4 elderly men and 19 women (71 +/- 5 years of age) and in 75 young-adult men (24 +/- 11 years of age) and 52 women (24 +/- 9 years of age) in St. Paul, Minnesota, USA. Six samples were obtained from each subject around a 24-hour span. The sampling sessions in the elderly subjects in Romania and in the children extended over all four seasons. A circadian rhythm statistically verified by Cosinor analysis was evident in all groups in both locations. A statistically significant sex difference with lower circadian mean (mesor) and a lower amplitude in the women was found in the Romanian elderly subjects. The children in Romania showed no sex difference in any circadian rhythm parameters. The young adult subjects in Minnesota showed a significantly higher mesor and a phase delay in the men as compared with the women. The elderly subjects of both sexes at both geographic locations had a lower circadian mesor than the young adults and the children. In the Romanian elderly subjects also the circadian amplitude was lower, which was not the case in the Minnesotans. While the acrophase in the elderly subjects and in the children in Romania was comparable (0928 and 0932 local time resp.), the young adults in Minnesota showed in comparison to the Romanians a phase delay (1132 local time) and the elderly in Minnesota showed a phase advance (0732 local time) in comparison to all other groups. The latter finding will have to be confirmed by more extensive studies. In the elderly subjects in Romania the circadian rhythm in serum iron concentration was in phase with the circadian rhythms in total serum bilirubin and alkaline phosphatase but showed significant phase differences from the circadian rhythms in serum albumin, urea nitrogen (BUN), gammaglutamyl transferase (Gamma-GT), serum globulins, glucose, insulin and total serum proteins. The elderly subjects in Romania showed a statistically significant circadian phase delay in summer as compared to fall but showed no seasonal variation of the mesor. The children showed a circadian phase advance in fall as compared to the other seasons and a seasonal variation of their mesor with higher values in spring and summer as compared with winter and fall.(ABSTRACT TRUNCATED AT 400 WORDS)

Infection control practices in Minnesota nursing homes.

Because infection is a major cause of hospitalization among nursing home residents, we assessed infection control activities and related employee health policies in Minnesota nursing homes, using a questionnaire. The majority of institutions (378/440, 85.9%) responded. We found traditional isolation techniques were widely used, but blood and urine precautions were employed in less than half of the homes. Infection surveillance tended to focus on chart review. Antibiotic utilization studies were done in 76% of homes. Procedures for urinary catheter care were often at variance with current recommendations. Employee health policies required a physical examination of a new employee in a minority of institutions. Policies required by Minnesota statute (eg, skin testing for tuberculosis and documentation of employee illness) were carried out by most institutions. Infection control policies and procedures in nursing homes should be redefined so that, where appropriate, they are more consistent with practices in acute-care hospitals.

Circadian endocrine time structure in humans above 80 years of age.

The circadian rhythms in blood hormone concentrations of 17 pituitary, adrenal, pancreatic, testicular, and thyroid hormones were determined in 9 women and 5 men 81 to 91 years of age. Six samples over a 24-hr span were studied for each hormone. Even with the small sample available, 9 of the 17 hormones determined showed a statistically significant circadian rhythm as a group phenomenon (prolactin, estradiol, 17-hydroxyprogesterone, insulin, C-peptide, thyroid stimulating hormone, aldosterone, cortisol, dehydroepiandrosterone sulfate). No rhythm detection by population mean cosinor analysis at the .05 level was obtained in this relatively small group of subjects for adrenocorticotropic hormone, follicle stimulating hormone, growth hormone, luteinizing hormone, triiodothyronine, thyroxine, progesterone (determined in women only) and testosterone (determined in men only).

The value of annual medical examinations in the nursing home.

Although annual medical examinations are required in many nursing homes for all residents, little is known about the value of these examinations. To investigate this, 732 annual examinations were evaluated for frequency of positive findings and clinical importance of the findings. Although 51 per cent of examinations yielded a finding that was new or related to a known chronic disease process, only 3 per cent of findings were judged by primary care physicians to be of major importance. Approximately a fourth of findings were considered to be of intermediate importance. These results provide only modest support for endorsing annual medical examinations for nursing home residents.

Causes for hospitalization of nursing home residents: the role of infection.

Little is known about specific clinical conditions that lead to hospitalization of nursing home patients. To explore this, the authors examined the hospitalizations of 128 nursing home residents and compared them with hospitalizations of 320 patients from the outpatient clinic. Hospitalized nursing home patients were older, were admitted to medical services more frequently, and had more nonspecific complaints on admission. Nursing home patients were hospitalized most frequently for diseases of the circulatory system (16 per cent), respiratory system (14 per cent), and genitourinary system (12 per cent); clinic patients, for diseases of the circulatory system (25 per cent) and nervous system (10 per cent), neoplasms (10 per cent), and signs and symptoms of ill-defined conditions (10 per cent). The most frequent causes of hospitalization for all patients were diseases of the circulatory system (23 per cent), nervous system (10 per cent), and neoplasms (10 per cent). Among patients from the nursing home, infections caused substantially more admissions (27 per cent) than among patients originating from clinic (12 per cent; P less than 0.001). These findings disclose an important opportunity to reduce health care costs and enhance quality of life in the nursing home, particularly through the treatment and control of infections.