A Review of Chlorhexidine Oral Care in Patients Receiving Mechanical Ventilation.

BACKGROUND: Chlorhexidine gluconate has been considered the criterion standard of oral care for patients receiving mechanical ventilation because of its ability to reduce the incidence of ventilator-associated events. Optimal concentrations and frequencies remain unclear, as do adverse events related to mortality in various intensive care unit populations. OBJECTIVE: To examine the current evidence for the efficacy of chlorhexidine gluconate in reducing the incidence of ventilator-associated events, mortality, intensive care unit length of stay, and duration of mechanical ventilation in patients receiving ventilator support. METHODS: In this integrative review, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, and Health Source: Nursing/Academic Edition were searched using terms related to mechanical ventilation and chlorhexidine gluconate oral care with dates ranging from 2012 to 2023. RESULTS: Seventeen articles were included in this review: 8 systematic reviews, 8 randomized clinical trials (3 of which were not included in any systematic review), and 1 quasi-experimental study. Chlorhexidine gluconate oral care was associated with a reduced incidence of ventilator-associated events, but efficacy depended on concentration and frequency of administration. With stratification by intensive care unit population type, a nonsignificant trend toward increased mortality was found among non-cardiac surgical patients who received this care. CONCLUSION: The evidence regarding the efficacy of chlorhexidine gluconate oral care in reducing ventilator-associated events in specific intensive care unit populations is contradictory. Recently published guidelines recommend de-implementation of chlorhexidine gluconate oral care in all patients receiving mechanical ventilation. Such care may be beneficial only in the cardiac surgical population.

Screening Out False Participants in Research Recruitment from Social Media Groups.

ABSTRACT: Social media-based groups offer a rich opportunity for nurse researchers to connect with potential study participants. However, as the authors discovered from recruitment of acute respiratory distress syndrome survivors in social media-based survivorship groups, there is a risk of enrollment of both false and duplicate participants. Nurse researchers should adopt best practices to screen out false participants and prevent duplicate participation. Lessons learned from recruitment in social media groups include avoiding the use of survey links, requiring video interviews or home visits for confirmation of identity, adoption of strategic screening questions, and avoidance of international groups (unless the aim is to recruit foreign nationals). Adoption of these practices can help to ensure that the data collected from group patrons are trustworthy. Nurses who read research and adopt findings into practice should critically examine if researchers implemented strategies to screen out false and duplicate participants to protect data integrity.

Factors Associated with Mental Health of Medicare Beneficiaries During the COVID-19 Pandemic.

OBJECTIVES: This study examined factors associated with the mental health of Medicare beneficiaries during the COVID-19 pandemic. METHODS: The Medicare Current Beneficiary Survey COVID-19 Supplement administered in the Fall of 2020 of beneficiaries aged ≥65 years was analyzed (n = 6,173). A survey-weighted logistic model, adjusted for socio-demographics and comorbidities, was performed to examine factors (e.g., accessibility of medical/daily needs, financial security, and social connectivity) associated with stress/anxiety. RESULTS: Of Medicare beneficiaries, 40.8% reported feeling more stressed/anxious during the pandemic. Factors that were associated with this increased stress/anxiety include the inability to get home supplies (95% CI [3.4%, 16.5%]) or a doctor's appointment (95% CI [1.7%, 20.7%]), feeling less financially secure (95% CI [23.1%, 33.2%]) or socially connected (95% CI [19.1%, 25.6%]), and being female (95% CI [7.2%, 12.2%]), when compared with their respective counterparts. Non-Hispanic blacks were less likely to report feeling more stressed/anxious than non-Hispanic whites (95% CI [-19.9%, -9.0%]). CONCLUSIONS: Our findings highlight that beneficiaries' mental health was adversely influenced by the pandemic, particularly in those who felt financially insecure and socially disconnected. CLINICAL IMPLICATIONS: It is warranted to screen at risk beneficiaries for stress/anxiety during Medicare wellness visits and advocate for programs to reduce those risk factors.

Faculty writing accountability groups: A protocol for traditional and virtual settings.

Publishing is a measure of faculty performance, yet barriers often include getting started, time management, and difficulty finishing. Manuscript submissions also lack deadlines, which creates additional challenges. Writing accountability groups (WAGs) are associated with increased faculty writing productivity. The purpose of this paper is to provide an overview of WAGs, including the process, participants, writing productivity outcomes, benefits, challenges, and unintended consequences. To maintain our writing progress during the COVID-19 pandemic, we moved our WAG sessions to a virtual platform. Our WAG protocol (both face-to-face and virtual) is shared to help other faculty members or doctoral students implement writing accountability groups. We also advocate for hybrid WAG sessions to promote attendance. In addition to facilitation of scholarly writing and improved writing habits, our WAG created opportunities for scholarly communication and networking with colleagues.

Urosepsis in Older Adults: Epidemiologic Trends in Florida.

The incidence and geographic distribution of urosepsis, a life-threatening condition in older adults, is not well understood. The Florida State Inpatient Databases (2012-2014) showed an increase in the incidence of community-acquired urosepsis (5.37 to 6.16 per 1000), particularly among Hispanic older adults residing in low socioeconomic, urban areas with large numbers of nursing homes. These findings suggest a state policy is needed to address community-based preventative care and education for early detection of urosepsis in low-income urban areas. It is important for local health departments to partner with nursing homes to address disparities in care that disproportionally impact Hispanics.

Prominent Cognitive Impairment Sequelae in Adult Survivors of Acute Respiratory Distress Syndrome.

PURPOSE: The primary objective of this scoping review was to identify prominent cognitive impairment sequelae in adult survivors of an intensive care unit admission for acute respiratory distress syndrome (ARDS). DESIGN: A scoping review was performed. METHODS: Search terms were entered into multiple EBSCOhost databases. Articles pertaining to pediatric survivors, not in English, lacking cognitive impairment sequelae, or focused on a single sequela were excluded; 12 articles remained. RESULTS: Cognitive impairment developed in 83.5% of patients with ARDS prior to discharge and persisted in 51.3% (n = 300/585) of survivors at the 1 year mark after discharge (range: 16.7%-100% across studies). Prominent sequelae included impairments in executive function, mental processing speed, immediate memory, and attention/concentration. CONCLUSIONS: Survivors of an intensive care unit stay for ARDS often develop cognitive impairment persisting long after their admission. Clinicians in rehabilitation facilities should screen for these sequelae and connect survivors with treatment to improve cognitive outcomes. CLINICAL RELEVANCE: Early recognition of prominent cognitive impairment sequelae by rehabilitation clinicians and referrals to neuropsychologists by providers are critical to limiting the severity of impairment.

Use of Social Media to Exchange Critical Care Practice Evidence During the Pandemic.

BACKGROUND: The evidence-based practice (EBP) process was challenged during the early phase of the COVID-19 pandemic by factors such as a novel disease, rapidly changing guidelines, shortage of personal protective equipment, and other health care supplies. OBJECTIVES: Our aims were to (1) explore sources of evidence sought by critical care nurses during a pandemic and (2) explore nurses' perceptions of EBP. METHODS: A qualitative exploratory study was conducted using deidentified data from the American Association of Critical-Care Nurses (ACCN) open-access Facebook page, January 28 to April 30, 2020. RESULTS: Two major themes were identified: (1) "sharing and seeking evidence," that is, nurses used both formal and informal sources to explore evidence supporting evolving clinical practices, and (2) "concerns about evidence," that is, nurses expressed concerns about lack of evidence and mistrust of evolving evidence. DISCUSSION: Initially, there was a mismatch in nurses' expectations of the American Association of Critical-Care Nurses Facebook page. A major limitation of Facebook is the lack of a repository for quick retrieval of information. Despite these limitations, and fear and mistrust of changing guidelines, social media was used to communicate, collaborate, and share evidence to support clinical practice. Critical care nurses seemed to value evidence to support patient management and their personal safety during this evolving health crisis. CONCLUSIONS: Social media played a large role in dissemination of timely evidence-based information during the early pandemic. Our results show that current EBP models should be revised to prepare for future crises and include direction for dealing with limited health care resources, and lack of and/or rapidly changing evidence.

A Call for the World Health Organization to Create International Classification of Disease Diagnostic Codes for Post-Intensive Care Syndrome in the Age of COVID-19.

Post-intensive care syndrome (PICS), a condition found in survivors of critical illness, is characterized by persistent physical, cognitive, and psychological sequelae that impact the quality of life after discharge from an intensive care unit (ICU). At present, there are no International Classification of Disease (ICD) billing codes for this condition. Without financial alignment, clinicians cannot diagnose PICS, hindering tracking of its prevalence and impeding policy development for this condition. Clinicians should be screening for PICS in all survivors of critical illness, particularly those with acute respiratory distress syndrome (ARDS). Results from single-center studies suggest over 75 percent of ARDS survivors develop PICS. With nearly 5 percent of patients with COVID-19 requiring ICU admission for ARDS, it is important for clinicians to be able to diagnose PICS in survivors, and researchers to be able to track it. Member states should impress upon the World Health Organization to create ICD-10 codes for PICS.

Factors Associated With Avoiding Health Care Among Community-Dwelling Medicare Beneficiaries With Type 2 Diabetes.

INTRODUCTION: Health care avoidance by Medicare beneficiaries with chronic conditions such as type 2 diabetes can result in adverse health and economic outcomes. The objective of this study was to describe factors associated with choices to avoid health care among Medicare beneficiaries with type 2 diabetes. METHODS: We used a survey-weighted logistic model and the nationally representative 2016 Medicare Current Beneficiary Survey to analyze data on 1,782 Medicare beneficiaries aged ≥65 with type 2 diabetes, to examine associations between Medicare beneficiaries' decisions to avoid health care and multiple factors (eg, dissatisfaction with information given by providers, health problems that should have been discussed with providers but were not, worry about health more than other people their age). RESULTS: Of our study sample, 26.1% reported they avoid health care. Five factors were associated with avoiding health care: delaying care (vs not) because of costs (adjusted odds ratio [aOR] = 2.06; P = .005); having health problems that should have been discussed with providers but were not (vs having discussions) (aOR = 1.50; P = .04); worrying (vs not) about health more than other people their age (aOR = 2.13; P < .001); self-reporting "other" minority race (vs non-Hispanic White) (aOR = 2.01; P = .006); and education levels. Participants with less than a high school diploma (aOR = 1.95; P = .001) and participants with a high school diploma only (aOR = 1.49; P = .049) were more likely than participants with an education beyond high school to report avoiding health care. CONCLUSION: Approximately 1 in 4 Medicare beneficiaries with type 2 diabetes avoid health care. We found inequities in care-seeking behavior by race/ethnicity and education level. Health care perceptions and lack of appropriate discussion of health care concerns with health care providers are also associated with this behavior. Clinical interventions (eg, improved patient-provider communication) and educational outreach are needed to decrease the numbers of Medicare beneficiaries who avoid health care.

The Weekend Effect in Older Adult Urosepsis Admissions.

BACKGROUND: Urosepsis is common in older adults with more infections identified as community-acquired as opposed to hospital-acquired. Despite the prevalence of urosepsis and its high mortality rates, very little is known about the care outcomes of older adult patients with community-acquired urosepsis who are admitted to the hospital on a weekend. OBJECTIVES: To determine if a weekend admission was associated with inpatient mortality in older adults admitted to an acute care hospital with a diagnosis of community-acquired urosepsis. METHODS: Data from the State Inpatient Datasets for Florida were merged with data from the American Hospital Association Annual Survey on hospital characteristics for the year 2014. Logistic regression models with a sizable number of patient and hospital controls were used to identify factors associated with inpatient mortality in patients 65 years of age and older with a primary or secondary diagnosis of community-acquired urosepsis. RESULTS: In total 21,904 older adults were admitted to a Florida hospital with a diagnosis of community-acquired urosepsis; 5736 of these patients were admitted on a weekend. In a fully adjusted logistic regression model, weekend admission was associated with a 12% increase in the odds of mortality, and each additional hour of nursing care per patient day was associated with a 2% decrease in the odds of mortality. CONCLUSIONS: Our findings suggest that weekend admission was associated with an increase in the odds of mortality in older adults with community-acquired urosepsis. Small increases in nurse staffing seem to reduce the odds of mortality.

Implications of the new sepsis definition on research and practice.

INTRODUCTION: The Society of Critical-Care Medicine and the European Society of Intensive Care Medicine recently announced a marked change in the sepsis definition. A task force of 19 sepsis clinicians and researchers made the change based on advances in the pathobiological understanding of the septic process. SUMMARY OF CHANGE: The task force determined that there were numerous justifications for a revision of the sepsis definition, which are outlined in this article. The systemic inflammatory response criteria have been replaced by the Sequential Organ Failure Assessment (SOFA) score in the newly operationalized definition (Singer et al., 2016). In addition to the definition change, the task force recommended using the new quick SOFA (qSOFA) score in non-ICU settings, as a risk stratification tool to identify patients who may be septic or be at risk of developing sepsis. IMPLICATIONS ON RESEARCH & PRACTICE: The change in definition will likely have a negative impact on sepsis research in the short-term as hospitals adjust their coding for the new definition, but may result in less misclassification bias and improved research data in the long-term. While the intent of the SCCM/ESICM task force was to better define sepsis for coding and epidemiological research purposes, there is the potential for improved patient outcomes if clinicians are better able to differentiate between sepsis and inflammatory events. The qSOFA tool may also aid clinicians in recognizing sepsis in a quicker manner, leading to more timely treatment, and potentially better outcomes. CONCLUSIONS: While the new operationalized Sepsis-3 definition appears on the surface to be an improvement over the previous iterations, it remains to be seen if research data will be more robust using the new criteria. There is the potential for better patient outcomes if clinicians are better able to differentiate sepsis from inflammatory events with the new definition, and if sepsis cases are recognized sooner with qSOFA. Future research on the impact of this definition change on research and practice will be essential, to determine if the Sepsis 3 definition, its associated clinical criteria, and the qSOFA need further revision.

Risk Factors for Urosepsis in Older Adults: A Systematic Review.

Objective: To identify factors that predispose older adults to urosepsis and urosepsis-related mortality. Method: A systematic search using PubMed and CINAHL databases. Articles that met inclusion criteria were assessed using the Strengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and were scored on a 4-point Likert-type scale. Results: A total of 180 articles were identified, and six met inclusion criteria. The presence of an internal urinary catheter was associated with the development of urosepsis and septic shock. Although a number of factors were examined, functional dependency, number of comorbidities, and low serum albumin were associated with mortality across multiple studies included in this review. Discussion: Little scientific evidence is available on urosepsis, its associated risk factors, and those factors associated with urosepsis-related mortality in older adults. More research is warranted to better understand urosepsis in this vulnerable population in an effort to improve the quality of patient care.