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1.
Am J Crit Care ; 33(2): 115-124, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38424023

RESUMO

BACKGROUND: Children often experience respiratory illnesses requiring bedside nurses skilled in recognizing respiratory decompensation. Historically, recognizing respiratory distress has relied on teaching during direct patient care. Virtual reality simulation may accelerate such recognition among novice nurses. OBJECTIVE: To determine whether a virtual reality curriculum improved new nurses' recognition of respiratory distress and impending respiratory failure in pediatric patients based on assessment of physical examination findings and appropriate escalation of care. METHODS: New nurses (n = 168) were randomly assigned to complete either an immersive virtual reality curriculum on recognition of respiratory distress (intervention) or the usual orientation curriculum (control). Group differences and changes from 3 months to 6 months after the intervention were examined. RESULTS: Nurses in the intervention group were significantly more likely to correctly recognize impending respiratory failure at both 3 months (23.4% vs 3.0%, P < .001) and 6 months (31.9% vs 2.6%, P < .001), identify respiratory distress without impending respiratory failure at 3 months (57.8% vs 29.6%, P = .002) and 6 months (57.9% vs 17.8%, P < .001), and recognize patients' altered mental status at 3 months (51.4% vs 18.2%, P < .001) and 6 months (46.8% vs 18.4%, P = .006). CONCLUSIONS: Implementation of a virtual reality-based training curriculum was associated with improved recognition of pediatric respiratory distress, impending respiratory failure, and altered mental status at 3 and 6 months compared with standard training approaches. Virtual reality may offer a new approach to nurse orientation to enhance training in pediatrics-specific assessment skills.


Assuntos
Enfermeiras e Enfermeiros , Síndrome do Desconforto Respiratório , Insuficiência Respiratória , Realidade Virtual , Criança , Humanos , Competência Clínica , Currículo , Síndrome do Desconforto Respiratório/diagnóstico , Insuficiência Respiratória/diagnóstico
2.
J Nurses Prof Dev ; 36(4): 235-240, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251173

RESUMO

An immersive virtual reality curriculum was piloted with new nurse graduates that focused on improving clinical reasoning and situational awareness for pediatric respiratory distress and impending respiratory failure. Learnings from this pilot could inform strategies for development of standardized, efficient, and safe onboarding curricula to increase the likelihood of successful transition to practice.


Assuntos
Conscientização , Competência Clínica/normas , Aprendizagem , Realidade Virtual , Adulto , Feminino , Humanos , Masculino , Pediatria , Insuficiência Respiratória/prevenção & controle , Adulto Jovem
3.
Am J Emerg Med ; 29(4): 367-72, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20825802

RESUMO

Screening for HIV in the emergency department (ED) is recommended by the Centers for Disease Control and Prevention. The relative importance of efforts to increase consent among those who currently decline screening is not well understood. We compared the risk characteristics reported by patients who decline risk-targeted, opt-in ED screening with those who consent. We secondarily recorded reasons for declining testing and reversal of the decision to decline testing after prevention counseling. Of 199 eligible patients, 106 consented to testing and 93 declined. Of those declining, 60 (64.5%) of 93 completed a risk assessment. There were no differences in HIV risk behaviors between groups. Declining patients reported recent testing in 73.3% of cases. After prevention counseling, 4 (6.7%) of 60 who initially declined asked to be tested. Given similarities between those who decline and those who consent to testing, efforts to increase consent may be beneficial. However, this should be tempered by the finding that many declined because of a recent negative test. Emphasizing risk during prevention counseling is not a promising strategy for improving opt-in consent rates.


Assuntos
Aconselhamento Diretivo , Serviço Hospitalar de Emergência , Infecções por HIV/diagnóstico , Consentimento Livre e Esclarecido/psicologia , Programas de Rastreamento , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Sorodiagnóstico da AIDS , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Tomada de Decisões , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
4.
J Med Screen ; 16(1): 29-32, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19349528

RESUMO

OBJECTIVES: Outcomes in an episodic care setting like an emergency department (ED) are traditionally evaluated in comparison with the number of visits as opposed to the number of unique patients, although patients commonly present to the ED multiple times. We examined the differences in HIV screening programme outcomes that would occur if the analysis were conducted at the patient-level, rather than the traditional visit-level. We hypothesized that while our ED-based HIV screening programme does test some patients repeatedly, the primary programme outcome of percent positive is not substantially altered by the unit of analysis. METHODS: We reviewed the clinical database of an ED HIV screening programme at a large, urban, teaching hospital in the United States from 2003-2007. Data were analyzed descriptively. The main outcome measure was the rate of positive test results computed with either the visit or the patient as the unit of analysis. RESULTS: HIV testing was provided at 9629 visits, representing 8450 unique patients. For patient-level analysis, the proportion of patients found to be positive was 0.91%. For visit-level analysis, the proportion of tests with positive results was 0.83%. Of the 910 patients with repeat testing, 7 (0.77%) were identified as positive at a repeat test. The median time between tests was 383 days (range 1-1742). CONCLUSIONS: Results changed little regardless of whether unique patients or unique visits were used as the unit of analysis. Any differences in positive rates were mitigated by the contribution of repeat testing to the identification of newly infected patients. Given these findings, and the difficulty of tracking repeat testing over time, visit-level analysis are appropriate for comparing programme outcomes when detailed modeling of epidemiology, cost, and/or outcomes is not required.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Infecções por HIV/diagnóstico , Adulto , Feminino , Humanos , Masculino
5.
BMC Public Health ; 8: 220, 2008 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-18578881

RESUMO

OBJECTIVE: Early HIV diagnosis reduces transmission and improves health outcomes; screening in non-traditional settings is increasingly advocated. We compared test venues by the number of new diagnoses successfully linked to the regional HIV treatment center and disease stage at diagnosis. METHODS: We conducted a retrospective cohort study using structured chart review of newly diagnosed HIV patients successfully referred to the region's only HIV treatment center from 1998 to 2003. Demographics, testing indication, risk profile, and initial CD4 count were recorded. RESULTS: There were 277 newly diagnosed patients meeting study criteria. Mean age was 33 years, 77% were male, and 46% were African-American. Median CD4 at diagnosis was 324. Diagnoses were earlier via partner testing at the HIV treatment center (N = 8, median CD4 648, p = 0.008) and with universal screening by the blood bank, military, and insurance companies (N = 13, median CD4 483, p = 0.05) than at other venues. Targeted testing by health care and public health entities based on patient request, risk profile, or patient condition lead to later diagnosis. CONCLUSION: Test venues varied by the number of new diagnoses made and the stage of illness at diagnosis. To improve the rate of early diagnosis, scarce resources should be allocated to maximize the number of new diagnoses at screening venues where diagnoses are more likely to be early or alter testing strategies at test venues where diagnoses are traditionally made late. Efforts to improve early diagnosis should be coordinated longitudinally on a regional basis according to this conceptual paradigm.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Sorodiagnóstico da AIDS , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Contagem de Linfócito CD4 , Estudos de Coortes , Diagnóstico Precoce , Feminino , Infecções por HIV/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , Avaliação de Resultados em Cuidados de Saúde , Encaminhamento e Consulta , Estudos Retrospectivos , Carga Viral
6.
BMC Health Serv Res ; 7: 164, 2007 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-17937817

RESUMO

BACKGROUND: HIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention. Emergency Departments (EDs) frequently care for PLWH, but do not typically endorse a prevention mission. We conducted a pilot exploratory evaluation of the first reported ED program to address the prevention needs of PLWH. METHODS: This retrospective observational cohort evaluation reviewed program records to describe the first six months of participants and programmatic operation. Trained counselors provided a risk assessment and counseling intervention combined with three linkage interventions: i) linkage to health care, ii) linkage to case management, and iii) linkage to partner counseling and referral. RESULTS: Of 81 self-identified PLWH who were approached, 55 initially agreed to participate. Of those completing risk assessment, 17/53 (32%, 95 CI 20% to 46%) reported unprotected anal/vaginal intercourse or needle sharing in the past six months with a partner presumed to be HIV negative. Counseling was provided to 52/53 (98%). For those requesting services, 11/15 (73%) were linked to healthcare, 4/23 (17%) were coordinated with case management, and 1/4 (25%) completed partner counseling and referral. CONCLUSION: Given base resources of trained counselors, it was feasible to implement a program to address the prevention needs for persons living with HIV in an urban ED. ED patients with HIV often have unmet needs which might be addressed by improved linkage with existing community resources. Healthcare and prevention barriers for PLWH may be attenuated if EDs were to incorporate CDC recommended prevention measures for healthcare providers.


Assuntos
Aconselhamento , Transmissão de Doença Infecciosa/prevenção & controle , Serviço Hospitalar de Emergência , Infecções por HIV/prevenção & controle , Adulto , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Observação , Ohio , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta , Estudos Retrospectivos , Medição de Risco , Sexo Seguro , Parceiros Sexuais
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