Effect of Intravenous (IV) Assistive Device (VeinViewer) on IV Access Attempts, Procedural Time, and Patient and Nurse Satisfaction.

This study evaluated the effectiveness of VeinViewer for peripheral vascular accessing a pediatric hematology oncology clinic. After obtaining consent, 53 patients were randomly assigned to either the VeinViewer group (n = 27) or standard methods group (n = 26). Data on number of attempts, procedural time, access complications, and patient and nurse satisfaction were collected. Patients randomized to the VeinViewer group required significantly less time to access a vein as compared with the standard methods group (P ≤ .05). Additionally, these patients rated nurses as having significantly more skill than nurses who did not use VeinViewer (P ≤ .05) and assigned significantly higher scores for "overall experience"(P ≤ .05). Responses by nurses using VeinViewer overall saw the device in a positive light.

Racial differences in women's prodromal and acute symptoms of myocardial infarction.

BACKGROUND: Minority women, especially black and Hispanic women, have higher rates of coronary heart disease and resulting disability and death than do white women. A lack of knowledge of minority women's symptoms of coronary heart disease may contribute to these disparities. OBJECTIVE: To compare black, Hispanic, and white women's prodromal and acute symptoms of myocardial infarction. METHODS: In total, 545 black, 539 white, and 186 Hispanic women without cognitive impairment at 15 sites were retrospectively surveyed by telephone after myocardial infarction. With general linear models and controls for cardiovascular risk factors, symptom severity and frequency were compared among racial groups. Logistic regression models were used to examine individual prodromal or acute symptoms by race, with adjustments for cardiovascular risk factors. RESULTS: Among the women, 96% reported prodromal symptoms. Unusual fatigue (73%) and sleep disturbance (50%) were the most frequent. Eighteen symptoms differed significantly by race (P<.01); blacks reported higher frequencies of 10 symptoms than did Hispanics or whites. Thirty-six percent reported prodromal chest discomfort; Hispanics reported more pain/discomfort symptoms than did black or white women. Minority women reported more acute symptoms (P < .01). The most frequent symptom, regardless of race, was shortness of breath (63%); 22 symptoms differed by race (P <.01). In total, 28% of Hispanic, 38% of black, and 42% of white women reported no chest pain/discomfort. CONCLUSIONS: Prodromal and acute symptoms of myocardial infarction differed significantly according to race. Racial descriptions of women's prodromal and acute symptoms should assist providers in interpreting women's symptoms.

A low-literacy medication education tool for safety-net hospital patients.

BACKGROUND: To improve medication adherence in cardiac patients, in partnership with a safety-net provider, this research team developed and evaluated a low-literacy medication education tool. METHODS: Using principles of community-based participatory research, the team developed a prototype of a low-literacy hospital discharge medication education tool, customizable for each patient, featuring instruction-specific icons and pictures of pills. In 2007, a randomized controlled clinical trial was performed, testing the tool's effect on posthospitalization self-reported medication adherence and knowledge, 2 weeks postdischarge in English- and Spanish-speaking safety-net inpatients. To validate the self-report measure, 4 weeks postdischarge, investigators collected self-reports of the number of pills remaining for each medication in a subsample of participants. Nurses rated tool acceptability. RESULTS: Among the 166/210 eligible participants (79%) completing the Week-2 interview, self-reported medication adherence was 70% (95% CI=62%, 79%) in intervention participants and 78% (95% CI=72%, 84%) in controls (p=0.13). Among the 85 participants (31%) completing the Week-4 interview, self-reported pill counts indicated high adherence (greater than 90%) and did not differ between study arms. Self-reported adherence was correlated with self-reported pill count in intervention participants (R=0.5, p=0.004) but not in controls (R=0.07, p=0.65). There were no differences by study arm in medication knowledge. The nurses rated the tool as highly acceptable. CONCLUSIONS: Although the evaluation did not demonstrate the tool to have any effect on self-reported medication adherence, patients who received the schedule self-reported their medication adherence more accurately, perhaps indicating improved understanding of their medication regimen and awareness of non-adherence.

The effect of HIV/AIDS disease progression on spirituality and self-transcendence in a multicultural population.

This study examined the relationship of sociodemographic and clinical factors with spirituality and self-transcendence in people with HIV/AIDS. It involved 420 HIV/AIDS patients from an HIV clinic who were predominantly Hispanic (79%) and male (82%), with a mean age of 39 years. Subjects completed spirituality, self-transcendence, health status, and depression scales. Medical charts were reviewed to obtain demographics, current therapies, depression diagnosis, CD4 cells (sometimes called T-cells), and viral load levels. Self-transcendence was related to levels of energy (p < .05) and acculturation (p < .05). Spirituality was related to levels of energy (p < .001) and pain (p < .02). Neither disease progression nor severity was related to self-transcendence or spirituality. The findings suggest the concept of self-transcendence may not be culturally meaningful to Hispanic patients. The development of valid and reliable tools specific for this population is important for future research.

A comprehensive assessment program to improve blood-administering practices using the FOCUS-PDCA model.

BACKGROUND: The Joint Commission on the Accreditation of Healthcare Organizations requires that hospitals have a planned approach to systematically collect data on processes related to the use, ordering, and administering of blood components. This study describes how a comprehensive blood-administering assessment program and the FOCUS-PDCA approach improved overall blood-administering practices. STUDY DESIGN AND METHODS: Nurses were trained to observe blood issuance, blood administering, and patient monitoring steps, and to audit patient's charts to measure compliance with blood-ordering procedures. The observations were recorded on a standardized scannable form, which allowed automatic entry of recorded data directly into a computer database. RESULTS: A total of 982 assessments were completed during the 51-month study period. Documentation of informed consent improved from 80 percent to 100 percent. Compliance with a California law that requires patients to receive information on the risks, benefits, and alternatives to transfusion rose from 30 percent to 100 percent. Physicians' compliance in specifying the rate of blood administration improved from 30 percent to 100 percent, and verification of information on the patient's identification band with the patient's self-identification rose from 50 percent to 100 percent. For all other blood-administering steps, compliance remained high throughout the study period. For the past 9 months, 100-percent compliance has been maintained for all transfusion processes, and during this period no mistransfusions or blood administration near-misses have been reported. CONCLUSION: The blood-administering assessment program described above has improved transfusion practice, reduced the number of near-miss events, and may have prevented mistransfusions.