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Cale AS, Hoffman LA, McNulty MA. Pre- and post-examination reflections of first-year medical students in an integrated medical anatomy course. Anat Sci Educ 2024; 17:186-198. [PMID: 37772662 DOI: 10.1002/ase.2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/13/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
Due to the rigor and pace of undergraduate medical anatomy courses, it is not uncommon for students to struggle and fail initially. However, repetition of coursework places an additional burden on the student, instructor, and institution. The purpose of this study was to compare the exam preparation strategies of repeating and non-repeating students to identify areas where struggling students can be supported prior to course failure. As part of their integrated anatomy course, first-year medical students at Indiana University completed a metacognitive Practice-Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the PBLIs, students were asked to reflect on their exam preparation strategies, confidence, and satisfaction, as well as their predicted and actual exam performance. PBLI responses from non-repeating and repeating students were then analyzed quantitatively and qualitatively. A total of 1802 medical students were included in this study, including 1751 non-repeating and 51 repeating students. Based on their PBLI responses, non-repeating students were appropriately confident, somewhat satisfied, and more accurate when predicting their exam performance. Repeating students were overconfident, dissatisfied, and inaccurate when predicting their first exam performance on their initial, unsuccessful attempt but were more successful on their second, repeat attempt. Qualitative analysis revealed that repeating students aimed to improve their studying by modifying their existing study strategies and managing their time more effectively. In conjunction with other known risk factors, these insights into repeater and non-repeater exam preparation practices can help anatomy educators better identify and support potential struggling students.
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Affiliation(s)
- Andrew S Cale
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leslie A Hoffman
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Fort Wayne, Indiana, USA
| | - Margaret A McNulty
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Cale AS, Hoffman LA, McNulty MA. Promoting metacognition in an allied health anatomy course. Anat Sci Educ 2023; 16:473-485. [PMID: 35951462 DOI: 10.1002/ase.2218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 05/11/2023]
Abstract
Metacognition, the ability to self-regulate one's learning and performance, has been shown to improve student outcomes. Anatomy is recognized as one of the toughest courses in allied health curricula, and students could benefit from metacognitive activities. The purpose of this study was to explore the changes in metacognition of allied health students in an anatomy course and identify which groups need support with this skill. First-year physician assistant (MPAS), physical therapy (DPT), and occupational therapy (OTD) students (n = 129) were invited to participate. At the beginning and end of the course, students completed a questionnaire including the metacognitive awareness inventory (MAI) that assesses metacognition. Students were also asked to reflect on their examination performances using a modified Likert scale and participated in reflective discussion boards to encourage development of metacognitive skills, which were thematically analyzed. Paired metacognition scores had increased significantly by the end of the course. However, middle-performers anticipated high grades and were less satisfied with their grade, indicating a disconnect in their metacognition compared to high- and low-performers. Students' receptiveness to modifying study strategies to improve performance declined throughout the course; by mid-way through, they relied more on existing strategies. Increasing time constraints were frequently cited as a major factor when considering study strategies and modification of such strategies. To maximize the effectiveness of metacognitive activities, they should be positioned early in the course when students are most receptive. In addition, middle performers may benefit from additional support to improve metacognition.
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Affiliation(s)
- Andrew S Cale
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leslie A Hoffman
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Fort Wayne, Indiana, USA
| | - Margaret A McNulty
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Robertson KA, Agosto ER, Hoffman LA, Deane AS, Byram JN. Students' Perception of the Anatomy Educational Environment at Regional Medical Campuses (RMC) and Main Campus. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kyle A. Robertson
- Anatomy, Cell Biology, & Physiology, IndianapolisIndiana University School of MedicineIndianapolisIN
| | - Elizabeth R. Agosto
- Anatomy, Cell Biology, & Physiology, IndianapolisIndiana University School of MedicineIndianapolisIN
| | - Leslie A. Hoffman
- Anatomy, Cell Biology, & Physiology, Ft. WayneIndiana University School of MedicineFort WayneIN
| | - Andrew S. Deane
- Anatomy, Cell Biology, & Physiology, IndianapolisIndiana University School of MedicineIndianapolisIN
| | - Jessica N. Byram
- Anatomy, Cell Biology, & Physiology, IndianapolisIndiana University School of MedicineIndianapolisIN
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Cale AS, McNulty MA, Hoffman LA. Learning from the Past: A Five‐Year Analysis of the Exam Preparations of Students Repeating an Integrated Medical Anatomy Course. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew S. Cale
- Department of Anatomy, Cell Biology, and PhysiologyIndiana University School of MedicineIndianapolisIN
| | - Margaret A. McNulty
- Department of Anatomy, Cell Biology, and PhysiologyIndiana University School of MedicineIndianapolisIN
| | - Leslie A. Hoffman
- Department of Anatomy, Cell Biology, and PhysiologyIndiana University School of MedicineFort WayneIN
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Hoffman LA. Anatomy Education Elective: A Model for Vertical Integration and Self‐Directed Learning in the Medical Curriculum. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Leslie A. Hoffman
- Anatomy, Cell Biology & PhysiologyIndiana University School of MedicineFort WayneIN
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Hoffman LA, Lufler RS, Brown KM, DeVeau K, DeVaul N, Fatica LM, Mussell J, Byram JN, Dunham SM, Wilson AB. A review of U.S. Medical schools' promotion standards for educational excellence. Teach Learn Med 2020; 32:184-193. [PMID: 31746230 DOI: 10.1080/10401334.2019.1686983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phenomenon: Given the growing number of medical science educators, an examination of institutions' promotion criteria related to educational excellence and scholarship is timely. This study investigates the extent to which medical schools' promotion criteria align with published standards for documenting and evaluating educational activities. Approach: This document analysis systematically analyzed promotion and tenure (P&T) guidelines from U.S. medical schools. Criteria and promotion expectations (related to context, quantity, quality, and engagement) were explored across five educational domains including: (i) teaching, (ii) curriculum/program development, (iii) mentoring/advising, (iv) educational leadership/administration, and (v) educational measurement and evaluation, in addition to research/scholarship and service. After independent review and data extraction, paired researchers compared findings and reached consensus on all discrepancies prior to final data submission. Descriptive statistics assessed the frequency of referenced promotion criteria. Findings: Promotion-related documents were retrieved from 120 (of 185) allopathic and osteopathic U.S. medical schools. Less than half of schools (43%; 52 of 120) documented a well-defined education-related pathway for advancement in academic rank. Across five education-specific domains, only 24% (12 of 50) of the investigated criteria were referenced by at least half of the schools. The least represented domain within P&T documents was "Educational Measurement and Evaluation." P&T documents for 47% of schools were rated as "below average" or "very vague" in their clarity/specificity. Insights: Less than 10% of U.S. medical schools have thoroughly embraced published recommendations for documenting and evaluating educational excellence. This raises concern for medical educators who may be evaluated for promotion based on vague or incomplete promotion criteria. With greater awareness of how educational excellence is currently documented and how promotion criteria can be improved, education-focused faculty can better recognize gaps in their own documentation practices, and more schools may be encouraged to embrace change and align with published recommendations.
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Affiliation(s)
- Leslie A Hoffman
- Department of Anatomy and Cell Biology, Indiana University, Indianapolis, Indiana, USA
| | - Rebecca S Lufler
- Department of Medical Education, Tufts University, Boston, Massachusetts, USA
| | - Kirsten M Brown
- Department of Anatomy and Cell Biology, George Washington University, Washington DC, USA
| | - Kathryn DeVeau
- Department of Anatomy and Cell Biology, George Washington University, Washington DC, USA
| | - Nicole DeVaul
- Department of Anatomy and Cell Biology, George Washington University, Washington DC, USA
| | - Lawrence M Fatica
- Department of Anthropology, George Washington University, Washington DC, USA
| | - Jason Mussell
- Department of Cell Biology and Anatomy, Louisiana State University, New Orleans, Louisiana, USA
| | - Jessica N Byram
- Department of Anatomy and Cell Biology, Indiana University, Indianapolis, Indiana, USA
| | - Stacey M Dunham
- Department of Anatomy and Cell Biology, Indiana University, Bloomington, Indiana, USA
| | - Adam B Wilson
- Department of Cell and Molecular Medicine, Rush University, Chicago, Illinois, USA
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Jubran A, Grant BJB, Duffner LA, Collins EG, Lanuza DM, Hoffman LA, Tobin MJ. Long-Term Outcome after Prolonged Mechanical Ventilation. A Long-Term Acute-Care Hospital Study. Am J Respir Crit Care Med 2020; 199:1508-1516. [PMID: 30624956 DOI: 10.1164/rccm.201806-1131oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rationale: Patients managed at a long-term acute-care hospital (LTACH) for weaning from prolonged mechanical ventilation are at risk for profound muscle weakness and disability. Objectives: To investigate effects of prolonged ventilation on survival, muscle function, and its impact on quality of life at 6 and 12 months after LTACH discharge. Methods: This was a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at an LTACH. Measurements and Main Results: At discharge, 53.7% of patients were detached from the ventilator and 1-year survival was 66.9%. On enrollment, maximum inspiratory pressure (Pimax) was 41.3 (95% confidence interval, 39.4-43.2) cm H2O (53.1% predicted), whereas handgrip strength was 16.4 (95% confidence interval, 14.4-18.7) kPa (21.5% predicted). At discharge, Pimax did not change, whereas handgrip strength increased by 34.8% (P < 0.001). Between discharge and 6 months, handgrip strength increased 6.2 times more than did Pimax. Between discharge and 6 months, Katz activities-of-daily-living summary score improved by 64.4%; improvement in Katz summary score was related to improvement in handgrip strength (r = -0.51; P < 0.001). By 12 months, physical summary score and mental summary score of 36-item Short-Form Survey returned to preillness values. When asked, 84.7% of survivors indicated willingness to undergo mechanical ventilation again. Conclusions: Among patients receiving prolonged mechanical ventilation at an LTACH, 53.7% were detached from the ventilator at discharge and 1-year survival was 66.9%. Respiratory strength was well maintained, whereas peripheral strength was severely impaired throughout hospitalization. Six months after discharge, improvement in muscle function enabled patients to perform daily activities, and 84.7% indicated willingness to undergo mechanical ventilation again.
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Affiliation(s)
- Amal Jubran
- 1 Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,2 Loyola University of Chicago Stritch School of Medicine, Maywood, Illinois.,3 RML Specialty Hospital, Hinsdale, Illinois
| | | | - Lisa A Duffner
- 1 Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,2 Loyola University of Chicago Stritch School of Medicine, Maywood, Illinois.,3 RML Specialty Hospital, Hinsdale, Illinois
| | - Eileen G Collins
- 1 Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,2 Loyola University of Chicago Stritch School of Medicine, Maywood, Illinois.,3 RML Specialty Hospital, Hinsdale, Illinois.,5 University of Illinois at Chicago, Chicago, Illinois
| | | | | | - Martin J Tobin
- 1 Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,2 Loyola University of Chicago Stritch School of Medicine, Maywood, Illinois.,3 RML Specialty Hospital, Hinsdale, Illinois
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Affiliation(s)
- Leslie A Hoffman
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, Indiana, USA
| | - Joel A Vilensky
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, Indiana, USA
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Hoffman LA, Furman DT, Waterson Z, Henriksen B. A Novel Resident-as-Teacher Curriculum to Improve Residents' Integration Into the Clinic. PRiMER 2019; 3:9. [PMID: 32537580 PMCID: PMC7205102 DOI: 10.22454/primer.2019.394096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Graduate medical education depends on senior residents to facilitate peer education. Previous studies have described the benefits of resident-as-teacher (RaT) curricula; however, means of assessing these interventions have proven difficult. The purpose of this study was to provide meaningful evaluation of a novel RaT curriculum and scribing activity. METHODS Didactic sessions on teaching skills were presented in July, 2017. First- and third-year residents then alternated scribing for each other for 4 weeks within the outpatient clinic to allow for near-peer educational exchange. Residents' attitudes toward teaching and perceptions of teaching abilities were assessed using preand postintervention surveys. Independent reviewers reviewed charts completed by PGY-1 residents during the scribing activity, and compared them to charts from the previous academic year. RESULTS All first-year (n=12; 100%) and third-year (n=10; 100%) residents participated in the study. After participating in the RaT curriculum, residents were more comfortable giving feedback to other residents and felt better prepared to teach and assess the effectiveness of their teaching. Although there was no significant difference in ratings between the 2016 and 2017 charts, reviewers noted that the 2017 charts contained fewer obvious omissions, and third-year residents felt the charts were completed in a timelier manner. First-year residents saw 16% more patients in 2017 than they had in 2016, which expedited integration into the clinic. CONCLUSION This innovative RaT curriculum with scribing activity improved residents' teaching and communication skills and provided first-year residents with a more efficient and meaningful orientation into the outpatient clinic.
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Clark-Cutaia MN, Sevick MA, Thurheimer-Cacciotti J, Hoffman LA, Snetselaar L, Burke LE, Zickmund SL. Perceived Barriers to Adherence to Hemodialysis Dietary Recommendations. Clin Nurs Res 2018; 28:1009-1029. [DOI: 10.1177/1054773818773364] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Barriers to following dietary recommendations have been described; however, they remain poorly understood. The purpose of this qualitative study was to explore perceived barriers to adherence to dietary recommendations in a diverse hemodialysis patient population. Participants were eligible to participate in a semi-structured qualitative telephone interview prior to randomization for an ongoing clinical trial to evaluate the efficacy of an intervention designed to reduce dietary sodium intake. Interviews were digitally recorded, transcribed verbatim and coded using an iterative qualitative process. In total, 30 (37% females, 53% Caucasians) participants, 63.2 ± 13.3 years, were interviewed. Time, convenience, and financial constraints hindered dietary adherence. Dietary counseling efforts were rated positively but require individualization. Ability to follow recommended guidelines was challenging. Suggestions for addressing barriers include technology-based interventions that allow patients to improve food choices and real-time decision-making, and permit tailoring to individual barriers and preferences.
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Choi J, Lingler JH, Donahoe MP, Happ MB, Hoffman LA, Tate JA. Home discharge following critical illness: A qualitative analysis of family caregiver experience. Heart Lung 2018; 47:401-407. [PMID: 29731146 PMCID: PMC6026552 DOI: 10.1016/j.hrtlng.2018.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have longitudinally explored the experience and needs of family caregivers of ICU survivors after patients' home discharge. METHODS Qualitative content analysis of interviews drawn from a parent study that followed family caregivers of adults ICU survivors for 4 months post-ICU discharge. RESULTS Family caregivers (n = 20, all white, 80% woman) viewed home discharge as positive progress, but reported having insufficient time to transition from family visitor to the active caregiver role. Caregivers expressed feelings of relief during the steady recovery of family members' physical and cognitive function. However, the slow pace of improvement conflicted with their expectations. Even after patients achieved independent physical function, emotional needs persisted and these issues contributed to caregivers' anxiety, worry, and view that recovery was incomplete. CONCLUSION Family caregivers of ICU survivors need information and skills to help managing patients' care needs, pacing expectations with actual patients' progress, and caregivers' health needs.
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Affiliation(s)
- JiYeon Choi
- Department of Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA; Yonsei University College of Nursing, Seoul, Republic of Korea.
| | - Jennifer H Lingler
- Department of Health and Community Systems, University of Pittsburg, School of Nursing, Pittsburgh, PA, USA
| | - Michael P Donahoe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Happ
- Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Leslie A Hoffman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Judith A Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
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Hoffman LA, Mehta R, Vu TR, Frankel RM. Experiences of Female and Male Medical Students With Death, Dying, and Palliative Care: One Size Does Not Fit All. Am J Hosp Palliat Care 2017; 35:852-857. [PMID: 29262696 DOI: 10.1177/1049909117748616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Medical students learn about death, dying, and palliative care (DDPC) through formal curricular offerings and informal clinical experiences; however, the lessons learned in the clinic may be at odds with the formal curriculum. Reflective writing is a means for students to "bracket" their DDPC experiences and reconcile conflicts between the formal and informal curriculum. OBJECTIVES The aim of this study is to compare the level of reflection demonstrated in medical students' narratives on DDPC with other experiences and to examine the domains of professionalism that students perceive to be prevalent in their DDPC experiences. METHODS Third-year medical students submitted professionalism narratives during their internal medicine clerkship. We identified a subset of narratives related to DDPC (n = 388) and randomly selected control narratives (n = 153). We assessed the level of reflection demonstrated in the narratives using a validated rubric and analyzed the professionalism domains that students identified as relevant to their experience. RESULTS There was no difference in reflective level between DDPC and control narratives. Within the DDPC group, female students demonstrated higher reflection (2.24 ± 0.71) than male students (2.01 ± 0.77; P < .001). Caring, compassion and communication, and honor and integrity were prominent among DDPC narratives. More females identified caring, compassion, and communication as relevant to their DDPC experiences, whereas more males identified altruism. CONCLUSION Males and females have different perceptions of DDPC experiences, and female students appear to be more deeply impacted. These findings can help clinical faculty engage students more effectively with this challenging topic.
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Affiliation(s)
- Leslie A Hoffman
- 1 Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, IN, USA
| | - Rakesh Mehta
- 2 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Robert Vu
- 2 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard M Frankel
- 2 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,3 Regenstrief Institute, Indianapolis, IN, USA.,4 Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
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Tucker C, Choby B, Moore A, Parker RS, Zambetti BR, Naids S, Scott J, Loome J, Gaffney S, Cianciolo AT, Hoffman LA, Kohn JR, O'Sullivan PS, Trowbridge RL. Teachers as Learners: Developing Professionalism Feedback Skills via Observed Structured Teaching Encounters. Teach Learn Med 2017; 29:373-377. [PMID: 29020524 DOI: 10.1080/10401334.2017.1365001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Southern Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of 4 experts who shared their thoughts stimulated by the study. These thoughts explore the value of the Observed Structured Teaching Encounter in providing structured opportunities for medical students to engage with the complexities of providing peer feedback on professionalism.
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Affiliation(s)
- Constance Tucker
- a Office of the Provost , Oregon Health & Science University , Portland , Oregon , USA
| | - Beth Choby
- b Department of Medical Education , University of Tennessee Health Sciences Center , Memphis , Tennessee , USA
| | - Andrew Moore
- c Graduate Medical Education , University of Tennessee ; Memphis , Tennessee , USA
| | - Robert Scott Parker
- d University of Tennessee College of Medicine , Chattanooga , Tennessee , USA
| | - Benjamin R Zambetti
- e Department of Cardiovascular Surgery , University of Tennessee Health Science Center , Memphis , Tennessee , USA
| | - Sarah Naids
- c Graduate Medical Education , University of Tennessee ; Memphis , Tennessee , USA
| | - Jillian Scott
- f Department of Surgery , University of Tennessee College of Medicine , Chattanooga , Tennessee , USA
| | - Jennifer Loome
- c Graduate Medical Education , University of Tennessee ; Memphis , Tennessee , USA
| | - Sierra Gaffney
- g Department of Health Policy and Management , Emory University , Atlanta , Georgia , USA
| | - Anna T Cianciolo
- h Department of Medical Education , Southern Illinois University School of Medicine , Springfield , Illinois , USA
| | - Leslie A Hoffman
- i Department of Anatomy and Cell Biology , Indiana University School of Medicine , Fort Wayne , Indiana , USA
| | - Jaden R Kohn
- j Baylor College of Medicine , Houston , Texas , USA
| | - Patricia S O'Sullivan
- k Office of Medical Education , University of California San Francisco , San Francisco , California , USA
| | - Robert L Trowbridge
- l Department of Medicine , Tufts University School of Medicine , Portland , Maine , USA
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Hoffman LA, Shew RL, Vu TR, Brokaw JJ, Frankel RM. The Association Between Peer and Self-Assessments and Professionalism Lapses Among Medical Students. Eval Health Prof 2017; 40:219-243. [PMID: 28705026 DOI: 10.1177/0163278717702191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peer and self-assessments are widely used to assess professionalism during medical school as part of a multisource feedback model. The purpose of this study was to examine the associations between peer and self-assessments and professionalism lapses at a large medical school. A retrospective case-control study design was used to compare peer and self-assessment scores from Years 1 to 3 of medical school for students who had been cited for professionalism lapses during medical school (case group; n = 78) with those of a randomly selected control group ( n = 230). Students in the case group had significantly lower peer assessment scores than students in the control group during all 3 years. Year 3 peer assessment scores showed the greatest difference (cases = 7.81 ± 0.65, controls = 8.22 ± 0.34, p < .01). Students with lower peer assessment scores were also significantly more likely to have been cited for a professionalism lapse (odds ratio = 6.25, 95% CI [3.13, 11.11], p < .01). This study reinforces the value of peer assessments of professionalism, which may be useful to help identify students who may be at risk for professionalism lapses during medical school.
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Affiliation(s)
| | - Ronald L Shew
- 2 Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Robert Vu
- 2 Indiana University School of Medicine, Indianapolis, IN, USA
| | - James J Brokaw
- 2 Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard M Frankel
- 3 Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
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Choi J, Donahoe MP, Hoffman LA. Psychological and Physical Health in Family Caregivers of Intensive Care Unit Survivors: Current Knowledge and Future Research Strategies. J Korean Acad Nurs 2017; 46:159-67. [PMID: 27182013 DOI: 10.4040/jkan.2016.46.2.159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/31/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE This article provides an overview of current knowledge on the impact of caregiving on the psychological and physical health of family caregivers of intensive care unit (ICU) survivors and suggestions for future research. METHODS Review of selected papers published in English between January 2000 and October 2015 reporting psychological and physical health outcomes in family caregivers of ICU survivors. RESULTS In family caregivers of ICU survivors followed up to five years after patients' discharge from an ICU, psychological symptoms, manifested as depression, anxiety and post-traumatic stress disorder, were highly prevalent. Poor self-care, sleep disturbances and fatigue were identified as common physical health problems in family caregivers. Studies to date are mainly descriptive; few interventions have targeted family caregivers. Further, studies that elicit unique needs of families from diverse cultures are lacking. CONCLUSION Studies to date have described the impact of caregiving on the psychological and physical health in family caregivers of ICU survivors. Few studies have tested interventions to support unique needs in this population. Therefore, evidence for best strategies is lacking. Future research is needed to identify ICU caregivers at greatest risk for distress, time points to target interventions with maximal efficacy, needs of those from diverse cultures and test interventions to mitigate family caregivers' burden.
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Affiliation(s)
- Jiyeon Choi
- Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Michael P Donahoe
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Leslie A Hoffman
- Department of Acute & Tertiary Care, School of Nursing & Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Bose E, Chen L, Clermont G, Dubrawski A, Pinsky MR, Ren D, Hoffman LA, Hravnak M. Risk for Cardiorespiratory Instability Following Transfer to a Monitored Step-Down Unit. Respir Care 2017; 62:415-422. [PMID: 28119497 DOI: 10.4187/respcare.05001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospitalized patients who develop at least one instance of cardiorespiratory instability (CRI) have poorer outcomes. We sought to describe the admission characteristics, drivers, and time to onset of initial CRI events in monitored step-down unit (SDU) patients. METHODS Admission characteristics and continuous monitoring data (frequency 1/20 Hz) were recorded in 307 subjects. Vital sign deviations beyond local instability trigger threshold criteria, with a tolerance of 40 s and cumulative duration of 4 of 5 min, were classified as CRI events. The CRI driver was defined as the first vital sign to cross a threshold and meet persistence criteria. Time to onset of initial CRI was the number of days from SDU admission to initial CRI, and duration was length of the initial CRI epoch. RESULTS Subjects transferred to the SDU from units with higher monitoring capability were more likely to develop CRI (CRI n = 133 [44%] vs no CRI n = 174 [31%] P = .042). Time to onset varied according to the CRI driver. Subjects with at least one CRI event had a longer hospital stay (CRI 11.3 ± 10.2 d vs no CRI 7.8 ± 9.2 d, P < .001) and SDU stay (CRI 6.1 ± 4.9 d vs no CRI 3.5 ± 2.9 d, P < .001). First events were more often due to SpO2 , whereas breathing frequency was the most common driver of all CRI. CONCLUSIONS Initial CRI most commonly occurred due to SpO2 and was associated with prolonged SDU and hospital stay. Findings suggest the need for clinicians to more closely monitor SDU patients transferred from an ICU and parameters (SpO2 , breathing frequency) that more commonly precede CRI events.
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Affiliation(s)
- Eliezer Bose
- School of Nursing, University of Texas, Austin, Texas.
| | - Lujie Chen
- Auton Laboratory, Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Artur Dubrawski
- Auton Laboratory, Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Dianxu Ren
- Department of Health and Community Systems, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leslie A Hoffman
- Department of Acute/Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Marilyn Hravnak
- Department of Acute/Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Liang Z, Ren D, Choi J, Happ MB, Hravnak M, Hoffman LA. Music intervention during daily weaning trials-A 6 day prospective randomized crossover trial. Complement Ther Med 2016; 29:72-77. [PMID: 27912960 DOI: 10.1016/j.ctim.2016.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 07/13/2016] [Accepted: 09/02/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To examine the effect of patient-selected music intervention during daily weaning trials for patients on prolonged mechanical ventilation. METHODS Using a crossover repeated measures design, patients were randomized to music vs no music on the first intervention day. Provision of music was alternated for 6 days, resulting in 3 music and 3 no music days. During weaning trials on music days, data were obtained for 30min prior to music listening and continued for 60min while patients listened to selected music (total 90min). On no music days, data were collected for 90min. Outcome measures were heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), blood pressure (BP), dyspnea and anxiety assessed with a visual analog scale (VAS-D, VAS-A) and weaning duration (meanh per day on music and non-music days). RESULTS Of 31 patients randomized, 23 completed the 6-day intervention. When comparisons were made between the 3 music and 3 no music days, there were significant decreases in RR and VAS-D and a significant increase in daily weaning duration on music days (p<0.05). A multivariate mixed-effects model analysis that included patients who completed ≥2 days of the intervention (n=28) demonstrated significant decreases in HR, RR, VAS-A, and VAS-D and a significant increase in daily weaning duration on music days (p<0.05). CONCLUSIONS Providing patient selected music during daily weaning trials is a simple, low-cost, potentially beneficial intervention for patients on prolonged mechanical ventilation. Further study is indicated to test ability of this intervention to promote weaning success and benefits earlier in the weaning process.
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Affiliation(s)
- Zhan Liang
- University of South Florida College of Nursing, Tampa, FL 33612, United States.
| | - Dianxu Ren
- University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, United States
| | - JiYeon Choi
- University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, United States
| | - Mary Beth Happ
- The Ohio State University, College of Nursing, Columbus, OH 43210, United States
| | - Marylyn Hravnak
- University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, United States
| | - Leslie A Hoffman
- University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, United States
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18
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Liang Z, Hoffman LA, Nouraie M, Kass DJ, Donahoe MP, Gibson KF, Saul MI, Lindell KO. Referral to Palliative Care Infrequent in Patients with Idiopathic Pulmonary Fibrosis Admitted to an Intensive Care Unit. J Palliat Med 2016; 20:134-140. [PMID: 27754815 DOI: 10.1089/jpm.2016.0258] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Palliative care has been recommended as a means to assist patients with idiopathic pulmonary fibrosis (IPF) in managing symptom burden and advanced care planning. Timing of referral is important because although most patients display a gradually progressive course, a minority experience acute deterioration, an outcome associated with high mortality. AIM To describe characteristics of IPF patients referred to a specialty lung disease center over a 10-year period who experienced acute deterioration and subsequent intensive care unit (ICU) admission, including frequency and timing of referral to palliative care. DESIGN Retrospective review. SETTING/PARTICIPANTS We identified 106 patients admitted to the ICU with acute deterioration due to a respiratory or nonrespiratory cause. Variables examined included demographics, date of first center visit, forced vital capacity, diffusing capacity of the lung for carbon monoxide (DLCO), and palliative care referral. RESULTS ICU admission occurred early (median 9.5 months) and, for 34%, within four months of their first center visit. For nearly one-half of these patients, ICU admission occurred before their third clinic visit. Only 4 (3.8%) patients received a palliative care referral before ICU admission. The majority (77%) died during ICU admission. With exception of the relationship between DLCO% predicted at first visit and time to ICU admission (r = 0.32, p = 0.005), no variables identified those most likely to experience acute deterioration. CONCLUSION Due to high mortality associated with ICU admission, patients and families should be informed about palliative care early following diagnosis of IPF.
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Affiliation(s)
- Zhan Liang
- 1 University of South Florida College of Nursing , Tampa, Florida
| | - Leslie A Hoffman
- 2 University of Pittsburgh School of Nursing , Pittsburgh, Pennsylvania
| | - Mehdi Nouraie
- 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania
| | - Daniel J Kass
- 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania
| | - Michael P Donahoe
- 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,5 Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kevin F Gibson
- 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania
| | - Melissa I Saul
- 5 Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kathleen O Lindell
- 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania
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De Vito Dabbs A, Hoffman LA, Dauber JH, Zullo T, Iacono AT. Evaluating the Reliability and Validity of the Questionnaire for Lung Transplant Patients. Prog Transplant 2016; 12:191-8; quiz 199-200. [PMID: 12371045 DOI: 10.1177/152692480201200307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context The Questionnaire for Lung Transplant Patients was designed for clinical use by the pulmonary transplant team in the routine evaluation of lung transplant recipients. Using the self-administered questionnaire, recipients check symptoms that they have had since their last evaluation and rate their shortness of breath, cough, and activity tolerance. Objective To determine whether the questionnaire meets reliability and validity standards for empirical measurement. Methods Demographics and disease-severity characteristics were examined in a cross-sectional survey of 37 recipients. Test-retest and intraclass correlation methods were used to estimate stability, and the Cronbach α was used to estimate internal consistency. Criterion validity was examined by using The Modified Symptom Frequency/Symptom Distress Scale, Functional Performance Inventory, and visual analog scales for cough and shortness of breath as criterion measures. Construct validity was examined to assess the predicted negative correlation between symptoms and functional performance. Results The questionnaire and its subscales were internally consistent (Cronbach α = 0.82, 0.76, 0.80, and 0.96), and the questionnaire was stable ( r = 0.70) and reliable (intraclass correlations = 0.80 and 0.90). Significant correlations were found between the questionnaire and all criterion measures ( r = 0.50–0.93). Significant correlations in the predicted negative direction were found between the respiratory subscale and functional performance ( r = −0.51) and between cough ( r = −0.51) and shortness of breath ( r = −0.68) ratings and functional performance. Conclusions The Questionnaire for Lung Transplant Patients is reliable and valid, and it provides scientifically sound information for clinical and empirical evaluation of symptoms and their effects on activity tolerance after lung transplantation.
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Affiliation(s)
- Annette De Vito Dabbs
- Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pa., USA
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20
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Abstract
Critical care nurses assess and treat clinical conditions associated with inadequate oxygenation. Changes in regional organ (gut) blood flow are believed to occur in response to a decrease in oxygenation. Although the stomach is a widely accepted monitoring site, there are multiple methodological and measurement issues associated with the gastric environment that limit the accuracy of P CO2 detection. The rectum may provide nurses with an alternative site for monitoring changes in PCO2 without the limitations associated with gastric monitoring. This pilot study used a repeated measures design to examine changes in gastric and rectal PCO2 during elective coronary artery bypass grafting with cardiopulmonary bypass (CPB) and in the immediate 4-hr postoperative period in 26 subjects. The systemic indicators explained little variation in the regional indicators during protocol. A comparison of rectal and gastric PCO2 revealed no statistically significant differences in the direction or magnitude of change over any phase of cardiac surgery (baseline, CPB, post-CPB). A reduction in both rectal and gastric PCO2 occurred during CPB, and both values trended upward during the post-CPB phase. However, poor correlation and agreement was found between the measures of PCO2 at the two sites. Although clinically important, the cause is unclear. Possible explanations include variation in CO2 production between the gastric and rectal site, differences in sensitivity of the two monitoring instruments, or the absence of hemodynamic complications, which limited the extent of change in PCO2. Further investigation using patients with more profound changes in oxygenation are needed to identify response patterns and possible mechanisms.
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Affiliation(s)
- Elaine M Fisher
- The University of Akron, College of Nursing, Akron, OH 44325-3701, USA.
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21
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Abstract
PURPOSE Recently, many have argued that learning to reflect on one's experiences is a critical component of professional identity formation and of professionalism. However, little empirical evidence exists to support this claim. This study explored the association between reflective ability and professionalism lapses among medical students. METHOD The authors conducted a retrospective case-control study of all students who matriculated at Indiana University School of Medicine from 2001 to 2009. The case group (n = 70) included those students who had been cited for a professionalism lapse during medical school; the students in the control group (n = 230) were randomly selected from the students who had not been cited for a professionalism lapse. Students' professionalism journal entries were scored using a validated rubric to assess reflective ability. Mean reflection scores were compared across groups using t tests, and logistic regression analysis was used to assess the relationship between reflective ability and professionalism lapses. RESULTS Reflection scores for students in the case group (2.46 ± 1.05) were significantly lower than those for students in the control group (2.82 ± 0.83) (P = .01). A lower reflection score was associated with an increased likelihood that the student had been cited for a professionalism lapse (odds ratio = 1.56; P < .01). CONCLUSIONS This study revealed a significant relationship between reflective ability and professionalism, although further study is needed to draw any conclusions regarding causation. These findings provide quantitative evidence to support current anecdotal claims about the relationship between reflection and professionalism.
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Affiliation(s)
- Leslie A Hoffman
- L.A. Hoffman is assistant professor, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, Indiana. R.L. Shew is senior lecturer, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana. T.R. Vu is associate professor of clinical medicine and associate director of the medicine clerkship, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. J.J. Brokaw is associate professor, vice chair for education, and director, Indiana University Center for Anatomical Sciences Education, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana. R.M. Frankel is professor of medicine, Department of Medicine, and director, Walther Program in Palliative Care Research and Education, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana
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Affiliation(s)
- Kathleen O Lindell
- University of Pittsburgh Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease at UPMC, Pittsburgh, PA; Division of Pulmonary, Allergy, and Critical Care Medicine, Pittsburgh, PA.
| | | | - Joseph Pilewski
- Division of Pulmonary, Allergy, and Critical Care Medicine, Pittsburgh, PA
| | | | - Kevin Gibson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Pittsburgh, PA; University of Pittsburgh Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease at UPMC, Pittsburgh, PA
| | - Naftali Kaminski
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT
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Traser CJ, Hoffman LA, Seifert MF, Wilson AB. Investigating the use of quick response codes in the gross anatomy laboratory. Anat Sci Educ 2015; 8:421-8. [PMID: 25288343 DOI: 10.1002/ase.1499] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/19/2014] [Accepted: 08/26/2014] [Indexed: 05/22/2023]
Abstract
The use of quick response (QR) codes within undergraduate university courses is on the rise, yet literature concerning their use in medical education is scant. This study examined student perceptions on the usefulness of QR codes as learning aids in a medical gross anatomy course, statistically analyzed whether this learning aid impacted student performance, and evaluated whether performance could be explained by the frequency of QR code usage. Question prompts and QR codes tagged on cadaveric specimens and models were available for four weeks as learning aids to medical (n = 155) and doctor of physical therapy (n = 39) students. Each QR code provided answers to posed questions in the form of embedded text or hyperlinked web pages. Students' perceptions were gathered using a formative questionnaire and practical examination scores were used to assess potential gains in student achievement. Overall, students responded positively to the use of QR codes in the gross anatomy laboratory as 89% (57/64) agreed the codes augmented their learning of anatomy. The users' most noticeable objection to using QR codes was the reluctance to bring their smartphones into the gross anatomy laboratory. A comparison between the performance of QR code users and non-users was found to be nonsignificant (P = 0.113), and no significant gains in performance (P = 0.302) were observed after the intervention. Learners welcomed the implementation of QR code technology in the gross anatomy laboratory, yet this intervention had no apparent effect on practical examination performance.
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Affiliation(s)
- Courtney J Traser
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leslie A Hoffman
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, Indiana
| | - Mark F Seifert
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam B Wilson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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24
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Yousef KM, Balzer JR, Bender CM, Hoffman LA, Poloyac SM, Ye F, Sherwood PR. Cerebral Perfusion Pressure and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. Am J Crit Care 2015; 24:e65-71. [PMID: 26134341 DOI: 10.4037/ajcc2015913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Whether delayed cerebral ischemia (DCI) mediates the relationship between Hunt and Hess grade and outcomes after aneurysmal subarachnoid hemorrhage remains unknown. OBJECTIVES To investigate the relationship between cerebral perfusion pressure, DCI, Hunt and Hess grade, and outcomes after aneurysmal subarachnoid hemorrhage. METHODS DCI was defined as neurological deterioration due to impaired cerebral blood flow. Relationships between minimum cerebral perfusion pressure and onset and occurrence of DCI were tested by using logistic regression and the accelerated failure time model. The mediation effect of DCI on relationships between Hunt and Hess grade and outcomes was tested by using the bootstrap confidence interval. Outcomes at 3 and 12 months included mortality and neuropsychological, functional, and physical outcomes. RESULTS DCI occurred in 211 patients (42%). About one-third of the patients had poor functional outcome at 3 (32%) and 12 (30%) months. Impaired neuropsychological outcome was observed in 33% of patients at 3 months and 17% at 12 months. For every increase of 10 mm Hg in cerebral perfusion pressure, odds for DCI increased by 2.78 (95% CI, 2.00-3.87). High perfusion pressure was associated with earlier onset of DCI (P < .001). CONCLUSIONS DCI does not mediate the relationship of Hunt and Hess grade to functional outcome or death. The relationship between cerebral perfusion pressure and DCI was most likely due to induced hypertension and hypervolemia. Clinical guidelines may need to include limits for induced hypertension.
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Affiliation(s)
- Khalil M Yousef
- Khalil M. Yousef is an assistant professor, Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan. Jeffrey R. Balzer is an associate professor of neurological surgery in the School of Nursing, University of Pittsburgh, and the Department of Neurosurgery and Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Catherine M. Bender is a professor and Leslie A. Hoffman is a professor emeritus, School of Nursing, Samuel M. Poloyac is a professor, School of Pharmacy, Feifei Ye is an assistant professor, School of Education, and Paula R. Sherwood is a professor in the School of Nursing and the School of Medicine, University of Pittsburgh.
| | - Jeffrey R Balzer
- Khalil M. Yousef is an assistant professor, Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan. Jeffrey R. Balzer is an associate professor of neurological surgery in the School of Nursing, University of Pittsburgh, and the Department of Neurosurgery and Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Catherine M. Bender is a professor and Leslie A. Hoffman is a professor emeritus, School of Nursing, Samuel M. Poloyac is a professor, School of Pharmacy, Feifei Ye is an assistant professor, School of Education, and Paula R. Sherwood is a professor in the School of Nursing and the School of Medicine, University of Pittsburgh
| | - Catherine M Bender
- Khalil M. Yousef is an assistant professor, Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan. Jeffrey R. Balzer is an associate professor of neurological surgery in the School of Nursing, University of Pittsburgh, and the Department of Neurosurgery and Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Catherine M. Bender is a professor and Leslie A. Hoffman is a professor emeritus, School of Nursing, Samuel M. Poloyac is a professor, School of Pharmacy, Feifei Ye is an assistant professor, School of Education, and Paula R. Sherwood is a professor in the School of Nursing and the School of Medicine, University of Pittsburgh
| | - Leslie A Hoffman
- Khalil M. Yousef is an assistant professor, Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan. Jeffrey R. Balzer is an associate professor of neurological surgery in the School of Nursing, University of Pittsburgh, and the Department of Neurosurgery and Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Catherine M. Bender is a professor and Leslie A. Hoffman is a professor emeritus, School of Nursing, Samuel M. Poloyac is a professor, School of Pharmacy, Feifei Ye is an assistant professor, School of Education, and Paula R. Sherwood is a professor in the School of Nursing and the School of Medicine, University of Pittsburgh
| | - Samuel M Poloyac
- Khalil M. Yousef is an assistant professor, Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan. Jeffrey R. Balzer is an associate professor of neurological surgery in the School of Nursing, University of Pittsburgh, and the Department of Neurosurgery and Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Catherine M. Bender is a professor and Leslie A. Hoffman is a professor emeritus, School of Nursing, Samuel M. Poloyac is a professor, School of Pharmacy, Feifei Ye is an assistant professor, School of Education, and Paula R. Sherwood is a professor in the School of Nursing and the School of Medicine, University of Pittsburgh
| | - Feifei Ye
- Khalil M. Yousef is an assistant professor, Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan. Jeffrey R. Balzer is an associate professor of neurological surgery in the School of Nursing, University of Pittsburgh, and the Department of Neurosurgery and Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Catherine M. Bender is a professor and Leslie A. Hoffman is a professor emeritus, School of Nursing, Samuel M. Poloyac is a professor, School of Pharmacy, Feifei Ye is an assistant professor, School of Education, and Paula R. Sherwood is a professor in the School of Nursing and the School of Medicine, University of Pittsburgh
| | - Paula R Sherwood
- Khalil M. Yousef is an assistant professor, Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan. Jeffrey R. Balzer is an associate professor of neurological surgery in the School of Nursing, University of Pittsburgh, and the Department of Neurosurgery and Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Catherine M. Bender is a professor and Leslie A. Hoffman is a professor emeritus, School of Nursing, Samuel M. Poloyac is a professor, School of Pharmacy, Feifei Ye is an assistant professor, School of Education, and Paula R. Sherwood is a professor in the School of Nursing and the School of Medicine, University of Pittsburgh
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Lindell KO, Liang Z, Hoffman LA, Rosenzweig MQ, Saul MI, Pilewski JM, Gibson KF, Kaminski N. Palliative care and location of death in decedents with idiopathic pulmonary fibrosis. Chest 2015; 147:423-429. [PMID: 25187973 DOI: 10.1378/chest.14-1127] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Palliative care, integrated early, may reduce symptom burden in patients with idiopathic pulmonary fibrosis (IPF). However, limited information exists on timing and clinical practice. The purpose of this study was to describe the time course of events prior to death in patients with IPF managed at a specialty center with a focus on location of death and timing of referral for palliative care. METHODS Data were retrospectively extracted from the health system's data repository and obituary listings. The sample included all decedents, excluding lung transplant recipients, who had their first visit to the center between 2000 and 2012. RESULTS Median survival for 404 decedents was 3 years from diagnosis and 1 year from first center visit. Of 277 decedents whose location of death could be determined, > 50% died in the hospital (57%). Only 38 (13.7%) had a formal palliative care referral and the majority (71%) was referred within 1 month of their death. Decedents who died in the academic medical center ICU were significantly younger than those who died in a community hospital ward (P = .04) or hospice (P = .001). CONCLUSIONS The majority of patients with IPF died in a hospital setting and only a minority received a formal palliative care referral. Referral to palliative care occurred late in the disease. These findings indicate the need to study adequacy of end-of-life management in IPF and promote earlier discussion and referral to palliative care.
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Affiliation(s)
- Kathleen O Lindell
- The University of Pittsburgh Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease at UPMC, School of Medicine, Pittsburgh, PA; Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Pittsburgh, PA.
| | - Zhan Liang
- School of Nursing, School of Medicine, Pittsburgh, PA
| | | | | | - Melissa I Saul
- Department of Biomedical Informatics, School of Medicine, Pittsburgh, PA
| | - Joseph M Pilewski
- Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Pittsburgh, PA
| | - Kevin F Gibson
- The University of Pittsburgh Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease at UPMC, School of Medicine, Pittsburgh, PA; Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Pittsburgh, PA
| | - Naftali Kaminski
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT
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Hopkins KG, Hoffman LA, Dabbs ADV, Ferson PF, King L, Dudjak LA, Zullo TG, Rosenzweig MQ. Postthoracotomy Pain Syndrome Following Surgery for Lung Cancer: Symptoms and Impact on Quality of Life. J Adv Pract Oncol 2015; 6:121-32. [PMID: 26649245 PMCID: PMC4601892 DOI: 10.6004/jadpro.2015.6.2.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Postthoracotomy pain syndrome (PTPS) is a common complication following thoracic surgery. Most studies examining the influence of PTPS on patient-reported symptoms include few patients managed using a minimally invasive approach. Associated sensory changes, potentially neuropathic in origin, are not well described. We therefore examined the symptoms and quality of life (QOL) of patients with and without PTPS who underwent a standard thoracotomy (n = 43) or minimally invasive surgery (n = 54). Patients in this prospective, cross-sectional study completed questionnaires to assess pain (McGill Pain Questionnaire), neuropathic symptoms (Neuropathic Symptom Questionnaire), symptom distress (Symptom Distress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and QOL (Functional Assessment Cancer Therapy–Lung). Excepting younger age (p = .009), no demographic or surgical characteristic differentiated patients with and without PTPS. Patients with PTPS described discomfort as pain only (15.1%), neuropathic symptoms only (30.2%) or pain and neuropathic symptoms (54.7%). Scores differed between patients with and without PTPS for symptom distress (p < .001), anxiety and depression (p < .001), and QOL (p = .009), with higher distress associated with PTPS. Despite new surgical techniques, PTPS remains common and results in considerable distress. A focused assessment is needed to identify all experiencing this condition, with referral to pain management specialists if symptoms persist.
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Affiliation(s)
- Kathleen G Hopkins
- Carlow University College of Health and Wellness, Department of Nursing, Pittsburgh, Pennsylvania
| | - Leslie A Hoffman
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | | | - Peter F Ferson
- University of Pittsburgh School of Medicine, Department of Cardiothoracic Surgery, Pittsburgh, Pennsylvania
| | - Linda King
- University of Pittsburgh School of Medicine, Department of General Internal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania
| | - Linda A Dudjak
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Thomas G Zullo
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Ott LK, Pinsky MR, Hoffman LA, Clarke SP, Clark S, Ren D, Hravnak M. Patients in the radiology department may be at increased risk of developing critical instability. ACTA ACUST UNITED AC 2015; 34:29-34. [PMID: 25821413 DOI: 10.1016/j.jradnu.2014.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to calculate the event rate for in-patients in the Radiology Department (RD) developing instability leading to calls for Medical Emergency Team assistance (MET-RD) compared to general ward (MET-W) patients. A retrospective comparison was done of MET-RD and MET-W calls in 2009 in a U.S. tertiary hospital with a well-established MET system. MET-RD and MET-W event rates represented as MET calls/hour/1000 admissions, adjusted for length of stay (LOS); rates also calculated for RD modalities. There were 31,320 hospital ward admissions had 1,230 MET-W, and among 149,569 radiology admissions there were 56 MET-RD. When adjusted for LOS, the MET-RD event rate was 2 times higher than the MET-W rate (0.48 vs. 0.24 events/hour/1000 admissions). Event rates differed by procedure: computed tomography (CT) had 38% of MET-RDs (event rate 0.89); magnetic resonance imaging (MRI) accounted for 27% (event rate 1.56). Nuclear medicine had 1% of RD admissions but these patients accounted for 5% of MET-RD (event rate 1.53). Interventional radiology (IR) had 6% of RD admissions but 16% of MET-RD (event rate 0.61). While general x-ray comprised 63% of RD admissions, only 11% of MET-RD involved their care (event rate 0.09). In conclusion, the overall MET-RD event rate was twice the MET-W event rate; CT, MRI and IR rates were 3.7-6.5 times higher than on wards. RD patients are at increased risk for a MET call compared to ward patients when the time at risk is considered. Increased surveillance of RD patients is warranted.
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Affiliation(s)
- Lora K Ott
- Department of Tertiary Care, School of Nursing, University of Pittsburgh
| | | | - Leslie A Hoffman
- Department of Tertiary Care, School of Nursing, University of Pittsburgh
| | | | - Sunday Clark
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh
| | - Dianxu Ren
- Department of Tertiary Care, School of Nursing, University of Pittsburgh
| | - Marilyn Hravnak
- Department of Tertiary Care, School of Nursing, University of Pittsburgh
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Choi J, Tate JA, Hoffman LA, Schulz R, Ren D, Donahoe MP, Given BA, Sherwood PR. Fatigue in family caregivers of adult intensive care unit survivors. J Pain Symptom Manage 2014; 48:353-63. [PMID: 24439845 PMCID: PMC4101057 DOI: 10.1016/j.jpainsymman.2013.09.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/09/2013] [Accepted: 09/15/2013] [Indexed: 12/25/2022]
Abstract
CONTEXT Family caregivers are a vital resource in the recovery of intensive care unit (ICU) survivors. Of concern, the stress associated with this role can negatively affect caregiver health. Fatigue, an important health indicator, has been identified as a predictor of various illnesses, greater use of health services, and early mortality. Examining the impact of fatigue on caregivers' physical health can assist in identifying critical time points and potential targets for intervention. OBJECTIVES To describe self-reported fatigue in caregivers of ICU survivors from patients' ICU admission to ≤ 2 weeks, two- and four-months post-ICU discharge. METHODS Patient-caregiver pairs were enrolled from a medical ICU. Caregiver fatigue was measured using the Short-Form 36 Health Survey Vitality subscale (SF-36 Vitality). Caregiver psychobehavioral stress responses included depressive symptoms, burden, health risk behaviors, and sleep quality. Patient data included self-reported physical symptoms and disposition (home vs. institution). RESULTS Forty-seven patient-caregiver pairs were initially enrolled. Clinically significant fatigue (SF-36 Vitality ≤ 45) was reported by 43%-53% of caregivers across the time points, and these caregivers reported worse scores in measures of depressive symptoms, burden, health risk behaviors and sleep quality, and patients' symptom burden. In 26 caregivers with data for all time points (55% of the total sample), SF-36 Vitality scores showed trends of improvement when the patient returned home and greater impairment when institutionalization continued. CONCLUSION In caregivers of ICU survivors, fatigue is common and potentially linked with poor psychobehavioral responses. Worsening fatigue was associated with greater symptom distress and long-term patient institutionalization.
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Affiliation(s)
- JiYeon Choi
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.
| | - Judith A Tate
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Leslie A Hoffman
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard Schulz
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dianxu Ren
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michael P Donahoe
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Barbara A Given
- College of Nursing, The Michigan State University, East Lansing, Michigan, USA
| | - Paula R Sherwood
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Nilsen ML, Sereika SM, Hoffman LA, Barnato A, Donovan H, Happ MB. Nurse and patient interaction behaviors' effects on nursing care quality for mechanically ventilated older adults in the ICU. Res Gerontol Nurs 2014; 7:113-25. [PMID: 24496114 DOI: 10.3928/19404921-20140127-02] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 12/05/2013] [Indexed: 01/26/2023]
Abstract
The study purposes were to (a) describe interaction behaviors and factors that may effect communication and (b) explore associations between interaction behaviors and nursing care quality indicators among 38 mechanically ventilated patients (age ≥60 years) and their intensive care unit nurses (n = 24). Behaviors were measured by rating videorecorded observations from the Study of Patient-Nurse Effectiveness with Communication Strategies (SPEACS). Characteristics and quality indicators were obtained from the SPEACS dataset and medical chart abstraction. All positive behaviors occurred at least once. Significant (p < 0.05) associations were observed between (a) positive nurse and positive patient behaviors, (b) patient unaided augmentative and alternative communication (AAC) strategies and positive nurse behaviors, (c) individual patient unaided AAC strategies and individual nurse positive behaviors, (d) positive nurse behaviors and pain management, and (e) positive patient behaviors and sedation level. Findings provide evidence that nurse and patient behaviors effect communication and may be associated with nursing care quality.
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Choi J, Hoffman LA, Schulz R, Tate JA, Donahoe MP, Ren D, Given BA, Sherwood PR. Self-reported physical symptoms in intensive care unit (ICU) survivors: pilot exploration over four months post-ICU discharge. J Pain Symptom Manage 2014; 47:257-70. [PMID: 23856099 PMCID: PMC3800224 DOI: 10.1016/j.jpainsymman.2013.03.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/25/2013] [Accepted: 03/29/2013] [Indexed: 12/01/2022]
Abstract
CONTEXT Survivors of critical illness must overcome persistent physical and psychological challenges. Few studies have longitudinally examined self-reported physical symptoms in intensive care unit (ICU) survivors. OBJECTIVES To describe prevalence and severity of self-reported symptoms in 28 adult medical ICU survivors during the first four months post-ICU discharge and their associations with family caregiver responses. METHODS Patients completed the Modified Given Symptom Assessment Scale. Caregivers completed the Shortened 10-item Center for Epidemiologic Studies Depression Scale, Brief Zarit Burden Score, Pittsburgh Sleep Quality Index, and the Caregiver Health Behavior form. Data at ICU discharge (two weeks or less), and two and four months post-ICU discharge were analyzed. RESULTS Across the time points, most patients reported one or more symptoms (88.5-97%), with sleep disturbance, fatigue, weakness, and pain the most prevalent. For these four symptoms with the highest prevalence, there were: 1) moderate correlations among symptom severity at two and four months post-ICU discharge; and 2) no difference in prevalence or severity by patients' disposition (home vs. institution), except worse fatigue in patients at home at two weeks or less post-ICU discharge. Patients' overall symptom burden showed significant correlation with caregivers' depressive symptoms two weeks or less post-ICU discharge. There were trends of moderate correlations between patients' overall symptom burden and caregivers' health risk behaviors and sleep quality at two and four months post-ICU discharge. CONCLUSION In our sample, sleep disturbance, fatigue, weakness, and pain were the four key symptoms during first four months post-ICU discharge. Future studies focusing on these four symptoms are necessary to promote quality in post-ICU symptom management.
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Affiliation(s)
- JiYeon Choi
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.
| | - Leslie A Hoffman
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard Schulz
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Judith A Tate
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael P Donahoe
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dianxu Ren
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Barbara A Given
- College of Nursing, The Michigan State University, East Lansing, Michigan, USA
| | - Paula R Sherwood
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Clark-Cutaia MN, Ren D, Hoffman LA, Burke LE, Sevick MA. Adherence to hemodialysis dietary sodium recommendations: influence of patient characteristics, self-efficacy, and perceived barriers. J Ren Nutr 2014; 24:92-9. [PMID: 24462498 DOI: 10.1053/j.jrn.2013.11.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To identify characteristics of hemodialysis patients most likely to experience difficulty adhering to sodium restrictions associated with their dietary regimen. DESIGN Secondary analysis using baseline data from an ongoing randomized clinical trial examining the effects of a technology-supported behavioral intervention on dietary sodium intake in hemodialysis patients. SETTING Thirteen dialysis centers in southwestern Pennsylvania. SUBJECTS We included 122 participants (61% women; 48% African American) aged 61 ± 14 years undergoing maintenance, intermittent hemodialysis for end-stage renal disease. MAIN OUTCOME MEASURES Normalized dietary sodium intake, adjusted interdialytic weight gain, perceived problems, and self-efficacy for restricting dietary sodium. RESULTS Younger participants were more likely to report problems managing their hemodialysis diet and low self-efficacy for restricting sodium intake. Consistent with these findings, younger participants had a higher median sodium intake and higher average adjusted interdialytic weight gain. Females reported more problems managing their diet. Race, time on dialysis, and perceived income adequacy did not seem to influence outcome measures. CONCLUSION Our findings suggest that patients who are younger and female encounter more difficulty adhering to the hemodialysis regimen. Hence, there may be a need to individualize counseling and interventions for these individuals. Further investigation is needed to understand the independent effects of age and gender on adherence to hemodialysis dietary recommendations and perceived self-efficacy.
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Affiliation(s)
- Maya N Clark-Cutaia
- Center for Health Equity Research and Center for Global Women's Health, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Dianxu Ren
- Department of Health and Community Systems, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leslie A Hoffman
- Acute and Tertiary Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lora E Burke
- Department of Health and Community Systems, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Ann Sevick
- Medicine, Public Health, Clinical and Translational Science, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and Nursing Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
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Faett BL, Brienza DM, Geyer MJ, Hoffman LA. Teaching self-management skills in persons with chronic lower limb swelling and limited mobility: evidence for usability of telerehabilitation. Int J Telerehabil 2013; 5:17-26. [PMID: 25945210 PMCID: PMC4296833 DOI: 10.5195/ijt.2013.6114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to evaluate the usability of telerehabilitation as a method of teaching self-management for chronic swelling of the lower limbs in persons with limited mobility. An in-home telerehabilitation self-management education protocol for chronic swelling of the lower limbs, termed Telerehabilitation to Empower You to Manage and Prevent Swelling (TR-PUMPS), was implemented using the Versatile and Integrated System for Telerehabilitation (VISYTER) software platform. Participants (n=11) were 36–79 years old, predominately female (72.7%) and diagnosed with a variety of health conditions. Participants’ perceived usability scores of the remote delivery of TR-PUMPS was high with a median score of 6.67 (range 4.90 – 7.00) on a Likert scale: 1= disagree to 7= agree. There was no correlation between participants’ familiarity with information technology and their perception of telerehabilitation usability. These results support telerehabilitation as a viable method for teaching a home-based, self-management protocol for chronic swelling.
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Affiliation(s)
- Becky L Faett
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - David M Brienza
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Mary Jo Geyer
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Leslie A Hoffman
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA
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Higgins LW, Robertson RJ, Kelsey SF, Olson MB, Hoffman LA, Rebovich PJ, Haile L, Orenstein DM. Exercise intensity self-regulation using the OMNI scale in children with cystic fibrosis. Pediatr Pulmonol 2013; 48:497-505. [PMID: 22997144 PMCID: PMC3541455 DOI: 10.1002/ppul.22639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 05/23/2012] [Indexed: 11/10/2022]
Abstract
Prescribing exercise at intensities that improve fitness is difficult in children with cystic fibrosis (CF) due to ventilatory limitations and fluctuating health status. Our aim was to determine if children with CF could regulate the intensity of cycle ergometer and treadmill exercise using target ratings of perceived exertion (RPE) derived from the Children's OMNI Scale. We examined prescription congruence (similar oxygen consumption [VO₂] and heart rate [HR] for target RPE) and intensity discrimination (different VO₂ and HR for different RPEs), from cycle to cycle and cycle to treadmill. Subjects were 24 children (12 male, 12 female), aged 10-17 years with varying disease severity. Each child participated in one orientation, one estimation trial (graded maximal exercise test), and two production trials (cycle and treadmill, alternating between RPE 4 and 7). At RPE 4, congruence was evident for both VO₂ and HR on the treadmill. On the cycle at RPE 4, VO₂ was significantly higher only in the first production trial, although HRs tended to be higher in the production trials than the estimation trial. Prescription congruence was also supported at RPE 7, with no significant differences in VO₂ or HR between estimation and production trials on cycle or treadmill. Results fully supported intensity discrimination, with significant differences between VO₂ and HR at RPE 4 and 7 (P < 0.0001). Children with CF appear capable of using the OMNI Scale to regulate cycle and treadmill exercise intensity. Training using this methodology has the potential to promote fitness in children with CF of varying severity.
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Affiliation(s)
- Linda W Higgins
- Schools of Medicine and Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Jubran A, Grant BJB, Duffner LA, Collins EG, Lanuza DM, Hoffman LA, Tobin MJ. Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial. JAMA 2013; 309:671-7. [PMID: 23340588 PMCID: PMC3711743 DOI: 10.1001/jama.2013.159] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patients requiring prolonged mechanical ventilation (>21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated. OBJECTIVE To compare weaning duration with pressure support vs unassisted breathing through a tracheostomy collar in patients transferred to an LTACH for weaning from prolonged ventilation. DESIGN, SETTING, AND PARTICIPANTS Between 2000 and 2010, a randomized study was conducted in tracheotomized patients transferred to a single LTACH for weaning from prolonged ventilation. Of 500 patients who underwent a 5-day screening procedure, 316 did not tolerate the procedure and were randomly assigned to receive weaning with pressure support (n = 155) or a tracheostomy collar (n = 161). Survival at 6- and 12-month time points was also determined. MAIN OUTCOME MEASURE Primary outcome was weaning duration. Secondary outcome was survival at 6 and 12 months after enrollment. RESULTS Of 316 patients, 4 were withdrawn and not included in analysis. Of 152 patients in the pressure-support group, 68 (44.7%) were weaned; 22 (14.5%) died. Of 160 patients in the tracheostomy collar group, 85 (53.1%) were weaned; 16 (10.0%) died. Median weaning time was shorter with tracheostomy collar use (15 days; interquartile range [IQR], 8-25) than with pressure support (19 days; IQR, 12-31), P = .004. The hazard ratio (HR) for successful weaning rate was higher with tracheostomy collar use than with pressure support (HR, 1.43; 95% CI, 1.03-1.98; P = .033) after adjusting for baseline clinical covariates. Use of the tracheostomy collar achieved faster weaning than did pressure support among patients who did not tolerate the screening procedure between 12 and 120 hours (HR, 3.33; 95% CI, 1.44-7.70; P = .005), whereas weaning time was equivalent with the 2 methods in patients who did not tolerate the screening procedure within 0 to 12 hours. Mortality was equivalent in the pressure-support and tracheostomy collar groups at 6 months (55.92% vs 51.25%; 4.67% difference, 95% CI, -6.4% to 15.7%) and at 12 months (66.45% vs 60.00%; 6.45% difference, 95% CI, -4.2% to 17.1%). CONCLUSION AND RELEVANCE Among patients requiring prolonged mechanical ventilation and treated at a single long-term care facility, unassisted breathing through a tracheostomy, compared with pressure support, resulted in shorter median weaning time, although weaning mode had no effect on survival at 6 and 12 months. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01541462.
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Affiliation(s)
- Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr VA Hospital, 111N, 5000 Fifth Ave, Hines, IL 60141, USA.
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Choi J, Hoffman LA, Schulz R, Ren D, Donahoe MP, Given B, Sherwood PR. Health risk behaviors in family caregivers during patients' stay in intensive care units: a pilot analysis. Am J Crit Care 2013; 22:41-5. [PMID: 23283087 DOI: 10.4037/ajcc2013830] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Studies of family caregivers of the critically ill have mainly focused on the psychological impact of the patients' stay in the intensive care unit and related stress. Despite known associations between stress and physical health, limited attention has been paid to the need to promote and maintain physical health in these caregivers. OBJECTIVE To explore how family caregivers' health risk behaviors are associated with patients' preexisting care needs and the caregivers' depressive symptoms and burden. METHODS During the intensive-care-unit stay of critically ill patients (who required mechanical ventilation for ≥4 days), 50 family caregivers were surveyed to determine the caregivers' depressive symptoms, burden, and health risk behaviors. Data were also collected on patients' care needs before admission to the intensive care unit. RESULTS One or more health risk behaviors were reported by 94% of family caregivers. More than 90% of caregivers reported depressive symptoms above the score indicating risk for clinical depression. A high level of burden was reported by 36% of caregivers. More health risk behaviors were associated with higher scores of depressive symptoms and burden (P < .001 for both). Caregivers' responses did not differ according to patients' preexisting care needs. CONCLUSION Health risk behaviors of family caregivers are associated with greater perceptions of burden and/or depressive symptoms but not with patients' care needs before admission to the intensive care unit.
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Affiliation(s)
- JiYeon Choi
- University of Pittsburgh School of Nursing, 336 Victoria Bldg, 3500 Victoria St, Pittsburgh, PA 15261, USA.
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Ott LK, Pinsky MR, Hoffman LA, Clarke SP, Clark S, Ren D, Hravnak M. Medical emergency team calls in the radiology department: patient characteristics and outcomes. BMJ Qual Saf 2012; 21:509-18. [PMID: 22389020 PMCID: PMC3630458 DOI: 10.1136/bmjqs-2011-000423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to identify the characteristics of patients who experience medical emergency team calls in the radiology department (MET-RD) and the relationship between these characteristics and patient outcomes. DESIGN/PARTICIPANTS Retrospective review of 111 inpatient MET-RD calls (May 2008-April 2010). SETTING Academic medical centre with a well established MET system. MEASUREMENTS The characteristics of patients before, during and after transport to radiology were extracted from medical records and administrative databases. These characteristics were compared between patients with good and poor outcomes. MAIN RESULTS The majority of patients who experience MET-RD calls had a Charlson Comorbidity Index ≥4 and were from non-intensive care units (60%). Almost half (43%) of MET-RD calls occurred during patients' first day in hospital. Patients commonly arrived with nasal cannula oxygen (38%), recent tachypnoea (28%) and tachycardia (34%). A minority (16%) fulfilled MET call criteria in the 12 h before the MET-RD. MET-RD etiologies were cardiac (41%), respiratory (29%) or neurological (25%), and occurred most frequently during CT (44%) and MRI (22%) testing. Post MET-RD, the majority of patients (70%) required a higher level of care. Death before discharge (25%) was associated with need for cardiovascular support prior to RD transport (p=0.02), need for RD monitoring (p=0.02) and need for heightened RD surveillance (p=0.04). CONCLUSIONS The majority of patients who experienced MET-RD calls came from non-intensive care units, with comorbidities and vital sign alterations prior to arrival at the RD. Risk appeared to be increased for those requiring CT and MRI. These findings suggest that prior identification of a subset of patients at risk of instability in the RD may be possible.
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Affiliation(s)
- Lora K Ott
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Abstract
During an ethnography conducted in an intensive care unit (ICU), we found that anxiety and agitation occurred frequently and were important considerations in the care of 30 patients weaning from prolonged mechanical ventilation. We conducted a secondary analysis to (a) describe characteristics of anxiety and agitation experienced by mechanically ventilated patients, (b) explore how clinicians recognized and interpreted anxiety and agitation, and (c) describe strategies and interventions used to manage anxiety and agitation with mechanically ventilated patients. We constructed the Anxiety/Agitation in Mechanical Ventilation Model to illustrate the multidimensional features of symptom recognition and management. Patients' ability to interact with the environment served as a basis for identification and management of anxiety or agitation. Clinicians' attributions about anxiety or agitation, and "knowing the patient," contributed to their assessment of patient responses. Clinicians chose strategies to overcome either the stimulus or the patient's appraisal of risk of the stimulus. This article contributes to the body of knowledge about symptom recognition and management in the ICU by providing a comprehensive model to guide future research and practice.
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Affiliation(s)
- Judith Ann Tate
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania 15162, USA.
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Thampatty BP, Sherwood PR, Gallek MJ, Crago EA, Ren D, Hricik AJ, Kuo CWJ, Klamerus MM, Alexander SA, Bender CM, Hoffman LA, Horowitz MB, Kassam AB, Poloyac SM. Role of endothelin-1 in human aneurysmal subarachnoid hemorrhage: associations with vasospasm and delayed cerebral ischemia. Neurocrit Care 2011; 15:19-27. [PMID: 21286855 PMCID: PMC3134137 DOI: 10.1007/s12028-011-9508-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endothelin-1 (ET-1) is a potent vasoconstrictor implicated in the pathogenesis of vasospasm and delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients. The aim of this study was to investigate the relationship between cerebrospinal fluid (CSF) ET-1 levels and angiographic vasospasm and DCI. METHODS Patients with aSAH were consented (n = 106). Cerebral vasospasm was determined by angiography. DCI was determined by transcranial Doppler (TCD) results and/or angiogram results with corresponding clinical deterioration. CSF ET-1 levels over 14 days after the initial insult was quantified by ELISA. ET-1 analysis included a group-based trajectory analysis and ET-1 exposure rate during 24, 48, and 72 h prior to, as well as 72 h post angiography, or clinical deterioration. RESULTS Trajectory analysis revealed two distinct groups of subjects with 56% of patients in the low ET-1 trajectory group (mean at day 1 = 0.31 pg/ml; SE = 0.04; mean at day 14 = 0.41 pg/ml; SE = 0.15) and 44% of patients in the high ET-1 trajectory group (mean at day 1 = 0.65 pg/ml; SE = 0.08; mean at day 14 = 0.61 pg/ml; SE = 0.06). Furthermore, we observed that ET-1 exposure rate 72 h before angiography and clinical spasm was a significant predictor of both angiographic vasospasm and DCI, whereas, ET-1 exposure after angiography and clinical spasm was not associated with either angiographic vasospasm or DCI. CONCLUSION Based on these results we conclude that ET-1 concentrations are elevated in a sub-group of patients and that the acute (72 h prior to angiography and clinical neurological deterioration), but not chronic, elevations in CSF ET-1 concentrations are indicative of the pathogenic alterations of vasospasm and DCI in aSAH patients.
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Happ MB, Hoffman LA. Research needs related to the care of patients on prolonged mechanical ventilation. Heart Lung 2011; 40:93-4. [PMID: 21396514 DOI: 10.1016/j.hrtlng.2010.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/20/2010] [Indexed: 12/01/2022]
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Ott LK, Hoffman LA, Hravnak M. Intrahospital Transport to the Radiology Department: Risk for Adverse Events, Nursing Surveillance, Utilization of a MET and Practice Implications. ACTA ACUST UNITED AC 2011; 30:49-52. [PMID: 21666851 DOI: 10.1016/j.jradnu.2011.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nurses providing care in the Radiology Department (RD) are challenged by the broad scope of conditions and varied acuity of patients served by this unit. Nurses must facilitate the required diagnostic testing and simultaneously provide the surveillance necessary to detect physiologic changes signaling the need for rescue interventions. When instability occurs, one method of rescue involves activation of a Medical Emergency Team (MET) to bring an experienced cadre of critical care providers to the unstable patient. Despite recognition that the RD can be a high risk area, there is little in the literature specific to the surveillance of RD patients, risk for and prevention of adverse events, MET activation or the management of patient instability specific to the RD. The purpose of this paper is to examine what is known regarding risk for adverse events during intrahospital transport, utilization of a MET as a rescue intervention, and practice implications.
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Affiliation(s)
- Lora K Ott
- School of Nursing University of Pittsburgh 3500 Victoria St. Pittsburgh, PA 15261
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Choi J, Donahoe MP, Zullo TG, Hoffman LA. Caregivers of the chronically critically ill after discharge from the intensive care unit: six months' experience. Am J Crit Care 2011; 20:12-22; quiz 23. [PMID: 21196567 DOI: 10.4037/ajcc2011243] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Chronically critically ill patients typically undergo an extended recovery after discharge from the intensive care unit, making involvement of family caregivers essential. Prior studies provide limited detail about specific ways this experience affects caregivers. OBJECTIVES To (1) describe lifestyle restrictions and distress among caregivers of chronically critically ill patients 1 and 6 months after discharge and (2) explore how caregivers' lifestyle restrictions and distress differ according to patients' and caregivers' characteristics. METHODS Sixty-nine chronically critically ill patients and their family caregivers completed follow-up at 1 and 6 months after discharge from the intensive care unit. Data were collected from medical records and survey via telephone or mail. RESULTS Caregivers' perceived lifestyle restrictions (Changes in Role Function) decreased from 1 month (mean [SD], 23.0 [8.3]) to 6 months (19.4 [8.6]) after discharge (P = .003), although patients' problem behaviors and caregivers' distress (8.9 [9.3] vs 7.9 [9.6], respectively; P = .32) did not change. Change in caregivers' lifestyle restrictions differed by patients' disposition (P = .02) and functional status (Health Assessment Questionnaire; P = .007). Caregiver's lifestyle restrictions remained high when patients never returned home or never recovered their preadmission functional status. Caregivers reported the most restrictions in social life and personal recreation. Patients' negative emotions and pain caused the most caregiver distress. CONCLUSIONS Caregivers of chronically critically ill patients perceived fewer lifestyle restrictions over time but reported no change in patients' problem behaviors or distress. Lifestyle restrictions and distress remained high when patients never returned home or regained their preadmission functional status.
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Affiliation(s)
- JiYeon Choi
- Department of Acute/Tertiary Care, University of Pittsburgh School of Nursing, PA 15261, USA.
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Fero LJ, O'Donnell JM, Zullo TG, Dabbs AD, Kitutu J, Samosky JT, Hoffman LA. Critical thinking skills in nursing students: comparison of simulation-based performance with metrics. J Adv Nurs 2010; 66:2182-93. [PMID: 20636471 PMCID: PMC5939573 DOI: 10.1111/j.1365-2648.2010.05385.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM This paper is a report of an examination of the relationship between metrics of critical thinking skills and performance in simulated clinical scenarios. BACKGROUND Paper and pencil assessments are commonly used to assess critical thinking but may not reflect simulated performance. METHODS In 2007, a convenience sample of 36 nursing students participated in measurement of critical thinking skills and simulation-based performance using videotaped vignettes, high-fidelity human simulation, the California Critical Thinking Disposition Inventory and California Critical Thinking Skills Test. Simulation-based performance was rated as 'meeting' or 'not meeting' overall expectations. Test scores were categorized as strong, average, or weak. RESULTS Most (75.0%) students did not meet overall performance expectations using videotaped vignettes or high-fidelity human simulation; most difficulty related to problem recognition and reporting findings to the physician. There was no difference between overall performance based on method of assessment (P = 0.277). More students met subcategory expectations for initiating nursing interventions (P ≤ 0.001) using high-fidelity human simulation. The relationship between videotaped vignette performance and critical thinking disposition or skills scores was not statistically significant, except for problem recognition and overall critical thinking skills scores (Cramer's V = 0.444, P = 0.029). There was a statistically significant relationship between overall high-fidelity human simulation performance and overall critical thinking disposition scores (Cramer's V = 0.413, P = 0.047). CONCLUSION Students' performance reflected difficulty meeting expectations in simulated clinical scenarios. High-fidelity human simulation performance appeared to approximate scores on metrics of critical thinking best. Further research is needed to determine if simulation-based performance correlates with critical thinking skills in the clinical setting.
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Affiliation(s)
- Laura J Fero
- University of North Carolina at Greensboro School of Nursing, Greensboro, NC, USA.
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Puccio AM, Hoffman LA, Bayir H, Zullo TG, Fischer M, Darby J, Alexander S, Dixon CE, Okonkwo DO, Kochanek PM. Effect of short periods of normobaric hyperoxia on local brain tissue oxygenation and cerebrospinal fluid oxidative stress markers in severe traumatic brain injury. J Neurotrauma 2010; 26:1241-9. [PMID: 19505175 DOI: 10.1089/neu.2008.0624] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Preliminary evidence suggests local brain tissue oxygenation (PbtO(2)) values of <or=15 mm Hg following severe traumatic brain injury (TBI) represent brain tissue hypoxia. Accordingly, many neurotrauma units attempt to maintain PbtO(2) >or=20 mm Hg to avoid hypoxia. This study tested the impact of a short (2 h) trial of normobaric hyperoxia on measures of oxidative stress. We hypothesized this treatment would positively affect cerebral oxygenation but negatively affect the cellular environment via oxidative stress mechanisms. Cerebrospinal fluid (CSF) was serially assessed in 11 adults (9 male, 2 female), aged 26 +/- 1.8 years with severe TBI (Glasgow Coma Scale score, 6 +/- 1.4) before, during, and after a FiO(2) = 1.0 challenge for markers of oxidative stress, including lipid peroxidation (F(2)-isoprostane [ELISA]), protein oxidation (protein sulfhydryl [fluorescence]), and antioxidant defenses (total antioxidant reserve (AOR) [chemiluminescence] and glutathione [fluorescence]). Physiological parameters [PbtO(2), arterial oxygen content (PaO(2)), intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP)] were assessed at the same time points. Mean (+/-SD) PbtO(2) and PaO(2) levels significantly changed for each time point. Oxidative stress markers, antioxidant reserve defenses, and ICP, MAP, and CPP did not significantly change for any time period. These preliminary findings suggest that brief periods of normobaric hyperoxia do not produce oxidative stress and/or change antioxidant reserves in CSF. Additional studies are required to examine extended periods of normobaric hyperoxia in a larger sample.
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Affiliation(s)
- Ava M Puccio
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Jubran A, Lawm G, Duffner LA, Collins EG, Lanuza DM, Hoffman LA, Tobin MJ. Post-traumatic stress disorder after weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36:2030-7. [PMID: 20661726 DOI: 10.1007/s00134-010-1972-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 05/23/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Weaning from prolonged mechanical ventilation may be associated with mental discomfort. It is not known whether such discomfort is linked with the development of post-traumatic stress disorder (PTSD). Accordingly, we investigated whether PTSD occurs in patients after weaning from prolonged ventilation. We also determined whether administering a questionnaire would identify patients at risk for developing PTSD. METHODS A prospective longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation was undertaken: 72 patients were studied 1 week after weaning, and 41 patients were studied again 3 months later. An experienced psychologist conducted a structured clinical interview 3 months after weaning to establish a diagnosis of PTSD. To assess for the presence of PTSD-related symptoms, the post-traumatic stress syndrome (PTSS-10) questionnaire was administered 1 week after weaning and 3 months later. RESULTS The psychologist diagnosed PTSD in 12% of patients 3 months after ventilator weaning. Patients who developed PTSD were more likely to have a previous history of psychiatric disorders (P < 0.02). A PTSS-10 score >20 one week after weaning reliably identified patients who were diagnosed with PTSD 3 months later: sensitivity 1.0; specificity 0.76; area under the receiver-operating characteristic curve 0.91. CONCLUSION PTSD was diagnosed in 12% of patients who were weaned from prolonged ventilation. A PTSS-10 score >20 one week after weaning identified patients diagnosed with PTSD 3 months later. This finding suggests that a simple questionnaire administered before hospital discharge can identify patients at risk for developing PTSD.
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Affiliation(s)
- Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital, Hines IL and Loyola University of Chicago Stritch School of Medicine, Maywood, IL, USA.
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Abstract
From the experiments described in this paper and in those previously published it can be concluded that dyes which can be reversibly oxidized and reduced, act as catalysts for some oxidative processes taking place in the living cells, as is manifested by an increase in their oxygen consumption. It has been found that the catalytic power of the dyes on the oxygen consumption of starfish eggs (mature, unfertilized) is conditioned by two factors: the reduction potential of the dye and the permeability of the cell surface. Dyes whose E'o is towards the positive side of the aerobic reduction potential of the starfish eggs have a maximum catalytic effect. This catalytic power decreases as the E'o becomes more negative than the reduction potential of the cell and becomes nil beyond certain limits. When a dye cannot penetrate into the cell, its effect is greatly diminished as in this case only those oxidative processes taking place at the outer surface of the cell can be activated. Whether a dye can act as a catalyst or not is dependent on whether the normal consumption of oxygen by the cell is slower or quicker than the oxidation activated by the dye. The speed of this activation is correlated to (1) the speed at which the dye is reduced by the cell, and (2) the speed at which the leuco-dye is oxidized by the atmospheric oxygen. If one of these two processes is slower than the normal respiration, the dye cannot increase the rate of oxygen consumption (phenol indophenol at low concentrations which is kept reduced by the cell is very slowly reoxidized by atmospheric oxygen, on the other hand safranin and neutral red which are not reduced by the cell or at least too slowly reduced, though rapidly reoxidized by air). It will depend on these two reactions velocities whether a dye will act as catalyst (methylene blue and dyes with similar E'o which are quickly reduced by the cell and the leuco-dyes of which are relatively quickly reoxidized). Though this relationship between the reduction potential of the dyes and its catalytic power would seem in contradiction with the well known thermodynamic assumption that there is in general no distinct relationship between the potential and velocity of the reaction, we have pointed out from the literature some of the various experiments where one does recognize this connection.
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Affiliation(s)
- E S Barron
- Chemical Division, Medical Clinic, The Johns Hopkins University, Baltimore, and The Marine Biological Laboratory, Woods Hole
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Sereika SM, Tate JA, DiVirgilio-Thomas D, Hoffman LA, Swigart VA, Broyles L, Roesch T, Happ MB. The association between bathing and weaning trial duration. Heart Lung 2010; 40:41-8. [PMID: 20561879 PMCID: PMC2997168 DOI: 10.1016/j.hrtlng.2010.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 02/11/2010] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe patterns of bath care for patients who are weaning from prolonged mechanical ventilation (PMV) and to explore the association between bathing and weaning trial duration. METHODS Descriptive correlational study. Clinical records from 439 weaning trial days for 30 patients who required PMV were abstracted for bathing occurrences during weaning trials, within 1 hour before a trial, and nocturnally. RESULTS Most baths occurred during weaning trials (30.8%) or at night (35.3%), and less frequently (16%) within 1 hour before a trial. No significant effects were found on trial duration for nocturnal bathing or bathing within 1 hour before a trial. By using random coefficient modeling, weaning duration was shown to be longer when bathing occurred during a weaning trial (P < .05), even when controlling for age, severity of illness, and days on bedrest. CONCLUSION Bathing occurred during approximately one third of PMV weaning trials. Baths during PMV weaning trials were associated with longer weaning trial duration.
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Affiliation(s)
- Susan M Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania 15261, USA
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Choi J, Hoffman LA, Sethi JM, Zullo TG, Gibson KF. Multiple flow rates measurement of exhaled nitric oxide in patients with sarcoidosis: a pilot feasibility study. Sarcoidosis Vasc Diffuse Lung Dis 2009; 26:98-109. [PMID: 20560290 PMCID: PMC2889917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Fraction of end tidal exhaled nitric oxide (FeNO) has been introduced as a non-invasive marker of airway inflammation in patients with asthma and may have value in monitoring disease activity in patients with sarcoidosis. This pilot study explored: 1) feasibility of the multiple flow rates maneuver to estimate alveolar (C(AlV)NO) and airway wall (J(AW)NO) NO in patients with sarcoidosis; and 2) utility of exhaled NO (FeNO, C(Alv)NO and J(AW)NO) measurements to detect and monitor treatment response in patients with active pulmonary sarcoidosis. Patients with sarcoidosis (n = 42) and healthy non-smokers (n = 20) underwent FeNO measurement at 7 flow-rates (50 to 400 ml/s). Using the Tsoukias and George (1998) model, C(Alv)NO and J(AW)NO were estimated. Both patients and healthy non-smokers were able to perform the multiple flow rates maneuver without discomfort, with first measurement success rate of 57% and 65%, respectively. No significant difference was found between patients with sarcoidosis and healthy non-smokers in exhaled NO. None were correlated with pulmonary function tests, except a significant negative correlation between C(Alv)NO and FVC% (p = 0.001) and DLCO% (p = 0.012). In 8 patients with active sarcoidosis, FeNO, C(Alv)NO or J(AW)NO were not different from those of patients with inactive sarcoidosis. Treatment of active sarcoidosis using oral prednisone and methotrexate did not show any consistent pattern of changes in C(Alv)NO or J(AW)NO. Due to a large inter-subject variability and difficulty controlling use of the inhaled corticosteroids, exhaled NO measurement did not appear to be a clinically useful method of monitoring disease progression in sarcoidosis.
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Affiliation(s)
- J Choi
- University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA.
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Puccio AM, Hoffman LA, Bayir H, Zullo TG, Michael FR, Darby JM, Alexander SA, Dixon CE, Okonkwo DO, Kochanek PM. Effect of short periods of normobaric hyperoxia on local brain tissue oxygenation and cerebrospinal fluid oxidative stress markers in severe traumatic brain injury. J Neurotrauma 2009. [DOI: 10.1089/neu.2008-0624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rodway GW, Choi J, Hoffman LA, Sethi JM. Exhaled nitric oxide in the diagnosis and management of asthma: clinical implications. Chron Respir Dis 2009; 6:19-29. [PMID: 19176709 DOI: 10.1177/1479972308095936] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Exhaled nitric oxide (eNO) used as an aid to the diagnosis and management of lung disease is receiving attention from pulmonary researchers and clinicians alike because it offers a noninvasive means to directly monitor airway inflammation. Research evidence suggests that eNO levels significantly increase in individuals with asthma before diagnosis, decrease with inhaled corticosteroid administration, and correlate with the number of eosinophils in induced sputum. These observations have been used to support an association between eNO levels and airway inflammation. This review presents an update on current opportunities regarding use of eNO in patient care, and more specifically on its potential usage for asthma diagnosis and monitoring. The review will also discuss factors that may complicate use of eNO as a diagnostic tool, including changes in disease severity, symptom response, and technical measurement issues. Regardless of the rapid, convenient, and noninvasive nature of this test, additional well-designed, long-term longitudinal studies are necessary to fully evaluate the clinical utility of eNO in asthma management.
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Affiliation(s)
- G W Rodway
- Center for Sleep and Respiratory Neurobiology, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19104, USA.
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