Current Health Care Arena Research Articles

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists.

The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored By American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Objective: The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results: New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusion: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues. A1C = hemoglobin A1c; AACE = American Association of Clinical Endocrinologists; ABCD = adiposity-based chronic disease; ACE = American College of Endocrinology; ADA = American Diabetes Association; AHI = Apnea-Hypopnea Index; ASA = American Society of Anesthesiologists; ASMBS = American Society of Metabolic and Bariatric Surgery; BMI = body mass index; BPD = biliopancreatic diversion; BPD/DS = biliopancreatic diversion with duodenal switch; CI = confidence interval; CPAP = continuous positive airway pressure; CPG = clinical practice guideline; CRP = C-reactive protein; CT = computed tomography; CVD = cardiovascular disease; DBCD = dysglycemia-based chronic disease; DS = duodenal switch; DVT = deep venous thrombosis; DXA = dual-energy X-ray absorptiometry; EFA = essential fatty acid; EL = evidence level; EN = enteral nutrition; ERABS = enhanced recovery after bariatric surgery; FDA = U.S. Food and Drug Administration; G4G = Guidelines for Guidelines; GERD = gastroesophageal reflux disease; GI = gastrointestinal; HCP = health-care professional(s); HTN = hypertension; ICU = intensive care unit; IGB = intragastric balloon(s); IV = intravenous; LAGB = laparoscopic adjustable gastric band; LAGBP = laparoscopic adjustable gastric banded plication; LGP = laparoscopic greater curvature (gastric) plication; LRYGB = laparoscopic Roux-en-Y gastric bypass; LSG = laparoscopic sleeve gastrectomy; MetS = metabolic syndrome; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; NSAID = nonsteroidal anti-inflammatory drug; OA = osteoarthritis; OAGB = one-anastomosis gastric bypass; OMA = Obesity Medicine Association; OR = odds ratio; ORC = obesity-related complication(s); OSA = obstructive sleep apnea; PE = pulmonary embolism; PN = parenteral nutrition; PRM = pulmonary recruitment maneuver; RCT = randomized controlled trial; RD = registered dietician; RDA = recommended daily allowance; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy; SIBO = small intestinal bacterial overgrowth; TOS = The Obesity Society; TSH = thyroid-stimulating hormone; T1D = type 1 diabetes; T2D = type 2 diabetes; VTE = venous thromboembolism; WE = Wernicke encephalopathy; WHO = World Health Organization.

Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists.

The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

Abstract NS9: ARN Professional Rehabilitation Nurse Competency Model: Application to Stroke Care

As the nursing profession continues to become more specialized, there have been more models developed to define specific practice areas. Rehabilitation nursing is practiced in diverse settings along the healthcare continuum with clients who have experienced a disability/chronic illness, such as stroke. No framework was noted in the literature that defined the necessary competencies of the rehabilitation nurse Purpose: To develop a Competency Model for Professional Rehabilitation Nursing and its application to clinical practice. Method: An Association of Rehabilitation Nurses’ (ARN) task force was convened, conducted a literature review and participated in “brainstorming” that yielded four domains of professional practice: nurse-led evidence-based interventions; promotion of health and successful living, leadership, and interprofessional practice; and essential role competencies. The competencies were further defined into three levels of proficiency: beginner, intermediate, and advanced (ARN, 2014). Results: Model is a circle with professional rehabilitation nurse at the center surrounded by four domains and the role competencies, separated by broken lines illustrating the crossover of knowledge and skills represented in each domain. This practice Model can be used to inform stroke care in various settings across the healthcare continuum; and competencies such as facilitating safe and effective care transitions can be used in plan for the stroke survivor and caregiver. Facilitating the stroke survivor’s transition to the right level of care is an essential rehabilitation nurse competency and promotes better outcomes (Camicia et al., 2014). Using competencies, such as interventions based on best evidence, are essential in managing stroke sequela: neurogenic bladder, dysphagia, hemiplegia, etc. The Model can also be used to address the caregiver role and frame the assessment to determine education, community resource, and support needs. Conclusion: ARN Rehabilitation Professional Nurse Competency Model reflects diversity of rehabilitation nursing in the current healthcare arena; and is an efficacious tool which can assist rehabilitation nurses at various levels to provide optimum stroke care and contribute to best practice.

The Competency Model for Professional Rehabilitation Nursing.

Rehabilitation nursing is practiced in various settings along the healthcare continuum. No framework is noted in the literature that defines the necessary competencies of the rehabilitation nurse. To develop a Competency Model for Professional Rehabilitation Nursing and its application to clinical and educational practice. A seven-member Association of Rehabilitation Nurses (ARN) task force was convened; conducted a literature review, reviewed current and historical ARN documents, including the Strategic Plan, and developed a Competency Model for Professional Rehabilitation Nursing practice. The Competency Model for Professional Rehabilitation Nursing delineates four domains of rehabilitation nursing practice and essential role competencies. The Competency Model for Professional Rehabilitation Nursing addresses this diverse specialty practice in the current healthcare arena. This framework can be used to guide nurses practicing at different levels of proficiency in various settings. The Competency Model can be used as a structure for staff orientation, evaluation tools, clinical ladder components, role descriptions and rehabilitation nursing courses.

DEVELOPING AN EDUCATIONAL INTERVENTION TO ADDRESS THE DISCREPANCIES IN PRN ‘AS REQUIRED’ PRESCRIPTIONS WITHIN A HOSPICE SETTING

BackgroundWithin the current healthcare arena, the identification of risks within organisations and minimising their negative impact on patient care is fundamental. Reports from the national and international literature have identified...

Experiences of negative pressure wound therapy from the patient's perspective

Enabling patients to be active in their care is constantly being promoted in the current healthcare arena, and there is strong evidence to suggest that outcomes can be improved through promoting this in the clinical setting. For clinicians to incorporate this in practice, we must firstly examine the patient's perspective of treatments offered to them. This article explores the few studies that have investigated the patient's experiences of negative pressure wound therapy, to provide clinicians with an awareness of the issues that are raised by patients when receiving NPWT. The findings demonstrate that NPWT impacts on patients physically and psychologically, in both positive and negative ways. Clinicians have the ability to deal with some of these issues but others will rely on technological advances.

Clinical errors, nursing shortage and moral distress: The situation in Jordan

Abstract In the current healthcare arena, clinical errors are receiving much attention. Unintentionally, nurses commit errors, which require guiding ethical principles. This replicated study aimed to assess Jordanian Registered Nurses’ (RNs) perceptions of clinical errors they had committed over the past year: assess nurses’ perceptions of clinical errors committed by other nurses’ detect if these errors were related to the nursing shortage and assess whether or not nurses felt any moral distress. The studied phenomena were compared across different hospitals as well as in various units and wards. A survey was used to collect data from 420 nurses from 13 hospitals. A considerable percentage of RNs reported that they omitted to give medication/treatment or gave medication/treatment at the wrong time, and also indicated that other nurses gave incorrect medication or incorrectly administered treatments; practice issues which were related to the nursing shortage and causing moral distress. RNs perceived that clinical errors/untoward clinical incidents that they and other nurses experienced occurred largely because of the nursing shortage and resulted in moral distress. Moreover, a considerable percentage of RNs perceived that other nurses made clinical errors and/or experienced untoward clinical incidents related to the nursing shortage more frequently than the RNs themselves. Across different types of hospitals, nurses were not different in regard to clinical errors and their treatments, and the resultant moral distress. Nurses in units were slightly higher than nurses in wards in reporting clinical errors, treating them when they occurred, relating these errors to the nursing shortage, and thus were experiencing more moral distress. Aggravated by the nursing shortage, moral distress that occurs as a result of clinical errors is increasing, thus nurse managers should assess the contributing factors of moral distress and find ways to eliminate them.

Implementing a Home Telemonitoring Program

In the current healthcare arena, it is imperative that home healthcare agencies seek to reduce costs and produce positive outcomes from the care they give. Telemonitoring offers the ability to monitor closely the daily status of the patients that home healthcare agencies serve, to provide best practice care, and to produce positive outcomes from that care. This article presents the experience of how 1 hospital-based agency implemented a home telemonitoring program and describes the lessons learned throughout the process. The current healthcare arena demands cost reduction and improved patient care outcomes from home healthcare agencies (HHAs). The direction that each HHA chooses to take to answer these demands will set the stage for their future. This article describes the steps needed to implement a telemonitoring program. The description is based on how 1 HHA chose its course of action and set it in motion and shows what was learned throughout the process.

Kathleen Mears Memorial Lecture: Electroneurodiagnostics—for the Joy of It!

ABSTRACT.During the middle of the last century, discoveries about the brain and the nervous system gave birth to a new technology. Thanks to the pioneers in those efforts, the early EEG technicians, and our efforts through the years, the technology has grown, expanded, and become amazingly sophisticated. This is about loving what we do, and finding joy and satisfaction in our accomplishments. We make health care better. We improve the quality of people's lives. We prompt physicians to sit up and take notice because we complement their efforts at diagnosing, monitoring, and treating people's neurologic illnesses.We're old enough to have a history, and a story … about Kathy Mears and hundreds of dedicated technologists, many of whom sprouted from those first small groups trained by the Fathers of EEG to give them important scientific data. And here we are, fifty-some years later, several thousand strong, influenced by things those first technicians never dreamed about! We're still producing data, but things have changed. Let's examine the challenges electroneurodiagnostic (END) technologists encounter in the current healthcare arena, and focus on what we need to find joy and fulfillment in our important work. Come celebrate our profession. Come share the joy!

An application of health literacy research

Finding methods to improve the delivery of educational materials by the practicing nurse is imperative in the current health care arena. Time, energy, and effectiveness are all aspects that are critical as the health care provider attempts to meet the growing needs of the compromised client. Low functional health literacy is one public health problem that impacts the nurse’s ability to effectively provide health instruction in a timely, organized manner. This article presents a pilot research project used to investigate the mastery of educational information by clients in a West Texas area. The research project is used as the foundation for discussion of several interesting facets resulting from the initial research. Ideas are presented as a direction for implementation for practice within the health care community. Low health literacy is a grave challenge, which currently is not understood nor considered by the nurse at the bedside. Practicing health care providers need the opportunity to carefully and specifically investigate the role of health care literacy in producing positive client outcomes.

Invest in yourself. Start a clinical research project.

Experienced clinical healthcare providers ought to investigate challenging roles and activities. The utilization of seasoned role models is an effective method for learning thought-provoking aspects of the professional role. Lifelong learning is a responsibility for every professional nurse. The challenge of seeking and succeeding at acquiring new competence within a different role is a goal to be aggressively sought in the current healthcare arena. The willingness to confront fears and challenges is a quality to be developed and utilized. As the nursing profession is endeavoring to establish its unique place in the healthcare field, the eagerness to confront challenges is a quality to be valued. Since the face of America is changing, professional nurses must be ready and capable of meeting the challenges confronting the healthcare arena. Cultural awareness, moving to a higher level of practice by incorporating research ideas, and changing the mindset of how nurses think are vital aspects integrated into this changing environment. Nurses must have a vision about the future. By being open and interested in seeking new trials, the nursing profession can make changes to improve the future for clients, thus the practice of nursing.

Planning strategies for the avoidance of pitfalls in intervention research.

With the exception of large clinical trials, few studies in nursing and other social sciences test interventions. The discipline of nursing needs to maintain a full range of research designs for continued knowledge development. Intervention research presents unique opportunities and challenges for the novice as well as the seasoned researcher. Some of these methodological challenges include the complex nature of human subjects and interventions, including many factors that interfere with the study variables. Preliminary studies often reveal challenges that may not always be predicted or reflected in research texts. These challenges may be as important as the study results for success in future research efforts. Difficulties encountered in intervention research and suggested strategies for maintaining the integrity of the study are addressed. These challenges include maintaining an adequate sample size, intervention demands, measuring variables, timing issues, and experiencing unexpected events. Strategies presented include the importance of extensive planning, minimizing subject expectations and rewarding efforts, attention to control group members, incorporating retention strategies, expanding knowledge of variables and the study population, preliminary studies as well as anticipating unexpected events. The need for enhanced communication among nurse researchers, educators and clinicians is addressed. In the current health care arena, nurse researchers must understand organizational dynamics and marketing strategies. Collaborative research efforts can increase the visibility of nursing research as well as funding opportunities.

Pharmacists Strive to Promote the Safe and Appropriate Use of Medications: A Commentary on Eckerd's Patient Care™ Program

In the current health care arena, patients have a multitude of prescription, over-the-counter, herbal, natural, and nutritional products available to them. A common perception among the public at large is that any medication that does not require a prescription is safe to take. This simply is not the whole truth. Eckerd pharmacists play an important role in preventing accidental poisoning through monitoring of patient use of, and addressing patient inquiries about, any medication-related products.

The POP Program

In 1992, a preoperative education program was developed for total joint replacement patients in a small community hospital. The goals of the program were to increase educational opportunities for the joint replacement patients, prepare patients for hospitalization, plan for discharge needs, and increase efficiency of the orthopaedic program. Since 1992, approximately 600 patients have attended the education program. Outcomes have included positive responses from patients regarding their preparedness for surgery, increased participation in their plan of care, coordinated discharge planning, decreased length of stay, and progression across the continuum of care. A multidisciplinary approach to preparing patients for surgery allows for a comprehensive and efficient education program. Marketing of successful programs can enhance an institution's competitive advantage and help ensure the hospital's viability in the current health care arena.

Decreasing the Cost of Trauma Care: A System of Secondary Inhospital Triage

The financial realities of the current health care arena make it imperative that deliverers of trauma care initiate programs that reduce the cost of trauma. Triage can be one process that attempts to attain this goal. Once patients are assigned to a Level I trauma center, it is possible to triage patients again to complement field triage. A two-tiered, inhospital trauma response system was developed in which different team responses are initiated depending on the patient status. This tiered, in-house response system differs with respect to human and material resources. Personnel, operating room, laboratory work, and protective wear savings account for approximately $1,042 per code patient, yielding an annual $629,404 institutional savings. [DeKeyser FG, Paratore A, Seneca RP, Trask A: Decreasing the cost of trauma care: A system of secondary inhospital triage. Ann Emerg Med April 1994;23:841-844.]