A Quality Improvement Project to Identify Patients With Advanced Heart Failure for Potential Palliative Care Referral in Telemetry and Cardiac Intensive Care Units.

Although national guidelines recommend timely initiation of palliative care for hospitalized patients with advanced heart failure (AHF), providers may not recognize which patients who have heart failure are most in need of consultation. A tool was developed and pilot-tested to screen patients admitted to a cardiology inpatient service with a left ventricular ejection fraction (LVEF) of 50% or less for potential triggers signifying palliative care needs in the telemetry or cardiac intensive care unit (CICU). The tool was completed during cardiology rounds.

Implementation of an interferon-gamma release assay to screen for tuberculosis in refugees and immigrants.

Despite increased use and accuracy of interferon-gamma release assays to detect latent tuberculosis infection (LTBI) in foreign-born arrivals in the United States, risk characteristics associated with positive results are not well characterized. We conducted a retrospective record review of 541 refugees and immigrants screened for LTBI with QuantiFERON(®)-TB Gold In-Tube (QFT-IT) at the Spokane Public Health Clinic from January 2, 2008, through June 5, 2009. Overall, 24 % of the arrivals had a positive QFT-IT, with the greatest frequency of positive results occurring in arrivals from Liberia (100 %) and Bhutan (39 %).

Quantitative and qualitative QuantiFERON(®)-TB gold in-tube results among groups with varying risks of exposure to tuberculosis.

Objective: We sought to describe qualitative and borderline quantitative QuantiFERON(®)-TB Gold In-Tube (QFT-IT; Cellestis, Valencia, CA) results among persons screened in the context of routine reasons, employment, contact investigation, high-risk foreign-born arrivals in the United States ≤ 5 years, and high-risk United States residents >5 years.

Methods: We performed a retrospective review of 3288 QFT-IT results from a clinical laboratory in the Pacific Northwest from January 2, 2008 to June 5, 2009. Interferon-γ (IFN-γ) responses were quantified as low, borderline, or high for tuberculosis (TB) antigens (IFN-γ [TB]) and a positive mitogen control (IFN-γ [mitogen]), after subtracting a background control (IFN-γ [nil]).

Screening for Mycobacterium tuberculosis using an interferon-gamma release assay.

Context: The Centers for Disease Control and Prevention recommend analyzing characteristics of populations screened for Mycobacterium tuberculosis infection using interferon-gamma release assays (IGRAs).

Objective: We characterized requests for IGRA analyses submitted to the first laboratory in Washington State that began to offer IGRAs as a tuberculosis screening test. In addition, we chronicled the process by which this program was launched.

Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic marker of ventilator-associated pneumonia.

Objective: To determine the utility of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) levels in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) samples from patients who underwent bronchoscopy for a clinical suspicion of ventilator-associated pneumonia (VAP), to categorize patients as VAP positive and VAP negative, when compared to quantitative culture results of BALF.

Methods: Observational study conducted on admitted patients in the trauma-surgical, medical-cardiac, burn, and neurosurgical ICUs of Harborview Medical Center between March 2009 and May 2010. BALF and EBC samples were obtained from 45 patients with clinically suspected VAP.

Triggering receptor expressed on myeloid cells type 1 as a potential therapeutic target in sepsis.

Excessive and unregulated inflammation contributes to multiorgan failure and death in sepsis. Triggering receptor expressed on myeloid cells type 1(TREM-1) is expressed on neutrophils and monocytes and is upregulated in the presence of bacterial pathogens. Engagement of TREM-1 results in increased expression of proinflammatory chemokines and cytokines and amplifies the inflammatory response.

Biomarkers for ventilator-associated pneumonia: review of the literature.

Objective: Ventilator-associated pneumonia (VAP) contributes significantly to morbidity and mortality in critically ill patients, but it can be difficult to diagnose. Clinical criteria, Clinical Pulmonary Infection Score, and quantitative culture of bronchoalveolar lavage have been used to distinguish between patients who are likely positive (sensitivity) and patients who are likely negative (specificity). Despite these test methods, patients continue to be misclassified.

Fitness support group for organ transplant recipients: self-management, self-efficacy and health status.

Title: Fitness support group for organ transplant recipients: self-management, self-efficacy and health status.

Aim: This paper is a report of a study conducted to describe postoperative self-management behaviours, perceived self-efficacy and health outcomes in adult organ transplant recipients who participated in a fitness support group.

Background: Self-management behaviours designed to promote patient autonomy contribute to positive health outcomes after therapeutic interventions.

Tuberculosis education for nurse practitioner students: where we are and where we need to go.

Tuberculosis (TB) has reemerged as a public health concern. This study tested the reliability and validity of an instrument examining self-efficacy in providing TB care, beliefs about educational preparation, and knowledge about TB among nurse practitioner students from diverse programs. A one-time self-report instrument was distributed during a final clinical course.

Personal healthcare worker (HCW) and work-site characteristics that affect HCWs' use of respiratory-infection control measures in ambulatory healthcare settings.

Objectives: To identify healthcare worker (HCW) and work-site characteristics associated with HCWs' reported use of recommended respiratory-infection control practices in primary and emergency care settings.

Design: A cross-sectional study using a self-administered questionnaire for HCWs during the summer and fall of 2005.

Setting: Primary and emergency care clinics at 5 medical centers in King County, Seattle, Washington.

Appraisal of recommended respiratory infection control practices in primary care and emergency department settings.

Background: The severe acute respiratory syndrome (SARS) epidemic and concern about pandemic influenza prompted the Centers for Disease Control and Prevention (CDC) to develop guidelines to prevent the transmission of all respiratory infections in health care settings during first contact with a potentially infected person. The extent to which health care workers and institutions use these CDC recommended practices is uncertain.

Methods: The study examined health care worker adherence to CDC recommended respiratory infection control practices in primary care clinics and emergency departments of 5 medical centers in King County, Washington, using a self-administered questionnaire.

Educational competencies to strengthen tuberculosis curricula in undergraduate nursing programs.

Worldwide, at least two million people die annually from tuberculosis (TB), with projections of 36 million more global deaths between the years 2003 and 2020. To help nursing faculty strengthen TB curricula and standardize TB content in national and international undergraduate nursing programs, the Nurse Discipline Group of the National Tuberculosis Curriculum Consortium (NTCC) has developed comprehensive TB core competencies and specific student objectives for the classroom setting. These core competencies address the knowledge, ability, and/or skills required for an undergraduate nursing student to provide qualified holistic care for patients, families, and communities impacted by TB.

Development of the American association of critical-care nurses' sedation assessment scale for critically ill patients.

Clinicians commonly sedate critically ill patients. Sedatives should be administered to achieve predetermined end points. Most currently available scales used to assess sedation are inadequate because they focus on a single domain, such as consciousness.

Clinical nurse specialists and nurse practitioners: complementary roles for infectious disease and infection control.

Background: The escalation of infectious diseases worldwide heralds an unprecedented need for nurses with advanced practice graduate preparation.

Objective: To describe how a graduate program prepares clinical nurse specialists and nurse practitioners in infectious diseases or infection control to provide distinct yet complementary care for patients with contagious disease and potentially antimicrobial-resistant infections.

Results: The University of Washington School of Nursing launched a new master of nursing program for infectious disease and infection control to reduce the threat of infectious diseases and multiple-resistant organisms.