Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care.

Purpose: An intensive care unit (ICU) patient's primary care physician (PCP) may be able to assist family with certain ICU shared medical decisions. We explored whether families of patients in nonopen ICUs who nevertheless report involvement of a patient's PCP in medical decision making are more satisfied with ICU shared decision making than families who do not.

Methods: Between March 2013 and December 2015, we administered the Family Satisfaction in the ICU 24 survey to family members of adult neuroscience ICU patients.

Dedicated Afternoon Rounds for ICU Patients' Families and Family Satisfaction With Care.

Objective: It was hypothesized that adding dedicated afternoon rounds for patients' families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU.

Design: Pre- and postimplementation (pre-I and post-I) design.

Setting: Single academic neuroscience ICU.

Efficacy of antipsychotics for irritability and aggression in children: a meta-analysis.

Background: Aggression and irritability in children occur across a range of diagnoses, and are associated with both economic cost and negative psychosocial outcomes. Antipsychotics are frequently prescribed in these cases.

Methods: A random effects meta-analysis of 14 random controlled trials was conducted.

Challenges of Inpatient Glycemic Control.

Hyperglycemia occurs in more than 30% of hospitalized patients. The condition has been associated with higher mortality and poor outcomes. Systems to effectively treat dysglycemia have been put into place, although many focus on critical care areas.

The incidence of pedestrian distraction at urban intersections after implementation of a Streets Smarts campaign.

Background: Pedestrians distracted by digital devices or other activities are at a higher risk of injury as they cross streets. We sought to describe the incidence of pedestrians distracted by digital devices or other activities at two highly traveled urban intersections after the implementation of a pedestrian safety intervention at one of the intersections.

Methods: This was an observational field study of two urban intersections.

Statins: The Good, the Bad, and the Unexpected.

More than 13 million Americans are taking statin drugs in order to lower cholesterol levels and thereby avoid potential cardiovascular disease. Home healthcare clinicians are well suited to educate patients about this sometimes-controversial medication class. The purpose of this article is to describe the link between cholesterol and statins, and to provide an overview for healthcare providers including drug actions, indications, and possible adverse effects.

Managing Celiac Disease for Women: Implications for the Primary Care Provider.

Although many people have symptoms of celiac disease, it can take a while to diagnose. Villous atrophy may be present long before any gastrointestinal symptoms. An important point to acknowledge is that celiac disease could be identified earlier in some women with a positive family history.

Managing Sjogren's Syndrome.

There are approximately 4 million Americans diagnosed with Sjogren's Syndrome. This article discusses the epidemiology, pathophysiology, diagnostics, and implications for home care clinicians who may encounter patients with this syndrome. Chronic pain is discussed as well as interventions to manage symptoms such fatigue, dry eyes mouth and skin.

Geriatric sexual experiences: The seniors tell all.

Aim: To gain insight into the aging sexual health experiences and concerns of older adults aged 60 years or older.

Background: Despite the prevalence of sexual activity among older adults and the documented health benefits, little is known about how sexual health changes as individuals age.

Methods: Participants for this study were recruited through a local senior center and qualitative interviews were conducted.

Use of phosphodiesterase type 5 inhibitors in assistive living and home care settings.

Unlabelled: The purpose of this descriptive study was to assess frequency of phosphodiesterase type (PDE-5) inhibitor use (sildenafil, tadalafil, ardenafil) in community settings.

Methods: A retrospective record review was conducted to determine PDE-5 inhibitor use in older males (mean age 79.2) residing in three assisted living communities (n=126), or living in private homes with home care services (n=109).

Methotrexate.

The purpose of this article is to educate healthcare professionals about the many uses of the drug Methotrexate. Information regarding dosing, action, contraindications, adverse effects, drug interactions, as well as tips for patient education are included.

Polymylagia rheumatica: common disease, elusive diagnosis.

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease with little known about its etiology or incidence. Frequently found in older adult women, this disease can be debilitating, painful, and dangerous. Diagnosing PMR can be elusive due to lack of specific laboratory tests, and treatment with use of long-term glucocorticoids can be difficult due to side effects.

The development of professional identity and the formation of teams in the Veterans Affairs Connecticut Healthcare System's Center of Excellence in Primary Care Education Program (CoEPCE).

Purpose: The United States Department of Veterans Affairs Connecticut Healthcare System (VACHS) is one of five Centers of Excellence in Primary Care Education (CoEPCE) pilot sites. The overall goal of the CoEPCE program, which is funded by the Office of Academic Affiliations, is to develop and implement innovative approaches for training future health care providers in postgraduate education programs to function effectively in teams to provide exceptional patient care. This longitudinal study employs theoretically grounded qualitative methods to understand the effect of a combined nursing and medical training model on professional identity and team development at the VACHS CoEPCE site.

In situ pediatric trauma simulation: assessing the impact and feasibility of an interdisciplinary pediatric in situ trauma care quality improvement simulation program.

Objective: This study aimed to evaluate the feasibility and measure the impact of an in situ interdisciplinary pediatric trauma quality improvement simulation program.

Methods: Twenty-two monthly simulations were conducted in a tertiary care pediatric emergency department with the aim of improving the quality of pediatric trauma (February 2010 to November 2012). Each session included 20 minutes of simulated patient care, followed by 30 minutes of debriefing that focused on teamwork, communication, and the identification of gaps in care.

Improving surgical outcomes in pancreatic surgery with preoperative nutrition.

The purposes of this study were (1) to describe the relationship between preoperative physical status and postoperative outcomes in patients undergoing Whipple resection, and (2) to determine if the use of specialized immunonutrition with IMPACT Advanced Recovery supplementation improved postoperative outcomes (pancreatic leak rate, length of stay, and postoperative complications) in patients undergoing Whipple resection. The trial was a case-controlled prospective pilot study that took place in an outpatient gastrointestinal surgical oncology office in an urban community hospital in the northeast United States. The study population consisted of nine patients undergoing Whipple surgery.

Promoting nursing students' understanding and reflection on cultural awareness with older adults in home care.

It is important for nursing programs to use culturally focused activities to increase student preparation in caring for diverse older adults in their homes. The purpose of this study was to examine strategies that promote students' reflection on cultural awareness using home care-focused case studies, simulations, and self-reflective writing activities. Cases and simulations were designed to depict diverse patients living at home with a variety of demographic characteristics, such as health history, age, culture, religion, dietary preferences, marital status, family involvement, and socioeconomic status.

Collaborations between home healthcare agencies and schools of nursing: bridging the theory-practice gap at home.

Home healthcare (HHC) agencies and schools of nursing (SONs) share the mutual goal of using evidence-based knowledge to deliver care while fostering a professionally stimulating environment. As HHC agencies strive to deliver clinically effective, cost-efficient, patient-centered nursing care, SONs use scholarly methods to develop sound practitioners with investigative skills. Collaborations have long existed between these two entities, but few studies describe how theory and practice meld in the ever-growing HHC arena.

Teambuilding across healthcare professions: the ELDER project.

Background: The key to ensuring quality care for older adults is a nursing workforce that collaborates across professions and provider levels (Wright M.C., Phillips-Bute, B.

Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization.

Objectives: In patients with acute coronary syndrome (ACS), we sought to: 1) describe arrhythmias during hospitalization, 2) explore the association between arrhythmias and patient outcomes, and 3) explore predictors of the occurrence of arrhythmias.

Methods: In a prospective sub-study of the IMMEDIATE AIM study, we analyzed electrocardiographic (ECG) data from 278 patients with ACS. On emergency department admission, a Holter recorder was attached for continuous 12-lead ECG monitoring.

Nursing students identify fears regarding working with diverse critically ill patients: development of guidelines for caring for diverse critically ill older adults.

Undergraduate students need to gain more exposure to communicating, assessing, and planning appropriate care and evaluating outcomes of care with diverse critically ill geriatric patients. This project developed teaching strategies that facilitated additional opportunities for gaining these valuable learning experiences for students. Nurse educators can use the Guidelines for Caring for Diverse Critically Ill Older Adults, the case study and simulation examples, and topical outline to assist them in teaching critical care students and nurses about diverse critically ill older adults.

Medication management at home: enhancing nurse's skills and improving patient satisfaction--a longitudinal study.

The purpose of this longitudinal study was to improve nurse medication management skills during home care (HC) visits, and thus improve care quality and the related patient ratings of nurse performance. Nurses completed presurveys asking how often they asked to see, taught about, and explained side effects of patient medications. Two focus groups were held with HC nurses to determine barriers to provision of such medication interventions, followed by presentation of a series of 5 medication-related educational sessions.