Nursing Leader Collaboration to Drive Quality Improvement and Implementation Science.

Nursing leadership opportunities to improve quality and align resources in health care exist. An estimated 18% of United States gross domestic product is spent on health care delivery systems that produce poor outcomes. The purpose of this article was to describe how quality improvement and implementation science initiatives enhance outcomes using nursing leadership strategies that play an integral role in aligning key colleagues to drive the collaborative process.

Gastric residual evaluation in preterm neonates: a useful monitoring technique or a hindrance?

It is routine practice in most neonatal intensive care units to measure the volume and color of gastric residuals (GRs) prior to enteral bolus feedings in preterm very low birth weight infants. However, there is paucity of evidence supporting the routine use of this technique. Moreover, owing to the lack of uniform standards in the management of GRs, wide variations exist as to what constitutes significant GR volume, the importance of GR color and frequency of GR evaluation, and the color or volume standards that dictate discarding or returning GRs.

Evaluation of contraindicated drug-drug interaction alerts in a hospital setting.

Background: Risks associated with contraindicated drug-drug interaction alerts (CDDIAs) should always outweigh benefits. Misclassified CDDIAs should be eliminated.

Objective: To review CDDIAs and determine if they are contraindicated according to Food and Drug Administration-approved product labeling and if there are circumstances in which contraindicated interactions are acceptable.

When snakes bite: the management of North American Crotalinae snake envenomation.

There are more than 120 species of snakes indigenous to the United States, 25 of which are venomous. Although snake envenomation carries a relatively low risk of mortality in the United States, it can result in significant morbidity if left untreated. The venom of Crotalinae snakes contains a complex mixture of enzymatic proteins with various clinical implications.

The cannon catheter--a prospective analysis.

Clinical outcomes associated with hemodialysis catheters often depend on correct tip positioning. Improper positioning of the catheter tips can reduce blood flow and lead to long-term complications. The authors evaluated the clinical performance of the Arrow Cannon II Plus hemodialysis catheter (Teleflex Medical, Research Triangle Park, North Carolina), a catheter that was designed for tip-first (retrograde) placement to ensure accurate central positioning in the right atrium for optimal flow and minimal recirculation.

Root cause analysis and subsequent intervention to improve first dose antibiotic turnaround time for hospitalized pediatric patients.

Objective: Antibiotic timing is used as a quality standard for hospital accreditation and is an important quality measure. The study aim was to identify barriers in the process of first dose antibiotic administration on the pediatric floors at a tertiary healthcare center and carry out and test an intervention to improve turnaround time to less than one hour.

Methods: We conducted a quasi-experimental pre-post study of hospitalized pediatric patients up to 18 years of age initiated on intravenous antibiotics.

Using whiteboards: fixed identities.

Using whiteboards to help patients identify just who does what.

Efficacy and safety of oral phenylephrine: systematic review and meta-analysis.

Background: Oral phenylephrine is used as a decongestant, yet there has been no previously published systematic review supporting its efficacy and safety.

Objective: To assess the efficacy and safety of oral phenylephrine as a nonprescription decongestant.

Methods: MEDLINE, the Cochrane Central Registry of Controlled Trials, EMBASE, International Pharmaceutical Abstracts, and the Federal Register were searched for English and non-English-language studies published through January 2007 that measured the effects of oral phenylephrine on nasal airway resistance (NAR) in patients with nasal congestion.

Treatment of Burkitt's lymphoma during pregnancy.

Objective: To report a case of both successful maternal treatment outcome and normal fetal outcome in a patient who was diagnosed with Burkitt's lymphoma (BL) and aggressively treated with 6 different chemotherapy agents during the second and third trimesters of pregnancy.

Case Summary: A 21-year-old white woman was diagnosed with stage II BL of the head and neck at 26 weeks' gestation. She was treated with 2 cycles of systemic intensive polychemotherapy, including cyclophosphamide, vincristine, doxorubicin, cytarabine, etoposide, ifosfamide, mesna, and intrathecal cytarabine with growth factor support during the second and third trimesters.

New strategies of antifungal therapy in hematopoietic stem cell transplant recipients and patients with hematological malignancies.

Invasive fungal infections (IFIs) are associated with considerable morbidity and mortality among high-risk individuals. Outcomes for IFI historically have been suboptimal and associated with a high mortality rate, hence global prophylaxis strategies have been applied to at-risk populations. Among certain populations, fluconazole prophylaxis has reduced systemic and superficial infections caused by Candida species.

Health promotion in the operating room--a quality improvement project.

Rising health care costs and an aging workforce have led many companies to actively promote wellness in the workplace to help their employees and lower their health care-related costs. A quality improvement initiative examined the health status of perioperative personnel in one facility before and after they took part in an onsite fitness program.

Pharmacokinetic evaluation of the drug interaction between intravenous itraconazole and intravenous tacrolimus or intravenous cyclosporin A in allogeneic hematopoietic stem cell transplant recipients.

A single-institution, open-label prospective pharmacokinetic evaluation of the interaction between intravenous itraconazole and intravenous cyclosporin A and tacrolimus was conducted in allogeneic hematopoietic stem cell transplant recipients. The study was conducted in 2 phases, with patients acting as their own controls. In phase 1, steady-state concentrations and clearance of cyclosporin A and tacrolimus administered alone were evaluated.

The need for routine bleomycin test dosing in the 21st century.

Objective: To review the clinical evidence for routine use of bleomycin test dosing.

Data Sources: English-language review articles, references from retrieved articles, case reports, and clinical trials were identified from a MEDLINE literature search (1966-July 2005). Key search terms included bleomycin, test dose, anaphylactic reactions, and hypersensitivity.

Economic effects of aspergillosis management in high-risk patients.

Aspergillosis mortality has risen exponentially over the last 2 decades, related primarily to the availability of medical treatments and procedures that prolong the survival of patients with other disorders who are at high risk because of immunologic compromise. In addition to excess mortality, aspergillosis results in increased costs for hospitalization and treatment, including management of adverse events associated with conventional amphotericin B treatment. Compared with amphotericin B, the triazole antifungal voriconazole has excellent efficacy and a favorable side-effect profile.

Stress ulcer prophylaxis in the postoperative period.

Purpose: The implications of recent studies for guidelines that pertain to stress ulcer prophylaxis in the postoperative period are discussed.

Summary: The therapeutic guidelines on stress ulcer prophylaxis published by the American Society of Health-System Pharmacists (ASHP) provided clinicians with recommendations regarding appropriate candidates for stress ulcer prophylaxis and selection of a pharmacologic agent. Since these guidelines were published in 1999, additional research has been completed to resolve some of the controversial issues surrounding stress ulcer prophylaxis.

Infections following hematopoietic stem cell transplantation.

Numerous advances have been made in the management of infection in HSCT recipients. With increasing knowledge the authors are able to prevent several serious infections from occurring, and reduce the severity of infections once they occur. Despite these advances, several previously unrecognized pathogens have emerged and pose risks to this population.

Antiepileptic hypersensitivity syndrome in children.

Objective: To assess clinical features and outcomes of childhood antiepileptic hypersensitivity syndrome (AHS). AHS is an idiosyncratic reaction to aromatic anticonvulsants that can result in severe multiorgan dysfunction and death.

Methods: Children with suspected AHS (fever, rash, lymphadenopathy, liver dysfunction) were identified by an in-house computerized adverse drug event reporting system.

Bismuth subgallate-epinephrine paste in adenotonsillectomies.

Objective: To evaluate the role of bismuth subgallate-epinephrine (BSE) paste as a hemostatic in adenotonsillectomies.

Data Sources: MEDLINE (January 1966-October 1999) and Current Contents (January 1997-October 1999) were searched, using bismuth subgallate, adenoidectomy, tonsillectomy, and adenotonsillectomy as search terms. A citation search was performed using Science Citation Index (January 1977-October 1999).

Effect of theophylline on the warm-up phenomenon.

This study examined whether the adenosine receptor antagonist theophylline prevents the warm-up phenomenon in patients with stable angina undergoing serial exercise tests. Our findings offer evidence that adenosine does not play a role in the warm-up phenomenon, and indirectly suggest that the warm-up phenomenon does not represent ischemic preconditioning in humans.