Posts Tagged ‘Evidence-based medicine’

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The 10 Most Popular Articles on AJN Right Now

October 11, 2013
From boliston, via Flickr

From boliston, via Flickr

The 10 current “most viewed” AJN articles are below. Sometimes we’re surprised by the ones that go to the top of this list. At other times, the high interest in the article makes perfect sense. Most of these articles are currently free, either because they are CE articles or because they are shorter opinion pieces or the like. We hope you’ll have a look.—Jacob Molyneux, senior editor

“The Care of Pregnant Women in the Criminal Justice System” 

CE article. Overview: Current practices in the treatment and transfer of pregnant inmates in this country may negatively affect maternal and fetal health or well-being. Some violate federal or state laws; others conflict with standards of obstetric care and are widely considered unethical or inhumane. This article discusses these practices; their legal status; and implications for nursing practice, policy, and research.

“Developing a Vital Sign Alert System”

CE. Overview: This article describes the implementation of a nurse-designed, automated system for enhancing patient monitoring on medical–surgical and step-down nursing units. The system . . . was found to substantially reduce out-of-unit codes without increasing nurses’ workload.

“Mouth Care to Reduce Ventilator-Associated Pneumonia”

CE. Overview: Despite the well-established association between good oral hygiene and the prevention of VAP, the importance of mouth care in infection control is seldom recognized. The authors discuss the pathophysiology of VAP and why oral care is crucial to its prevention. They also provide an evidence-based, step-by-step guide to providing optimal oral care for intubated patients.

“Decreasing Patient Agitation Using Individualized Therapeutic Activities”

CE. Overview: Hospitalized patients who are suffering from cognitive impairment, delirium, suicidal ideation, traumatic brain injury, or another behavior-altering condition are often placed under continuous observation by designated “sitters.” These patients may become agitated, which can jeopardize their safety even when a sitter is present. This quality improvement project was based on the hypothesis that agitation can be decreased by engaging these patients in individualized therapeutic activities. . . .

“Loneliness and Quality of Life in Chronically Ill Rural Older Adults” 

Original Research CE. Overview: Background: Loneliness is a contributing factor to various health problems in older adults, including complex chronic illness, functional decline, and increased risk of mortality. Objectives: A pilot study was conducted to learn more about the prevalence of loneliness in rural older adults with chronic illness and how it affects their quality of life. . . .

“Evidence-Based Practice: Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice”

Free. Part of AJN‘s evidence-based practice (EBP) series. Excerpt: “A spirit of inquiry is the foundation of EBP, and once nurses possess it, it’s easier to take the next step—to ask the clinical question. Formulating a clinical question in a systematic way makes it possible to find an answer more quickly and efficiently, leading to improved processes and patient outcomes.” Read the rest of this entry ?

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Using Evidence-Based Practice to Reduce CAUTIs

May 31, 2013

By Karen Roush, AJN clinical managing editor

Using evidence-based practice to . . .

Fill in the blank. There’s something on your unit that could be improved—the rate of ventilator-associated pneumonia (VAP), the engagement of family in care, the readmission rate of patients with heart failure, patient satisfaction with pain management. Whatever it may be, you have the ability to improve it. This month we have a CE article (link is below) about an evidence-based practice (EBP) project to reduce catheter-associated urinary tract infections (CAUTIs).

Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC

Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC

The really interesting thing about this article, and what makes it especially helpful for beginner quality improvers out there, is that it doesn’t just describe an effective project to reduce CAUTIs. It also describes how to do an EBP project, step-by-step. The author, Tina Magers, a novice EBP mentor, followed the seven steps outlined in AJN’s Evidence-Based Practice series and describes the actions involved in each step. It’s a great how-to on applying evidence to practice. Here’s the overview/abstract of this useful June CE article, “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections”:

Overview: In November 2009, AJN launched a 12-part series, Evidence-Based Practice, Step by Step, authored by nursing leaders from the Arizona State University College of Nursing and Health Innovation’s Center for the Advancement of Evidence-Based Practice. Through hypothetical scenarios, based on the authors’ collective clinical experience, the series illustrated the seven steps of evidence-based practice (EBP), defined as “a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.” This article reports on an EBP project in which the seven-step approach to EBP described in the AJN series was used to reduce the incidence of catheter-associated urinary tract infection among adult patients in a long-term acute care hospital by reducing the duration of catheterization.

Keywords: catheter-associated urinary tract infection, evidence-based practice, hospital-acquired infection, nurse protocol, quality improvement, urethral catheterization

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Article Types, Topics of Interest, and Other Considerations for Prospective AJN Authors

March 14, 2013

iPad app exhibit AORNBy Maureen Shawn Kennedy, AJN editor-in-chief

I recently wrote a post that attempted to give readers a clearer sense of what we are looking for in article submissions and what we are not looking for: “My Professor Said to Submit My Paper (We Hope They Also Told You This).”

This post will just provide a quick overview of the types of articles we publish, as well as a plug for why it’s good to be published in AJN.

In terms of impact factor, AJN ranks 29/95 among ranked nursing journals, with an impact factor of 1.119. (Nursing journals with higher impact factors tend to be specialty research journals, whereas AJN publishes a broad range of content in addition to research, and for a variety of audiences.) Through our robust print, digital, iPad, institutional, and social media channels, AJN reaches more nurses than any other nursing journal.

We publish original research, quality improvement (QI), and review articles as primary feature articles and as CE articles. We also publish shorter, focused columns. All submissions must be evidence based and are peer-reviewed.

Clinical features should cover epidemiology, pathology, current research/“what’s new” in knowledge and/or treatment, nursing implications. There is no specific limit for word count, though feature articles are usually in the range of 6,000 to 10,000 words. (We have done two-part and three-part series for larger papers.) For examples of feature articles, see any of the CE articles on our Web site, www.ajnonline.com.

Some specific clinical topics we are currently seeking articles about:

Sedating patients with dementia; pleural effusions; pneumonia; treatment options for chronic pain (or articles on other aspects of pain management); rheumatoid arthritis; most pediatric topics; hypertensive emergencies; strokes, seizures (and other neuro topics); approaches to managing prostate and ovarian cancer; adverse effects from therapies; updates on managing arrhythmias, rosacea, scoliosis and other orthopedic topics, progressive mobility

Columns are shorter, focused papers of 2,000–3,000 words. AJN columns (some monthly, some more intermittent) include:

Emerging Infections, Disaster Care, Emergency, Environments and Health, Correspondence from Abroad (international topics), In Our Community, Policy and Politics, Wound Care, iNurse, Diabetes Under Control, Professional Development, plus occasional columns that take an in-depth look at new research or treatment topics or provide drug updates for specific conditions.

Cultivating Quality is the section for QI reports (authors should follow the SQUIRE guidelines as detailed in the author guidelines).

And in several shorter columns, we publish opinion pieces (Viewpoint), narratives/personal essays (Reflections), and poetry and art (Art of Nursing).

We encourage all prospective authors to review AJN articles at www.ajnonline.com prior to submitting.

For author guidelines and submission information (do please read these, noting word limits and other important details; some specific columns have their own guidelines): www.editorialmanager.com/ajn.

Queries can be sent to alison.bulman@wolterskluwer.com. Note that all queries should include the article idea, including its focus; an abstract and outline; length of paper and target date for submission; background of all authors and their qualifications to write on the subject; the topic’s relevance to nursing today. Queries about completed papers should also give these same details about the paper. Please do not submit a paper as a query.

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‘Patient Activation’: Real Paradigm Shift or Updated Jargon?

February 7, 2013

By Jacob Molyneux, AJN senior editor

I attended a Health Affairs briefing yesterday in Washington, DC. Based on the February issue of the journal, it was called “A New Era of Patient Engagement.” A lot of research money appears to have been flowing to this area in recent years.

Our January article on "Navigating the PSA Screening Dilemma" includes a discussion of 'shared decision making'

Our January article on “Navigating the PSA Screening Dilemma” includes a discussion of ‘shared decision making’

The basic idea isn’t entirely new to anyone who’s been hearing the term “patient-centered care” for a long time: as Susan Dentzer writes in “Rx for the ‘Blockbuster Drug’ of Patient Engagement,” a useful article summarizing the main ideas raised in the Health Affairs issue: “Wherever engagement takes place, the emerging evidence is that patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs, than those who aren’t.”

One might add to these projected benefits: better experiences as patients.

Something’s got to change, so why not this? If many nurses feel they’ve heard all this before, the sense of a health care system in necessary flux is particularly acute right now, with mounting pressures from an aging Baby Boom generation with its full complement of chronic conditions, not to mention federal budget constraints and the influx of patients expected from the Affordable Care Act. It’s unlikely we’d be talking so much about patient engagement if we weren’t facing, perhaps as never before, the need to do something about the glaring gap between costs and quality in the U.S. health care system.

Patient activation. A term that got a huge amount of use at the briefing was “patient activation.” Hibbard and colleagues define it thus, in an article on the the evidence for cost reductions associated with patient activation: “understanding one’s own role in the care process and having the knowledge, skills, and confidence to take on that role.” Some examples of patient activation they cite are patients with type 2 diabetes performing regular foot checks and keeping a glucose diary, or patients who regularly exercise and get relevant screenings.

Don’t write off certain type of patients. Many of the presenters emphasized that it’s important to see patient activation as a possibility for every patient, whatever their socioeconomic level, disease severity, or cognitive limitations. As Hibbard put it, “there are more or less activated patients in every demographic.” Providers need to meet patients where they are and, as Marion Danis put it in an article on the ethical justification for getting patient activation right, set goals and have realistic expectations.

The physician problem. Many presenters noted that, without support from the health care system, individual efforts may not make much of a difference. In addition, physician resistance was mentioned repeatedly, whether attributed to their lack of time, their skepticism, or the overly common belief that more expensive care is always better. Bernabeo and colleagues observed that even those physicians who advocate shared decision making may not always engage in it. Their article on necessary competencies posits four crucial elements for true patient engagement: system support, providing patients with decision aids, collaborations and teamwork (can anyone say nurses?), and new reimbursement models.

Lin and colleagues, in looking at efforts to distribute decision aids in primary care practices, also noted physician-based problems with furthering patient activation, discovering that physicians

  • didn’t see a role for patients in their own care.
  • believed they lacked the time to give them decision aids.
  • didn’t see a potential benefit in doing so.

They also found, again unsurprisingly, that clinical support staff embraced the concept far more than the physicians did. Read the rest of this entry ?

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On Cats Sucking the Breath Out of Babies, and Other Health Superstitions

February 15, 2012

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

I recently babysat a friend’s busy toddlers, and was happy to share the long (but lovely) day with a good friend who happens to also be a nurse. We’d just gotten the babies tucked into their cribs and were stepping out of the nursery with a sigh when I noticed the family’s cat lounging in a padded rocking chair, blinking lazily at us.

“Wait!” I said, scooping up the cat. “We can’t leave the cat here. Cats suck the breath out of babies!”

My friend looked at me like I’d lost my mind, and I instantly wished that I hadn’t said it.  The absurdity of the statement was clear to me. And yet it felt like a truth I’d known forever, even if I couldn’t remember why.

As it turns out, it was something I was told as a child—by my grandmother. Knowing this makes my statement make sense, at least to me, as I adored my grandma and would have accepted anything she told me as undisputed truth. Even so, I’m surprised (and a little embarrassed) that in spite of higher education and years of nursing experience, despite the obvious physiologic impossibility of a cat sucking the breath from a baby, and despite the fact that I’ve had my own children, and cats, such a notion was lying dormant in my consciousness and escaped unexpectedly and unbidden.

In my curiosity about the idea of cats sucking breath from babies, I came across a 1930 book, Shattering Health Superstitions, by Morris Fishbein, MD. It’s subtitled “An Explosion of False Theories and Notions in the Field of Health and Popular Medicine.” Dr. Fishbein discusses 57 medical claims, asserting their fallacy only after explaining their origin.

Here are some of the chapter titles, verbatim:

  • Some people think that fish is a brain food and that a lot of mackerel in the diet will convert a moron into an Einstein.
  • Some people believe that warts can be removed by tying knots in a string and burying the string at a crossroads in the moonlight.
  • Some people think appendicitis is just an old-fashioned stomach ache and that the doctors developed the disease for their own satisfaction.
  • An apple a day keeps the doctors away.
  • When the oldest inhabitant begins to feel pain in his joints, there is going to be a change in the weather.
  • It takes whiskey to kill a cold.
  • A favorite Midwestern cure for rheumatism is to carry a buckeye in the trousers pocket.
  • Kissing can cause trouble, but it doesn’t cause cold sores.
  • Most people believe that a big head is sure evidence of a massive intellect.

While there may be a shred of truth in a couple of the beliefs alluded to in these chapter titles (many people with arthritis certainly do report worsening symptoms with changes in the weather; many claims have been made for the benefits of fish oil of late; etc.), most have as much basis as certain more recent widely held beliefs regarding the various evils of vaccinations. Read the rest of this entry ?

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Killing Traditional Nursing Duties #3 – NPO after Midnight

October 11, 2011
fasting Buddha/ via Wikipedia Commons

By Shawn Kennedy, editor-in-chief

In early August, on our Facebook page, we asked if there were “old nursing habits” that should be killed off. We received a lot of feedback, which we described in a blog post called “Killing Traditional Nursing Duties #1.” We did another post on the answers to our second question, “When you give IM injections, what site do you most often use—dorsogluteal (upper outer quadrant of buttocks), ventrogluteal (lateral hip), or deltoid (upper arm)?” This also got many comments in response.

Our last question was this:Does your institution routinely follow ‘NPO after midnight’ for preoperative patients?” Here’s some of the comments we received on the blog:

My institution does follow the NPO after midnight for preop patients. I sometimes disagree d/t the time patients may be going to surgery. If a patient is not scheduled for the OR until the following day at 5 pm, why should they have to be NPO after midnight the night before?

…most of the younger anesthesiologists/CRNA’s allowed BLACK COFFEE to be drunk right up until time  of surgery. No dairy or sugar in it, obviously.

The facility that I work for does routinely follow ‘nothing by mouth’ after midnight guidelines. If the patient  is scheduled for a late surgery I may call the doctor and request that the orders be altered and in most cases the doctor’s are agreeable and will change the orders, writing NPO after midnight with the exception of clear liquids.

Responses on Facebook, however, showed a stricter adherence to the traditional no eating or drinking after midnight before surgery; it was fairly unanimous that institutions still follow this ancient practice (though one person did ask, “What’s npo?”!).

Well, it’s clear that this month’s CE article by Jeannette Crenshaw is sorely needed. “Preoperative Fasting: Will the Evidence Ever Be Put into Practice?” addresses the fact that despite 25 years of evidence and standards showing that NPO after midnight is not good practice, it is still used in most hospitals and preoperative practices. The evidence support clear liquids up to a few hours before surgery, and many groups have endorsed carbohydrate-rich beverages along with clear liquids up to a few hours before surgery.

So read Crenshaw’s article and disseminate it to your colleagues and clinical practice committees—practice changes should be based on evidence, and for this, the evidence is clear.

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The Five Most Popular Articles at AJN

July 18, 2011

Amanda Geer, AJN administrative coordinator—We look at the statistical views and visits of users at AJN‘s home page to determine our most viewed articles, how many visitors listen to our podcasts, what day of the week we get the most traffic, and a number of other categories to make sure we keep up to date on what matters to our readers. We also look at what our users search for. Some of the most common keyword(s)/phrases are evidence-based practice, research, diabetes, cancer, and stroke. We also look at our most popular articles. For the last few months, the following five articles have dominated our top 10 chart (in an upcoming post, we’ll look at the most popular articles on this blog):

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