Advanced emergency nursing journal
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The goal of this project was to assess perceptions of medication reconciliation from health care professionals who perform this task. Specific areas of interest included the perceived amount of time spent on medication reconciliation; process complexity; and effectiveness of the current process. Opinions concerning the use of alternative processes were also solicited. ⋯ Participants felt that emergency triage may not be the most ideal time in which to perform medication reconciliation, and they expressed concerns about accuracy of these medication lists. Whereas some were interested in the possibility of using a patient medication database and expected that it would improve accuracy and save time, others were less open to a perceived additional step. Participants provided suggestions for changes in the current medication reconciliation process that they feel could improve patient satisfaction and increase efficiency.
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Community-acquired pneumonia (CAP) is a significant clinical and public health problem. Recently, attention has been paid to the potential for procalcitonin (PCT) both to differentiate the diagnosis and to indicate the prognosis of pneumonia. ⋯ The literature review suggests that PCT has the ability to supplement clinical information to determine whether or not the cause of the infection is likely to be bacterial. In addition, PCT seems to be superior to the most prevalent inflammatory biomarker C-reactive protein and also demonstrates a significant correlation between the current clinical scoring systems and actual mortality.
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Musculoskeletal disorders (MSDs) represent one of the most common occupational problems in nursing. MSDs can negatively impact one's quality of life. The aim of the study was to investigate the relationship between MSDs, job demands, and burnout among emergency nurses. ⋯ Multiple linear stepwise regression analysis identified the score of job demand and the severity of lower back pain as positive independent predictors of the burnout whereas the job demand score was the independent predictor of the number of MSDs. This study documents an increased prevalence of MSDs among emergency nurses, as predicted by increased job demand and associated with a higher level of burnout. Hence, it is important for hospital and nursing administrators to address the factors contributing to job stress and burnout, with emphasis on job satisfaction and work organization to alleviate the burden of psychosocial factors in this setting.
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Morbidly obese patients present safe patient handling challenges to emergency department (ED) personnel. Emergency departments are often ill-equipped to safely manage the patient of this size. The purpose of this study was to develop an assessment tool to determine ED readiness to safely manage the morbidly obese patient. ⋯ Four of 5 hospital EDs agreed that the tool was easy to use and helpful in determining their readiness to safely manage the morbidly obese patient. The tool was found to be usable on a limited basis. Additional application of the tool on a larger scale is recommended.
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Randomized Controlled Trial
Simplifying subclavian vein cannulation using innovative landmarks: a radiologic, anatomic, and clinical study.
The objective of this study was to investigate novel and optimal landmarks for subclavian vein (SV) cannulation. We conducted the study in three phases: (a) Various possible markers for SV cannulation were evaluated by anatomic measurements in patients from intensive care unit and the course of SV was evaluated by radiologic means; (b) Results acquired by the two means were compared and adjusted, then innovative landmarks and a new approach for SV cannulation was proposed; (c) The efficacy of new approach for SV cannulation was compared with that of a traditional one by a prospective, randomized, controlled study. Point A (the junction of the lateral border of sternocleidomastoideus clavicular head and inferior border of clavicle), point B (a point on the lower border of clavicle just above the middle of the line joining the coracoid process and midline of the body), and point D (where SV crosses the inferior border of clavicle) were close in proximity. ⋯ Beginners using the new method had significantly higher success rate (86.9% vs. 70.2%, p = 0.008); the time consumed by new method was significant shorter than that by traditional one (5.9 vs. 10.4 min, p = 0.001). Points A and B could be considered as landmarks for identifying puncture site for SV cannulation. Beginners using innovative landmarks for SV cannulation could significantly reduce operation time and increase success rate.