Author Archives: Amy

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About Amy

Clinical Informationist at EUH Branch Library

Does nonsurgical pain interfere with rehabilitation activities in patients who’ve had total knee arthroplasty?

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Search Method

Searched PubMed, CINAHL, and EMBASE for combinations of these concepts:

  • Pain – etiology, drug therapy, prevention and control
  • Postoperative period or postoperative care
  • Rehabilitation OR physical therapy OR physiotherapy
  • Factors that interfere with rehabilitation (looked for these terms:  interfere* OR delay* OR prohibit*)
  • Arthroplasty/rehabilitation
  • Comparative study or clinical trial or cohort study or prospective study

Search Results
One article differentiated between pain associated with surgery and other pain:
Wittig Wells, Deborah R, Susan EShapiro, and Melinda KHiggins. “Patients’ experiences of pain in the 48 hours following total knee arthroplasty.” Orthopedic nursing 32.1 (2013):39-44.

View a selected collection of other studies on postoperative care of arthroplasty patients in this PubMed collection.

Reviewed and updated 4/30/2014 ldt

What effect does standard clinical attire to help patients recognize different caregivers have on patient satisfaction?

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Search Methods
Searched PubMed and CINAHL for combinations of the following concepts:
dress OR attire OR uniforms
patient satisfaction
patient attitudes or perception
allied health personnel
patient care team
identification
nurse’s role

Search Results
Below are selected studies applying mostly to a general patient population. There are also studies about specific patient populations, such as behavioral health units.

PubMed
Relevant studies are in this PubMed collection.
These are observational studies of patient’s perception of nursing attire.

CINAHL
Title: An evidence-based approach to creating a new nursing dress code: a survey of patients reveal what nurses should — and shouldn’t — wear.
Authors: Windle L ; Halbert K ; Dumont C ; Tagnesi K ; Johnson K
Source: American Nurse Today (AM NURSE TODAY), 2008 Jan; 3(1): 17-9

Title: Dress code debate.
Authors: Kaser M ; Bugle LW ; Jackson E
Source: Nursing Management (NURS MANAGE), 2009 Jan; 40(1): 33-8
COMMENT: This small study included 20 patients and their family members and 12 nurses who represented children’s units. The preference of being able to distinguish nurses from other healthcare staff did come up in this study.

Title: Use of non-conventional nurses’ attire in a paediatric hospital: a quasi-experimental study.
Authors: Festini F ; Occhipinti V ; Cocco M ; Biermann K ; Neri S ; Giannini C ; Galici V ; de Martino M ; Caprilli S
Source: Journal of Clinical Nursing (J CLIN NURS), 2009 Apr; 18(7): 1018-26
COMMENT: Investigates parents and children’s (N=112) attitudes toward multi-colored v. white uniforms for nurses. Parents expressed preference for being able to distinguish nurses from other staff.

Title: True colors: more hospitals turn to standardized attire for nurses to better identify them to patients and to polish their professional image.
Authors: Gaskill M
Source: NurseWeek (15475131) (NURSEWEEK (S CENTRAL)), 2004 Oct 4; 11(21): 20-1

Reviewed and updated 4/16/2014

Are there studies on management of pain not related to surgery in postoperative patients?

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There are no studies addressing management of pain not related to surgery in postoperative patients.

Search Method

Searched PubMed, CINAHL, and EMBASE for different combinations of these concepts:

  • Pain – etiology, drug therapy, prevention and control
  • Postoperative period or postoperative care
  • Rehabilitation OR physical therapy OR physiotherapy
  • Factors that interfere with rehabilitation (looked for these terms:  interfere* OR delay* OR prohibit*)
  • Arthroplasty/rehabilitation
  • Comparative study or clinical trial or cohort study or prospective study

Reviewed 4/29/2014 ldt

 

In taking a blood sample from a central venous catheter for evaluating a catheter-related infection, does discarding initial blood make a difference in contamination of the sample?

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Bottom line: In samples drawn from central venous catheters, there may not be much difference between the contamination rate of the discard and that of the blood drawn after the discard.

Summary: Dwivedi S, Bhalla R, Hoover DR, Weinstein MP.  Discarding the initial aliquot of blood does not reduce contamination rates in intravenous-catheter-drawn blood cultures. J Clin Microbiol. 2009 Sep;47(9):2950-1.
This prospective study compared contamination rates of cultures of the discards to cultures of the sample taken after the discard for 653 consecutive samples on three oncology nursing units. RESULTS: Overall contamination rate was 10.9% for the discard vial versus 10.5% for the standard vial (p=0.90).

Reviewed 4/15/2014 ldt

Does taking calf and thigh measurements weekly prevent complications from lower extremity DVTs in acute rehabilitation patients?

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JAMA 1998 Apr 8;279(14):1094.
This systematic review of clinical assessment and tests for diagnosing DVTs found that leg swelling (as with other symptoms and signs, see Table 2) occurred in patients with and without DVTs. Presence of 1 or more of these signs (pain, tenderness, edema, Homans sign, swelling or erythema) did not have good positive or negative likelihood ratios for diagnosing or ruling out DVT (see Table 3 for LRs from various studies. Now various clinical prediction rules have been developed that combine clinical assessment with test results.

Phys Ther 2004 Aug;84(8):729. This review suggests physical therapists should screen for DVT using such a clinical decision rule and refer any patients with 3 points or more to physician immediately for possible further testing. Points based on the following:
Add 1 point each for
1. active cancer
2. paralysis, paresis or recent plaster immobilization of lower extremities
3. recent episode of being bedridden after major surgery
4. localized tenderness
5. leg swelling
6. calf swelling > 3 cm compared with asymptomatic leg
7. pitting edema
8. collateral superficial veins
Subtract 2 points if alternative diagnosis as or more likely than DVT. Limitations:  This review focused on outpatients.

Reviewed 4/21/2014 ldt

Which weight is used for weight-based medication dosing: daily, dry, admission, or wet?

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Burcat S, Kelly M.  Calculating doses and flow rates and administering continuous intravenous infusions.  In:  AACN Procedure Manual for Critical Care, Wiegand D, ed.  Elsevier/Saunders, 2011,  p. 1243.

According to authors, the choice of which weight to use is inconsistent in the literature.   They advocate using admission weight for consistency and consulting a clinical pharmacist in the case of an obese patient or for dosing medications that can have “dangerous toxicities.”

For articles discussing issues of weight-based dosages for specific medications, use PubMed and add “AND weight-based” to a search for the drug.

Reviewed 4/15/2014 ldt

What is the recent published evidence on risks and best practices for transporting critically ill patients within the hospital?

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Here are references from a PubMed search of the question concepts:  tranportation within the hospital and critically ill patients.  For a more specific search, add an outcome term to the search.

(“Transportation of Patients”[MeSH Terms] OR transport OR “Patient Transfer”[mesh terms]) AND intrahospital AND (critical care OR critically ill OR critical illness OR critical illnesses) Limit:  English

These references include reviews, prospective and retrospective studies, and guidelines.

Reviewed 4/15/2014 ldt