What is the evidence of the effects of electrolyte imbalances and fluid resuscitation on outcomes for patients undergoing surgery? Of particular interest is the population of cardiac surgery patients.

ELECTROLYTE IMBALANCES

A review of evidence in DynaMed identified the following:

Hyponatremia, Prognosis Section Large cohort study (N=950,000+ patients having major surgery).  Patients with preoperative hyponatremia had statistically significantly higher rates of 30-day all-cause mortality,perioperative major coronary events,wound infections, and pneumonia as compared to patients with normal sodium levels.  Arch Intern Med 2012 Oct 22;172(19):1474,

Hypokalemia, Complications Section.  A large prospective cohort study of patients undergoing elective coronary artery bypass grafting showed that patients with hypokalemia may have increased odds of having a perioperative arrhythmia and need for CPR.  JAMA 1999 Jun 16;281(23):2203

A PubMed search (“hypocalcemia”[mesh] OR “hypercalcemia”[mesh] OR “hyperkalemia”[mesh] OR “hypokalemia”[mesh] OR “hypophosphatemia”[mesh] OR “hyperphosphatemia”[mesh]) AND (“Surgical Procedures, Operative”[Mesh]) AND (case-control OR cohort study OR retrospective) identified several additional studies which are available in this MyNCBI Collection.

FLUID RESUSCITATION

Consult the book “Clinical Fluid Therapy in the Perioperative Setting”, 2011.  It is available in the EUH Library and cites evidence for fluid therapy in various settings.

In PubMed, this search will include reports of clinical trials that address fluid therapy in perioperative care of cardiac surgery patients:

(“Isotonic Solutions”[Mesh] OR “Fluid Therapy”[Mesh] OR “Ringer’s solution, potassium-free” [Supplementary Concept] OR “Ringer’s lactate” [Supplementary Concept] OR “bicarbonated Ringer’s solution” [Supplementary Concept] OR “Ringer’s solution” [Supplementary Concept] OR “crystalloid solutions” [Supplementary Concept] OR “Plasmalyte A” [Supplementary Concept] OR “Plasmalyte R” [Supplementary Concept] OR hetastarch) AND “Perioperative Care”[Mesh] AND ( “Thoracic Surgery”[Mesh] OR “Cardiac Surgical Procedures”[Mesh] ) Limits: Clinical Trials, Meta-analysis, Systematic Review

Effectiveness of music therapy as an adjunct to pharmacological pain relief in post-operative patients

Relevant articles will be found in PubMed using the search strategy listed below. To execute the search:
1. Go to www.health.library.emory.edu and then click on the PubMed link on right side of page.
2. When PubMed opens, copy/paste this search strategy in the search box (articles):
(“perioperative care”[Mesh] OR “perioperative care” [all fields] OR postoperative) AND (“music therapy”[Mesh] OR “music therapy”[all fields]) AND pain

impact of use of diapers in development of pressure ulcer and other skin related issues

Articles dated within the last ten years that are specific to the topic based on skimming the full text:

Sugama, Junko, et al. “Efficacy of an improved absorbent pad on incontinence-associated dermatitis in older women: cluster randomized controlled trial.” BMC Geriatrics 12(2012):22-22.

Shannon, Ronald J, LynneBrown, and DebashishChakravarthy. “Pressure Ulcer Prevention Program Study: a randomized, controlled prospective comparative value evaluation of 2 pressure ulcer prevention strategies in nursing and rehabilitation centers.” Advances in Skin & Wound Care 25.10 (2012):450-464.

Fader, Mandy, et al. “Management of night-time urinary incontinence in residential settings for older people: an investigation into the effects of different pad changing regimes on skin health.” Journal of clinical nursing 12.3 (2003):374-386.

Shigeta, Yoshie, et al. “Factors influencing intact skin in women with incontinence using absorbent products: results of a cross-sectional, comparative study.” Ostomy/Wound Management 56.12 (2010):26-28, 30-33.

Schindler, Christine A, et al. “Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care.” American journal of critical care 20.1 (2011):26-34.

Nix, Denise. “Prevention and treatment of perineal skin breakdown due to incontinence.” Ostomy/Wound Management. 52.4 (2006):26-28.

Whether nurses who receive evidence-based practice/evidence-based nursing (EBP/EBN) training are more likely to implement EBP projects

White Williams, Connie, et al. “Use, knowledge, and attitudes toward evidence-based practice among nursing staff.” The Journal of Continuing Education in Nursing 44.6 (2013):246-54.

Levin, Rona F, et al. “Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the advancing research and clinical practice through close collaboration model.” Nursing administration quarterly 35.1 (2011):21-33.

Johansson, Birgitta, MarieFogelberg Dahm, and BarbroWadensten. “Evidence-based practice: the importance of education and leadership.” Journal of nursing management 18.1 (2010):70-77.

Kiss, Teri L, MaureenO’Malley, and Thomas JHendrix. “Self-efficacy-based training for research literature appraisal: a competency for evidence-based practice.” Journal for nurses in staff development 26.4 (2010):170-177.

Strickland, Rosemary J, and ColleenO’Leary Kelley. “Clinical nurse educators’ perceptions of research utilization: barriers and facilitators to change.” Journal for nurses in staff development 25.4 (2009):164-71.

Mehrdad, Neda, MahvashSalsali, and AnooshiravanKazemnejad. “The spectrum of barriers to and facilitators of research utilization in Iranian nursing.” Journal of clinical nursing 17.16 (2008):2194-2202.

Morris, Jenny, and VeronicaMaynard. “The value of an evidence based practice module to skill development.” Nurse Education Today 27.6 (2007):534-541.

Caldwell, Kay, et al. “Preparing for professional practice: how well does professional training equip health and social care practitioners to engage in evidence-based practice?.” Nurse Education Today 27.6 (2007):518-528.

Olade, Rosaline A. “Attitudes and factors affecting research utilization.” Nursing forum 38.4 (2003):5-15.
Though this article does not address the question of whether nurses who receive EBP training are more likely to implement EBP projects, this article includes a survey that may be of use in a future study.

McCleary, Lynn, and G T TBrown. “Research utilization among pediatric health professionals.” Nursing and health sciences 4.4 (2002):163-171.

Wyatt, J C, et al. “Randomised trial of educational visits to enhance use of systematic reviews in 25 obstetric units.” BMJ. British medical journal 317.7165 (1998):1041-1046.

 

Invasive blood pressure (BP) versus non invasive BP monitoring in ICU patients

Searches of PubMed, Embase, and CINAHL yielded this one meta-analysis and two systematic reviews.

Kim, Sang-Hyun, et al. “Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis.” Anesthesiology 120.5 (2014):1080-1097.
Twenty-eight studies with 919 patients were included in this systematic review. “The overall random-effect pooled bias and SD were -1.6 ± 12.2 mmHg (95% limits of agreement -25.5 to 22.2 mmHg) for systolic arterial pressure, 5.3 ± 8.3 mmHg (-11.0 to 21.6 mmHg) for diastolic arterial pressure, and 3.2 ± 8.4 mmHg (-13.4 to 19.7 mmHg) for mean arterial pressure. In 14 studies focusing on currently commercially available devices, bias and SD were -1.8 ± 12.4 mmHg (-26.2 to 22.5 mmHg) for systolic arterial pressure, 6.0 ± 8.6 mmHg (-10.9 to 22.9 mmHg) for diastolic arterial pressure, and 3.9 ± 8.7 mmHg (-13.1 to 21.0 mmHg) for mean arterial pressure.
CONCLUSIONS: The results from this meta-analysis found that inaccuracy and imprecision of continuous noninvasive arterial pressure monitoring devices are larger than what was defined as acceptable. This may have implications for clinical situations where continuous noninvasive arterial pressure is being used for patient care decisions.”

Ben Sivarajan, V, and DesmondBohn. “Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2.” Pediatric critical care medicine 12.4 Suppl (2011):S2-S11.
The conclusion of this systematic review states, “literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography, and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.”

Chatterjee, Arjun, et al. “Results of a survey of blood pressure monitoring by intensivists in critically ill patients: a preliminary study.” Critical care medicine 38.12 (2010):2335-2338.
“Eight hundred eighty individuals received an invitation to complete the survey and 149 responded. We found that 71% (105 of 149) of intensivists estimated the correct cuff size rather than measuring arm circumference directly. In hypotensive patients, 73% of respondents (108 of 149) reported using noninvasive blood pressure measurement measurements for patient management. In patients on a vasopressor medication, 47% (70 of 149) of respondents reported using noninvasive blood pressure measurement for management.”

Increasing employee safety using closed system transfer devices

Miyake, Tomohiro, et al. “Impact of closed-system drug transfer device on exposure of environment and healthcare provider to cyclophosphamide in Japanese hospital.” SpringerPlus 2.1 (2013):273-273.

Wick, Catherine, et al. “Using a closed-system protective device to reduce personnel exposure to antineoplastic agents.” American journal of health-system pharmacy 60.22 (2003):2314-2320.

Sessink, Paul J M, JasonTrahan, and Joseph WCoyne. “Reduction in Surface Contamination With Cyclophosphamide in 30 US Hospital Pharmacies Following Implementation of a Closed-System Drug Transfer Device.” Hospital pharmacy 48.3 (2013):204-212.

Yoshida, Jin, et al. “Use of a closed system device to reduce occupational contamination and exposure to antineoplastic drugs in the hospital work environment.” Annals of occupational hygiene 53.2 (2009):153-160.

Favier, B, et al. “The PhaSeal system: impact of its use on workplace contamination and duration of chemotherapy preparation.” Journal of oncology pharmacy practice 18.1 (2012):37-45.

Harrison BR; Peters BG; Bing MR Comparison of surface contamination with cyclophosphamide and fluorouracil using a closed-system drug transfer device versus standard preparation techniques. American Journal of Health-System Pharmacy 2006 Sep 15; 63 (18): 1736-44.

Respiratory protective equipment: Cytotoxic Drugs. 2017

Gowns, Coveralls, and Overshoes: Cytotoxic Drugs. 2017

Sharma, Laveena [PhD (BiomedSc)]. Cytotoxic Drugs: Handling. 2017

Searched: PubMed, CINAHL, Joanna Briggs. Keywords: PhaSeal, Closed System Transfer device, safety

Updated links for entries from Joanna Briggs, 10/16/2017 ldt

What are some effective methods for effective and timely discharge?

Effective discharge planning — timely assignment of an estimated date of discharge.” Australian health review 35.3 (2011):357.

Hospitalist case managers save money, bed days for IPA: on-site staff help ensure timely discharge.” Case management advisor 20.3 (2009):25.

Lennard, C.Productive Ward initiative promotes better communication between mental health teams and ensures timely discharge for patients. Journal of Psychiatric & Mental Health Nursing , 2014 Feb; 21 (1): 93-6. (23 ref)

Greene J; Caldwell G; McVeigh A; Rankin MG; Sheeran C Timely and effective hospital discharge for older people: a person centred approach. International Journal of Clinical Leadership (INT J CLIN LEADERSH), 2008; 16 (1): 49-57.

Jimenez, Jeanne; DeSanto, Andrea Timely Discharge of Clinically Eligible Patients in the Postpartum Setting.
JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing (JOGNN), 2011 May; 40: S79.

Hospital discharge (pediatric asthma patients): Criteria Led Discharge. Streak, Judith [(nee Gomersall) BA Hons Hons MCom PhD].
[Evidence Summaries] 2013

Hospital Discharge (Patients with Community Acquired Pneumonia): Criteria Led Discharge.
Fong, Eric [MBBS]. [Evidence Summaries] 2016

Updated links 10/12/2017 ldt