Abstract: BACKGROUND: Cardiac rehabilitation (CR) is a long term multifactorial rehabilitation program aimed at the secondary prevention of cardiovascular events. However, delivery of CR services is less than optimal. AIM: This study explored the perceptions of cardiac rehabilitation (CR) coordinators relating to challenges for improving the delivery of CR services. METHODS: The study design used qualitative, semi-structured in-depth telephone interviews with 20 CR coordinators from NSW Australia. Interviews were transcribed verbatim and thematic content analysis was undertaken to identify common themes. RESULTS: Twenty CR coordinators participated in the study. Three major themes including obstacles to delivering cardiac rehabilitation services, challenges in achieving continuity and coordination, and complexities in delivering evidence-based health care were identified. Study findings indicate that limited service capacity due to a lack of investment and planning, rurality, lack of knowledge, and communication difficulties, are major challenges that CR coordinators need to overcome to provide effective services. CONCLUSIONS: The experiences of participants provide some detailed insight into the barriers encountered in providing CR services. The main message from this study is that providing CR services is a complex process and is collectively influenced by the health care system; professional and provider issues; and program characteristics.
Abstract: OBJECTIVE: The objective of this study was to investigate the diagnostic performance of biochemical tests used to determine placement of nasogastric (NG) tubes after insertion in adults. DESIGN: A systematic review of diagnostic studies was undertaken. DATA SOURCES: A literature search of the bibliographic databases and the World Wide Web was performed to locate original diagnostic studies in English or Chinese on biochemical markers for detecting NG tube location. REVIEW METHODS: Studies in which one or more different tests were evaluated with a reference standard, and diagnostic values were reported or could be calculated were included. Two reviewers independently checked all abstracts and full text studies for inclusion criteria. Included studies were assessed for their quality using the QUADAS tool. Study features and diagnostic values were extracted from the included studies. RESULTS: Of the 10 studies included in this review, seven investigated the diagnostic accuracy of pH, one investigated the diagnostic accuracy of pH and bilirubin respectively, two a combination of pH and bilirubin and one a combination of pH, pepsin and trypsin levels in identifying NG tube location. All studies used X-rays as the reference standard for comparison. Pooled results demonstrated that a pH of <or=4.0 had the ability to predict only 63% of the tubes located in the stomach. However, a pH value of <or=5.5 to determine gastric placement demonstrated a sensitivity of 0.89 (95% CI 0.82-0.94) and a specificity of 0.87 (95% CI 0.81-0.93). Bilirubin coupled with pH had a high specificity (0.99) which demonstrated the ability of the test to identify misplaced tubes in intestine. However, the ability of the test to correctly identify gastric placement of feeding tubes was relatively low (sensitivity<0.90). CONCLUSIONS: Due to the heterogeneity of the studies and small sample sizes, conclusions about the diagnostic performance of the different tests cannot be drawn. Better designed studies exploring the accuracy of diagnostic tests are needed to improve the diagnostic policy. Until stronger evidence becomes available practice related to the diagnostic tests used within the clinical setting will continue to be dictated by local preferences and cost factors.
Abstract: Aims This study explored the strategies used by cardiac rehabilitation (CR) coordinators to overcome the obstacles to implementation of the evidence-based Reducing Risk in Heart Disease guidelines. Methods The study design used qualitative, semistructured in-depth interviews with 20 CR coordinators from New South Wales, Australia, to explore the strategies used to facilitate guideline implementation. Non-probability sampling was used to recruit CR coordinators to obtain a broad understanding of the issues. Interviews were transcribed and thematic content analysis was undertaken to identify common themes. Results Coordinators addressed the barriers to implementing guidelines through their commitment to best practice and striving to overcome the odds through providing opportunistic health education, alternate methods of secondary prevention, and partnering and engaging with local communities. Conclusions Although CR coordinators face multiple barriers to implementing evidence-based guidelines for patients with coronary heart disease, they use strategies such as harnessing community capacity and using available resources creatively. The development of a more integrated, multifactorial and coordinated approach to improving use of guidelines in clinical practice to improve the treatment and secondary prevention of coronary heart disease is urgently needed.
Abstract: PURPOSE: This pilot study was to assess the feasibility of the health-related lifestyle self-management (HeLM) intervention as a strategy to decrease cardiovascular risk following acute coronary syndrome. METHODS: Participants in this randomised controlled trial were recruited from a tertiary teaching hospital in metropolitan Sydney Australia. The multifaceted HeLM intervention, using the principles of the transtheoretical model, involved the use of bibliotherapy, a structured evidence-based approach to cardiovascular risk reduction, a communication strategy with general practitioners, three supportive telephone calls to participants and provision of behavioural prompts and a health record diary. Differences in behavioural and clinical outcomes between the HeLM intervention group (n=29) and the standard cardiac rehabilitation group (n=22) were assessed. RESULTS: A total of 125 participants screened were eligible for participation in the study. Fifty-one participants, mean age 57 years (+/-8.78) were randomised. At the 8-week follow-up, participants in the HeLM intervention group had a reduced systolic blood pressure compared to the standard care group (120.3 S.D.: 16.3 vs. 126.4 S.D.: 14.6). There were no significant differences in diastolic blood pressure and cholesterol levels between the two groups. Participants in both the intervention and control group had a reduction in waist circumference although when compared to baseline values, women in the HeLM intervention group had a greater reduction compared to those receiving standard care. Patients reported high levels of satisfaction with this intervention. CONCLUSIONS: Findings support the feasibility of implementing the health-related lifestyle self-management intervention for risk factor modification in patients with acute coronary syndrome. An adequately powered randomised controlled trial is required to test the impact of the intervention on cardiovascular risk reduction.
Abstract: Meta-analysis is becoming increasingly used in contemporary nursing to synthesize the evidence from the biomedical literature. However, interpreting the meta-analysis graph continues to remain a problem for many clinicians. The purpose of this article is to provide clinicians with a basic understanding of the meta-analysis graph to objectively interpret the findings and implement them when applicable in clinical practice.
Abstract: AIM: To examine the effectiveness of the implementation of a clinical practice guideline on nurses screening patients for alcohol and other substance use, providing brief interventions, and referring patients at risk for treatment. METHOD: Medical record audits were conducted in selected medical and surgical wards of two metropolitan hospitals in Sydney prior to and three months following the guideline implementation. RESULT: Seventy-nine (pre) and 84 (post) patient records were audited. There were no differences in screening rates for alcohol (28% and 29%), tobacco (29% and 23%) and illicit drug use (16% and 8%) before and after implementation of the guideline. PRACTICE IMPLICATION: Factors which may have limited the effectiveness of the clinical practice guideline dissemination included design of the education program, existing level of nurses' knowledge and competence, and strategies in place to ensure sustainability of the program. We also provided suggestions for improvement of screening for alcohol and other substance use.
Abstract: PURPOSE: This study aims to assess the impact of an education program on Australian general nurses' knowledge and competence in identifying and managing patients with alcohol and substance use and misuse, and compare findings with existing literature on mental health nurses. DESIGN AND METHODS: Pre- and posttest design without a control group. FINDINGS: The nurses' knowledge of safe drinking limits and alcohol withdrawal management improved following the education. Nevertheless, overall the nurses reported a lack of adequate knowledge and competence. Compared to mental health nurses, the nurses in this study had lower levels of knowledge and competence. PRACTICE IMPLICATIONS: We suggest several opportunities for general nurses to strengthen their knowledge and skills and the need for a comprehensive and regular education program.
Abstract: Risk-factor modification after an acute coronary event is imperative, and intervention strategies are continuously being developed to assist patients with behavioral change and, consequently, decreasing the risk of further coronary episodes. This article describes the development of the health-related lifestyle self-management (HeLM) intervention, which is a brief structured intervention embedded within the transtheoretical model of behavioral change. The HeLM intervention was developed by undertaking three discrete yet interrelated studies and consisted of the following components: goal-setting, the HeLM booklet, feedback regarding personal risk, team-building and communication with the patient's family physician, three supportive telephone calls, trained interviewers, a refrigerator magnet, and a health diary for self-monitoring. The HeLM intervention has been successfully implemented in 50 patients with acute coronary syndrome after discharge from hospital and has been demonstrated to be feasible and practical and could easily be delivered by health care professionals.
Abstract: BACKGROUND: In spite of the benefit in participating in cardiac rehabilitation (CR) programs, low participation rates are well documented. Participation rates are potentially lower in people who have undergone percutaneous coronary interventions (PCI). Assessment of the barriers to CR participation in PCI patients could provide vital information for the development of alternate strategies for coronary risk factor modification. AIM: The aim of this study was to develop and evaluate the psychometric properties of a scale to assess obstacles to cardiac rehabilitation enrolment in patients following PCI. METHODS: Item generation for the 15 items of this scale was based on a comprehensive review of the literature and data collected from telephone interviews of CR coordinators related to cardiac rehabilitation enrolment obstacles (CREO). Content validity of the scale was undertaken using a reference group comprising of clinicians and patients. Construct validity was undertaken using a factor analysis. Data for the CREO scale was collected from December 2004 to March 2005 from 114 PCI patients recruited from a cardiology database in a Sydney metropolitan hospital. RESULTS: Factor analysis revealed a two-factor structure: patient-related obstacles and health service-related obstacles, which accounted for 58% of cumulative explained variance. The scale showed good internal consistency (Cronbach's alpha=0.89) and satisfactory divergent validity. CONCLUSION: This scale can be used as a useful tool for the early identification of patients who would not normally enrol into CR and offer them alternate strategies for health-related lifestyle modification.
Abstract: OBJECTIVE: The objective of this study was to investigate the views and current practices of registered nurses (RNs) and nurse unit managers (NUMs) working in metropolitan and non-metropolitan health facilities relating to medication administration by enrolled nurses (ENs). BACKGROUND: The advanced scope of practice role relating to medication administration is one area currently challenging Registered and Enrolled Nurses from the perspectives of the education, knowledge and skills required to support competence in this area of practice. METHOD: A self-administered survey comprising questions on participant demographics, their perceptions and their current practices relating to ENs administering medications was completed by 272 RNs and NUMs from metropolitan and non-metropolitan health care facilities within Australia. RESULTS: There were statistically significant differences among metropolitan and non-metropolitan based RNs relating to their views on the various routes by which ENs should be allowed to administer medications. Significantly more RNs from metropolitan hospitals indicated that they asked ENs to administer S3, S4 and S4D medications. Overall, a large proportion of RNs were opposed to ENs administering injectable medications. CONCLUSION: This study describes the current practices and view points of RNs relating to administration of medications by ENs.While the findings suggest that practice change could be slow, appropriate ongoing education for and consultation with RNs will support change of practice at the clinical level. Further formalising a medication administration role for ENs that acknowledges current practice will have potential organisational and patient safety benefits.
Abstract: Cardiovascular risk factor modification to prevent progression of coronary heart disease is important for patients following percutaneous coronary intervention. The aims of this study were to assess patient's awareness of modifiable cardiac risk factors and examine if patients with modifiable risk factors were more likely to identify these risk as amenable to change. Awareness of risk factors was measured using the Indiana Cardiac Rehabilitation Knowledge Questionnaire in a cohort of prospective, consecutive participants post percutaneous coronary intervention. Completed questionnaires were received from 75% of the participants. The majority were able to identify high cholesterol (87%), smoking (83%) and hypertension (82%) as modifiable risk factors. Less than half (46%) of the respondents identified diabetes as a modifiable risk factor. Only a third of participants recognized all six modifiable risk factors. A large proportion of patients who were smokers, or who had high cholesterol or hypertension, identified these as risk factors. A third of people with documented diabetes did not recognize this condition as a risk factor for heart disease. The findings have important implications for nursing practice in terms of directing educational efforts for the modification of risk factors for coronary heart disease.
Abstract: Evidence-based guidelines recommend participation in cardiac rehabilitation (CR) to reduce subsequent cardiovascular events following percutaneous coronary intervention (PCI). The objective of this study was to investigate the reasons for and the demographic characteristics of patients who participate in CR programmes following PCI in a single metropolitan setting in Australia. Logistic regression models were used to examine the data obtained using self-reports through mailed questionnaires from 202 patients 12-24 months following the index PCI. Thirty-five per cent of subjects reported to have participated in CR programmes, of whom less than a quarter were female. In this sample the main reason for programme participation was a recommendation given by the general practitioner (GP). The likelihood of participating in a CR programme decreased with age and absence of a partner. Additional research on determinants of participation in CR programmes among this cohort of patients could assist in the development of new strategies to encourage healthy behaviours and reduce the risk of further cardiac events.
Abstract: BACKGROUND: Coronary heart disease remains the leading cardiovascular cause of mortality and morbidity globally. Implementing evidence-based guidelines after a coronary event is vital to prevent recurrence of an acute episode. However, various barriers to guideline implementation have been identified. OBJECTIVE: This article presents the perspective of cardiac rehabilitation (CR) coordinators regarding patient-related barriers to implementing the evidence-based guidelines after an acute cardiac event. METHODS: Twenty CR coordinators from 4 geographic regions of New South Wales, Australia, participated in the study. A semistructured interview using open-ended questions was used to obtain the CR coordinator's perspectives of the patient-related barriers to guideline implementation. Interviews were transcribed, and content analysis was undertaken. FINDINGS: The most frequently identified patient-related barriers were (a) coming to terms with a diagnosis of heart disease, (b) challenges in changing behavior, (c) having heart disease is costly, and (d) other personal barriers. CONCLUSIONS: Despite CR coordinators having positive attitudes toward implementing evidence-based guidelines, several patient-related barriers were identified that obstructed the implementation process. The findings have important implications for nursing practice in terms of directing efforts at increasing participation in CR and engaging commitment of the patient to behavior change. Changes to health service policies that address identified barriers could further facilitate the provision of evidence-based care to patients with coronary heart disease.
Abstract: INTRODUCTION AND AIMS: The widespread use of alcohol and other drugs poses particular problems during hospitalisation. Although nurses have been identified as an appropriate group to screen patients and provide acute and ongoing management to people with drug and alcohol-related problems, rates of screening are low. The aims of this study were to identify current practices for screening by nurses working in medical and surgical wards, determine their knowledge relating to problems associated with substance use and identify their self-reported skills in managing patients with drug- and alcohol-related problems. DESIGN AND METHODS: A chart audit of medical records was completed and a survey was distributed to nurses working in the study wards. RESULTS: Screening for alcohol and drug use was documented on only 22/79 medical records, and detailed information about quantity and duration of use was recorded in only nine. Overall, the nurses reported that they had little knowledge about substance use problems, and felt that they lacked skills to care adequately for these patients. DISCUSSION AND CONCLUSIONS: The results of this study suggest a need for a comprehensive training and education to ensure that nurses are familiar with policies and protocols for management of patients and to assist nurses to provide evidence-based care and make appropriate referrals to specialist services.
Abstract: PURPOSE: The purpose of this study was to describe the trajectory of cardiac patient's perceptions of health-related quality of life (HRQoL) during a 24-month period in a community-based population. METHODS: After obtaining informed consent, a self-administered questionnaire was mailed to participants. Using the MacNew questionnaire, which assesses the emotional, physical, social, and global domains, HRQoL outcomes were assessed. RESULTS: Completed questionnaires were received from 202 participants (75%). Improvements in the emotional, physical, social, and global HRQoL scores were observed until 15 to 17 months after the index percutaneous coronary intervention, after which a decline was observed. However, the scores in all HRQoL domains remained high when compared with the scores at 12 months. No clinical or sociodemographic predictors for HRQoL were identified. CONCLUSIONS: The information obtained from this study will enable clinicians to further understand the process of recovery and adjustment of patients after percutaneous coronary intervention and the development of tailored strategies for patient management.
Abstract: BACKGROUND: Challenges in achieving optimal participation rates in cardiac rehabilitation (CR) are well described and include factors pertaining to health system and patient and clinical characteristics. Of note, participation rates of patients following percutaneous coronary intervention (PCI) are low. AIM: The aim of this study was to examine the psychometric properties of the Revised Cardiac Rehabilitation Preference Form (CRPF-R) in an Australian sample following a PCI and to determine the preferences of PCI patients in relation to CR. METHODS: One hundred forty participants who had PCI completed the self-administered CRPF-R scale. Principal component factor analysis was performed to detect underlying dimensionality of the scale. The internal consistency of the total scale and the subscales was tested with the Cronbach alpha analysis. Comparison for differences in CRPF-R scores, as well as demographic characteristics and CR attendance, was performed. RESULTS: Factor analysis revealed 2 distinct factors, supporting the validity of a 2-factor structure CRPF-R. Cronbach alpha coefficient values were high, with .87 for the total CRPF-R, .85 for factor 1 (program features), and .81 for factor 2 (convenience features). Women were more likely to place greater importance in the convenience features of a CR program than men. Those who were recommended by a healthcare professional to attend CR were more likely to place greater importance in the program features than those who were not. CONCLUSIONS: This study has demonstrated the acceptability and utility of the CRPF-R in the Australian setting. In addition, the study also identified important considerations in the structuring and delivery of CR programs.
Abstract: Digital technology has provided a new way of recording qualitative interviews, surpassing the clarity, usability and storage capabilities of conventional tape recorders. Ritin Fernandez and Rhonda Griffiths examine a technological resource that pervades modern social life and which can be used effectively for digitally recording interviews for qualitative research.
Abstract: The objective of this systematic review is to investigate the efficacy of educational interventions, relating to psychotropic medications, for consumers with a mental health disorder. This review included only randomized controlled trials that compared the effects of various educational interventions on knowledge retention, compliance to medication and treatment, incidence of relapse, and insight into illness in patients aged 18 years and over with a mental disorder. Twenty-one trials met the quality criteria and were included in the final analysis. Patients who were provided with education demonstrated a significant increase in the level of knowledge and compliance compared with those who were not. However, there was no difference in the incidence of relapse and insight in those who were provided education. A structured education session using both written and verbal methods followed by discussion of the contents is demonstrated to be effective. The evidence suggests that consumers who were provided multiple education sessions had greater knowledge gains in the short term (up to 1 month); however, the effectiveness of multiple sessions in the long term (2 years) is inconclusive. The review provides evidence that multiple education sessions are better than single education sessions in improving knowledge relating to medications and insight into illness. Evidence from the trials demonstrates that structured educational interventions delivered at frequent intervals are useful as part of the treatment programme for people with a mental illness. More well designed and reported randomized studies investigating the efficacy of education are urgently needed.
Abstract: BACKGROUND: Percutaneous coronary intervention (PCI) is a widely performed revascularization technique for coronary heart disease; however, there is limited research investigating the risk factor status of patients 1 year after the procedure. OBJECTIVE: This cross-sectional study was conducted to investigate the self-reported risk factor status by patients who had undergone a PCI at a major teaching hospital in Sydney, Australia. SUBJECTS:: Two hundred seventy participants who underwent PCI between April 2003 and March 2004 and who met the inclusion criteria were followed up 1 year after the PCI. METHODS: After obtaining informed consent, a follow-up self-administered questionnaire was mailed to participants. Information was collected relating to the following coronary risk factors: smoking, and physical activity status, blood pressure and cholesterol levels, body mass index, depression, anxiety, and stress levels. RESULTS: Two hundred two participants (75%) returned a completed questionnaire. Approximately one third of participants had at least two modifiable risk factors. The most common cardiovascular risk factors identified were physical inactivity, increased body mass index, high blood pressure, and high cholesterol. Approximately half the women (46%) and a quarter of the men had at least two modifiable risk factors. Only a minority (11%) of the participants continued to smoke at 1-year follow up. Participating in physical activity for a total time of 150 minutes or more per week was reported by only 42% of the participants. Depression and anxiety were present in 25% and stress in 17% of the participants. A third of the participants (n = 64) erroneously believed that they had no heart problems. CONCLUSIONS: The findings reveal inadequate management of modifiable risk factors among post-PCI participants 12 to 18 months after revascularization, which highlights a need for tailored secondary prevention interventions to address factors contributing to cardiovascular risk. The evidence obtained from this study will inform the development of an intervention to address cardiovascular risk factor modification.
Abstract: OBJECTIVE: A systematic review on the effect of duration of catheterization on urinary retention. MATERIALS AND METHODS: Published and unpublished randomized and nonrandomized control trials from January 1966 to July 2004 comparing the effects of duration of catheterization on patient outcomes were systematically reviewed. Relative risks (RR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, a narrative overview was undertaken. RESULTS: Eight trials were included. Two trials on patients following urethrotomy demonstrated no statistically significant difference in the number of patients developing restenosis, epididymitis, or urethral pain at any follow-up periods. Two trials comparing removal of the indwelling urethral catheter within 24-48 hours to usual surgical criteria after transurethral surgery demonstrated no statistically significant difference in the number of patients requiring recatheterization. However, significant reduction in the length of hospitalization was reported after removal of the indwelling urethral catheter within 24-48 hours. An increased risk of urinary tract infection was found when the catheter was removed after 48 hours. Catheter removal on day 1 compared to day 3 after vaginal or retropubic surgery demonstrated no statistically significant difference in urinary retention or urinary tract infection. CONCLUSIONS: No significant differences in patient outcome were found, but the timing of catheter removal is a balance between avoiding infection by early removal and circumventing voiding dysfunction by later removal. Shorter catheterizations appear to reduce mean length of hospital stay.
Abstract: OBJECTIVE: The objective of this review is to determine the effects of clamping short-term indwelling urethral catheters before removal on the incidence of urinary tract infection, time to first void, voiding dysfunction, incidence of recatheterization, and the length of hospital stay. MATERIALS AND METHODS: Published and unpublished randomized and quasi-randomized controlled trials, completed between January 1966 and July 2004, in English and other languages that compared the effects of clamping short-term indwelling urethral catheters, were systematically reviewed using multiple electronic databases. Determination of eligibility of trials for inclusion in the review, assessment of methodological quality, and data extraction were undertaken independently by 2 reviewers. Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate, a narrative overview has been undertaken. RESULTS: Three trials that investigated the effect of clamping the indwelling urethral catheter compared to free drainage before removal were eligible for inclusion. Two trials reported no significant difference in the incidence of urinary tract infection (UTI), number of patients who developed urinary retention or required recatheterization, and the length of hospital stay between the 2 groups. Another reported that the postvoid residual urine volume for patients who did not receive reconditioning of the bladder increased from 4.25 mL at baseline to 42.25 mL after removal of the indwelling urethral catheter, whereas the residual urine volume for patients who received reconditioning increased from 17.25 mL at baseline to 22 mL at follow-up. CONCLUSIONS: The evidence for clamping indwelling urethral catheters before removal remains equivocal. Given the current state of evidence, procedures relating to clamping of indwelling urinary catheters should not be initiated. Until stronger evidence becomes available, however, practices relating to clamping indwelling urethral catheters will continue to be dictated by local preferences and cost factors.
Abstract: OBJECTIVE: The objective of this systematic review was to determine the effect of the timing of removal of indwelling urethral catheters (IUCs) on the duration to and volume of first void, length of hospitalization, number of patients developing urinary retention and requiring recatheterization, patient satisfaction, and the percentage of IUCs removed according to the scheduled time for removal. MATERIALS AND METHODS: Published and unpublished literature in English and other languages between January 1966 and June 2002, which compared the effects of the timing of removal of short-term indwelling urethral catheters on patient outcomes, was systematically reviewed using multiple electronic databases. To determine eligibility of the trials for inclusion in the review, assessment of methodologic quality and data extraction was undertaken independently by 2 reviewers and verified by a third reviewer. Odds ratio (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, a narrative overview has been undertaken. RESULTS: Eight randomized controlled trials were eligible for this review. When IUCs were removed at midnight, the time to first void was significantly shorter (P = .012) after gynecologic surgery and significantly longer in patients after urologic surgery and procedures. Seven trials reported that the volume of the first void was greater in patients whose IUCs were removed late at night, and this was statistically significant in 4 trials. Patients who had their IUC removed at midnight were discharged from the hospital significantly (P < .00001) earlier than those who had their IUC removed in the morning, a finding that could result in potential cost savings for hospitals. CONCLUSION: Based on the limited available evidence, this article suggests benefits in terms of patient outcomes and reduction in the length of hospitalization after midnight removal of the IUCs. Further trials should be undertaken in wider settings and on specific groups of patients to enhance generalizability.
Abstract: BACKGROUND: Total parenteral nutrition (TPN) is a specialized form of nutrition support. The complexity associated with the management of patients receiving TPN therapy has led to the development of multidisciplinary TPN teams. The purpose of this review was to critically analyze the literature and present the best available evidence that investigated the effectiveness of multidisciplinary TPN teams in the provision of TPN to adult hospitalized patients. METHODS: A systematic review of studies identified from the Cochrane Library (2001, Issue 4), CINAHL, Complete MEDLINE, Complete Biomedical Collection, Complete Nursing Collection, and EMBASE, published in any language. RESULTS: Eleven studies, 4 with concurrent controls and 7 with historical controls, were eligible for inclusion in the review. Results of the studies indicate that the incidence of total mechanical complications is reduced in patients managed by the TPN team. However, the benefit of the TPN team in the reduction of catheter-related sepsis remains inconclusive. Four of the 5 studies reported fewer total metabolic and electrolyte abnormalities in patients cared for by the team, and these patients were more likely to receive their optimal caloric intake. However it was unclear if the management of the patients by the TPN team prevented the inappropriate use of TPN therapy. Although only 2 studies (n = 356) investigated total costs associated with management of patients by the TPN teams, there was evidence that a team approach is a cost-effective strategy. CONCLUSIONS: Overall, the general effectiveness of the TPN team has not been conclusively demonstrated. There is evidence that patients managed by TPN teams have a reduced incidence of total mechanical complications; however, it is unclear if there is a reduction in catheter-related sepsis and metabolic and electrolyte complications. The available evidence, although limited, suggests financial benefits from the introduction of multidisciplinary TPN teams in the hospital setting.
Abstract: Loss of peripheral intravenous (PIV) catheter patency is a common problem in the clinical setting. A survey of all private and public hospitals in a metropolitan city in Australia was conducted to identify practices related to maintaining patency of PIV catheters. Eighty-three hospitals were surveyed and responses were obtained from all of them. Normal saline was the most commonly used solution for flushing. The frequency for flushing ranged from 4 to 12 hours, and the volume of the irrigant used ranged from 2 to 10 mL in those hospitals where flushing is routine practice. Policy documents were available from only a few hospitals to validate the practice reported. Significant diversity in practices was documented among healthcare organizations.
Abstract: OBJECTIVE: This double-blind randomised controlled trial compared the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds. METHOD: The trial was conducted in two metropolitan community health centres in New South Wales, Australia. Thirty-five patients with 49 acute or chronic wounds were randomised to receive wound irrigation with either normal saline or tap water. RESULTS: Statistical analysis demonstrated there was no significant difference between the infection and healing rates in wounds irrigated with normal saline or tap water. CONCLUSION: Although the small sample size is a limitation of this study, the researchers conclude that drinkable tap water appears to provide a safe alternative to normal saline for wound cleansing and may be preferred by some patients.
