Identifying Patients with Low Health Literacy

The July issue of the AHRQ research activities reports that:

A simple question identifies patients with low health literacy

“How confident are you in filling out medical forms?” Asking this simple question, in either English or Spanish, may allow clinical researchers to identify persons with limited health literacy (HL) as effectively as using the English or Spanish versions of the short Test of Functional Health Literacy in Adults (s-TOFHLA), a new study reports. Earlier studies indicate that nearly half (46 percent) of the United States population has limited HL (inadequate or marginal HL), and that limited HL is associated with poor health outcomes. Unlike the versions of s-TOFHLA, which have to be administered in person, the single question, “How confident are you in filling out medical forms?” can be asked over the telephone.

Sarkar U, Schillilnger D, Lopez and others.  Validation of self-reported health literacy questions among diverse English and Spanish speaking populations.  Journal of General Internal Medicine 2011 Mar;16(3):265-271.

 

 

 

Updated Stable COPD Guidelines

The American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society have issued an update of their 2007 clinical practice guideline.  Included in the guideline is a one page summary with seven recommendations.

Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD, Denberg T, Schünemann H, Wedzicha W, Macdonald R, Shekelle P; for the American College of Physicians, the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society. Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011 Aug 2;155(3):179-191. PubMed PMID: 21810710.

Cancer in Northeastern Pennsylvania

The Northeast Regional Cancer Institute published a report on the incidence, mortality and survival for common cancers.  This May 2011 report covering the years 2003-2007 uses data from the Regional Cancer Registry, the National Cancer Database, and the Bureau of Health Statistics and Research of the Pennsylvania Department of Health

 

Some findings are:

• Five most commonly diagnoses cancer sites in Northeastern Pennsylvania were starting with the most common):  bronchus and lung; colon and rectum; breast; prostate; and urinary bladder.
• Cancer Incidence was significantly elevated in Northeastern Pennsylvania at 11 cancer sites for both sexes (unless otherwise noted): bronchus and lung; larynx; urinary bladder; kidney; esophagus; Hodgkin’s lymphoma; colon and rectum; ovary (female); uterus (female); cervix (female); and thyroid.
• Cancer Incidence was significantly decreased inNortheastern Pennsylvania at five sites for both sexes (unless otherwise noted): breast (female); prostate (male); melanoma; liver; and Non-Hodgkins lymphoma
• The cancer sites that resulted in the highest number of deaths in Northeastern Pennsylvania were (starting with the highest: bronchus and lung; colon and rectum; breast; pancreas; and prostate.
• Cancer mortality inNortheastern Pennsylvania was significantly elevated at six sites for both sexes (unless otherwise noted): colon and rectum; esophagus; larynx; Hodgkin’s lymphoma; ovary (female); uterus (female).
• Cancer mortality inNortheastern Pennsylvania was significantly decreased at three site for both sexes: bronchus and lung; multiple myeloma; and liver.

 

These regional findings should help all those involved in trying to ease  and understand the burden of cancer in Northeastern Pennsylvania. 

The complete report is available on the Northeast Regional Cancer Institute’s web site.

 

 

Updated Recommendations for Control of Surgical Site Infections

This extensive review of current literature with interpretation of findings updates the 1999 CDC recommendations for preventing surgical site infections.  The authors conclude:

This review suggests that uniform adherence to the proposed guidelines for the prevention of surgical infections could reduce wound infections significantly; namely to a target of less than 0.5% in clean wounds, less than 1% in clean contaminated wounds and less than 2% in highly contaminated wounds and decrease related costs to less than one-half the current amount.

Alexander JW, Solomkin JS, Edwards MJ.  Updated recommendations for control of surgical site infections.  Annals of Surgery  2011 June;253(6):1082-1093.

Clostridium Difficile Infection in Adults: 2010 Guidelines Update

The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) have issued updated clinical practice guidelines for Clostridium difficile infection.  As stated in the guidelines abstract:

C. difficile remains the most important cause of healthcare-associated diarrhea and is increasingly important as a community pathogen.  A more virulent strain of C. difficile has been identified and has been responsible for more-severe cases of disease worldwide.  Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease has been published.  … This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.

Clinical Practice Guidelines for Clostridium difficile Infection in Adults:  2010 Update by the Society for Healthcare epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).  Infect Control Hosp Epidemiol 2010; 31(5):431-455.

Partnering to Heal

The U.S. Department of Health & Human Services has initiated a new program to prevent health-care associated infections.  One part of this initiative is a computer-based, interactive learning  tool for clinicians, health professional students, and patient advocates.

Below is the website description of the program:

The training focuses on prevention of surgical site infections, central lines associated bloodstream infections, ventilator-associated pneumonia, Catheter-associated urinary tract infections, Clostridium difficile and Methicillin-resistant Staphylococcus aureus (MRSA). In addition, it includes information on basic protocols for universal precautions and isolation precautions to protect patients, visitors, and practitioners from the most common disease transmissions. The training promotes these key behaviors:

• Teamwork
• Communication
• Hand washing
• Vaccination against the flu
• Appropriate use of antibiotics
• Proper insertion, use, and removal of catheters and ventilators

Trainees assume the identity of characters in a computer-based video simulation and make decisions as each of those characters. Based upon their decisions, the training branches to different pathways and patient outcomes. The training is designed and developed for use by groups in facilitated training sessions and by individuals as a self-paced learning tool.

This interactive tool provides the opportunity for a fruitful learning experience.

Explore Partnering to Heal.

New Guidelines for Prevention of Intravascular Catheter-related Infections

The Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advsiory Committee (HICPAC) recently released updated intravascular catheter prevention guidelines.  These replace the 2002 guidelines with evidence-based recommendations.

Some recommendations include:

• For peripheral and midline catheters, an upper-extremity site is preferred in adults.
• Steel needles should be avoided when administering fluides and medications that might cause tissue necrosis if extravasation occurs.
• When the durations of intravascular therapy is likely to be more than 6 days, a midline catheter or PICC is preferred to a short peripheral catheter.
• The catheter insertion site should be evaluated daily, and peripheral venous catheters should be removed if signs of phlebitis develop.
• In adult patients, use of the femoral vein for central venous access should be avoided.
• Ultrasound guidance by those fully trained in its technique sould be used to place CVCs.

Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections.  Clinical Infectious Diseases 2011 May 1)52(9):1087-1099.

Web-Based Resources for Critical Care Education

The authors of this article have developed a categorized list of more than 135 web-based educational resources for critical care education.  By  searching  the web for resources and querying listservs used by critical care practitioners, they identified relevant sites which were screened on the basis of authority, objectivity, authenticity, reliability, timeliness, relevance, and efficiency.  Each website is very briefly described and includes a notation if the site is recommended by critical care program directors.

Some of the covered topics: Acid-base, ARDS, Anesthesia, Arrhythmia and ECG interpretation, Arterial blood gas (ABG) interpretation,Bioterrorism/disaster preparedness, Cardiovascular, Delirium, Gastroenterology, General critical care medicine, Hematology, hemodynamic monitoring, infectious disease/antibiotics, Laboratory tests, Neurology/neurosurgery, Nutrition in the Critically Ill, Pharmacology, Physical assessment, Pulmonary, Radiology, Renal failure, Sepsis, Suturing techniques, Therapeutic hypothermia, Trauma, and General educational sites.

Kleinpell R, Ely EW, Williams G, Liolios A, Ward N, Tisherman SA. Web-based resources for critical care education. Crit Care Med. 2011 Mar;39(3):541-53.
PubMed PMID: 21169819.

 

A Roadmap for Hospitals

The Joint Commission published the monograph, Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals.  In addition to having unique clinical needs each patient also has a spectrum of demographic and personal characteristics that require attention for the patient to receive optimum care.  As stated in the introduction:

A growing body of research documents that a variety of patient populations experience decreased patient safety, poorer healthoutcomes, and lower quality care based on race, ethnicity, language, disability and sexual orientation.

The Roadmap attempts to provide a guide for integrating the key issues relating to communication, cultural competence, and patient- and family-centered care into healthcare organizations.  Checklists with practical examples are included, as well as, appendices relating to relevant Joint Commission requirements and standards.

The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals.  Oakbrook Terrace, IL: The Joint Commission, 2010.

Critical-Care Visitation: The Patients’ Perspectives

This research project by North Caroline nurses provides a framework for approaching the question of what are the optimal visitation policies for intensive care units.  This framework recognized that while nurses and families  struggled with visitation issues, the views of patients were frequently overlooked.  After reviewing the literature, the researchers decided to determine critically ill patients’ satisfaction with the restricted visiting hours of a 435-bed acute care hospital in North Carolina.  The researchers developed and administered a questionnaire to assess patient preferences for visiting hours.

The analysis of the questionnaire revealed that patients want more control over visitation. 

Generally, most patients preferred a less restricted visitation policy and felt it would be more beneficial to them.  However, they also wanted to be able to have downtime when visitors would be asked to leave.

These results suggest that ICU nurses should be working with  patients to provide them with more control over visitation.  “Hence, nursing  leadership should consider tailored contractual agreements with patients and families on critical-care visitation.”

Hardin SR and others.  Critical-care visitation; the patients perspective.   Dimensions of Critical Care Nursing 2011 Jan/Feb;30(1):53-61.