Disseminated Varicella-Zoster Virus in a Patient on Pegloticase and Mycophenolate Mofetil for Gout.

There are various treatments for managing gout, including combination treatment with immunomodulators. However, these treatments can lead to significant immunosuppression, potentially leading to worse health outcomes, such as the one described in this case. We present the case of a 70-year-old female patient with a past medical history of atrial fibrillation, type 2 diabetes mellitus, and gout, who presented with progressively worsening altered mental status.

Deliberate practice of medication administration among nursing students: a pilot study.

Objectives: The objective of this pilot study was to investigate the deliberate practice teaching method with medication administration skills to prepare for a future larger study.

Methods: A multi-methods repeated measures design was used. Pre-licensure nursing students engaged in deliberate practice across two study visits that were spaced four to eight weeks apart.

Educational preparedness and perceived importance on confidence in new graduate registered nurses' medication administration.

Background: Medication errors are the most common type of error affecting patient safety and the most preventable cause of adverse medical events globally. Medication errors occur most frequently (33.3 %) during the administration phase.

The contributors to dosage calculation ability and its applicability to nursing education: An integrative review.

Medication errors are a major patient safety issue and account for 1-2 million hospitalizations and between 100,000 and 200,000 deaths annually. Approximately 41 % of all medication errors are due to improper dose calculations. Studies have shown mean scores on the medication dosage calculation test for nursing students range from 35 to 71 %.

The emergency nurse responses to triage interruptions and how these responses are perceived by patients: An observational, prospective study.

Background: Healthcare providers' responses to triage interruptions in the emergency department affect quality of care. The purposes for this study were to (1) Examine the relationship between nurses' response to triage interruption and each of, patients' perceived confidence in nurses' technical skills, perceived competence of triage nurse, and satisfaction with the triage experience, (2) Examine the relationship between nurses' response to triage interruption and nurse demographics.

Methods: Using an observational, prospective design, this study was conducted in an adult academic level 1 trauma center.

Systematic review of interruptions in the emergency department work environment.

Objective: The purpose of this systematic review is to describe the operationalization of interruptions measurement and to synthesize the evidence on the causes and consequences of interruptions in the emergency department (ED) work environment.

Methods: This systematic review of studies explores the causes and consequences of interruptions in the ED. Of 2836 abstract/titles screened, 137 full-text articles were reviewed, and 44 articles met inclusion criteria of measuring ED interruptions.

Patient Pain Experiences and the Emergency Department Encounter: A Qualitative Analysis.

Background: Legislation, practice recommendations, and the likely link between therapeutic opioid exposure and iatrogenic opioid use disorder (OUD) have led to reduced opioid prescribing. The effects of this change on unrelieved pain and the overdose crisis are not well-characterized.

Aim: We explored emergency department (ED) patients' beliefs and experiences involving pain and emergency care to inform the development of future psychosocial interventions that balance the need for acute pain management with risks from opioid exposure.

Interruption of initial patient assessment in the emergency department and its effect on patient perception of care quality.

Background: Triage is a critical first step in appropriately caring for patients in the emergency department (ED). Patients' assumptions of the care they will receive can be established in triage. Interruptions to this process can disrupt patient flow, cause errors and lead to patient dissatisfaction.

Identifying Strategies for the Management of Interruptions for Novice Triage Nurses Using an Online Modified Delphi Method.

Purpose: To use the Delphi Method to identify strategies used by triage nurses to effectively manage interruptions.

Design: This study was based on the concepts of Benner's Novice to Expert Model. An online, modified Delphi approach was used to engage triage, education, and operational management experts in generating consensus recommendations on successful strategies to address triage interruptions in the emergency department.

Understanding Exception from Informed Consent in Planned Emergency Research.

Many of the current accepted treatment practices provided to patients in the first critical hour after a traumatic injury, stroke, or cardiac arrest have not been rigorously tested in clinical research trials. The inability to obtain informed consent is often a barrier to research in emergency, time-sensitive situations in which the patient is not able to provide informed consent nor is their family member immediately available to provide consent on behalf of the patient. Planned emergency research, often with exception from informed consent, is a type of research study that involves a patient with a life-threatening medical condition that requires urgent interventions, wherein the current treatments may be unproven or suboptimal, and who, because of their current condition, is unable to provide informed consent.

Perceptions of the Essential Components of Triage: A Qualitative Analysis.

Introduction: Triage is an important process to determine severity of illness and prioritize patient emergencies while also ensuring patient safety. The emergency nurse must use critical thinking and decision-making to identify life-threatening emergencies and improve patient outcomes. However, the addition of risk screenings and quality improvement initiatives has extended the triage process time, which may increase interruptions and opportunities for errors.

Early Therapeutic Mobility and Changes in Scores for Pain and Fatigue.

This report is a secondary analysis of data from a larger study of a nurse-led early therapeutic mobility intervention among patients receiving mechanical ventilation. This analysis evaluated whether intervention frequency or intensity was associated with pain or fatigue. Frequency was defined as once-daily versus twice-daily interventions.

Patient perspectives of pregnancy loss in the emergency department.

Objectives: While threats to pregnancy such as vaginal bleeding are common, half will miscarry. The ED environment is not always conducive to the emotional and psychological needs of women grieving the loss of a pregnancy. Healthcare providers have a great impact on the women's experience of pregnancy loss.

Dose of Early Therapeutic Mobility: Does Frequency or Intensity Matter?

Objective: Investigate the feasibility of a nurse-led mobility protocol and compare the effects of once- versus twice-daily episodes of early therapeutic mobility (ETM) and low- versus moderate-intensity ETM on serum biomarkers of inflammation and selected outcomes in critically ill adults.

Design: Randomized interventional study with repeated measures and blinded assessment of outcomes.

Setting: Four adult intensive care units (ICUs) in two academic medical centers.

Effects of Interruptions on Triage Process in Emergency Department: A Prospective, Observational Study.

For 130 million people seeking emergency treatment in the United States, incomplete or inaccurate triage examination can result in delays, which could compromise patient outcomes. The purpose of this study was to identify triage interruptions and determine how interruptions affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews.

A Review of the Management of Loss of Pregnancy in the Emergency Department.

Introduction: Women frequently seek ED care for complications in early pregnancy, including loss of pregnancy. This review evaluates the current literature and discusses the care of patients experiencing loss of pregnancy in the emergency department.

Methods: A review of pertinent studies identified through multiple database searches was conducted to determine the existing body of knowledge for the care of ED patients diagnosed with loss of pregnancy.

Barriers to Research Recruitment of Women Experiencing a Pregnancy Loss in the Emergency Department.

Women often come to the emergency department (ED) with signs and symptoms suggesting an early pregnancy loss; yet, little is known about their experience and how it relates to future outcomes. To improve patient outcomes and experiences of women seeking care for a pregnancy loss, research is required. However, recruitment of participants experiencing an event such as a pregnancy loss is challenging.

Using Simulation to Assess the Impact of Triage Interruptions.

Introduction: Interruptions are common in the emergency department and contribute to catastrophic errors. Care priorities and acuity levels are assigned during triage, meaning that mistakes and omissions during the triage process could have detrimental effects on patients. The purpose of this project was to assess the feasibility of investigating the impact of interruptions on triage and the decision-making process in a simulated setting.

A realist review of shared medical appointments: How, for whom, and under what circumstances do they work?

Background: Shared medical appointments (SMAs) are doctor-patient visits in which groups of patients are seen by one or more health care providers in a concurrent session. There is a growing interest in understanding the potential benefits of SMAs in various contexts to improve clinical outcomes and reduce healthcare costs. This study builds upon the existing evidence base that suggests SMAs are indeed effective.

The Triage Interruptions Assessment Tool: An Instrument Development.

Interruptions contribute to catastrophic errors in health care. Interruptions are breaks in the performance of a human activity initiated by a source internal or external to the recipient. Errors during the initial triage assessment can lead to errors in estimating the acuity of a patient and resources required for appropriate care.

The nurse response to abnormal vital sign recording in the emergency department.

Aims And Objectives: To examine what occurs after a recorded observation of at least one abnormal vital sign in the emergency department. The aims were to determine how often abnormal vital signs were recorded, what interventions were documented, and what factors were associated with documented follow-up for abnormal vital signs.

Background: Monitoring quality of care, and preventing or intervening before harm occurs to patients are central to nurses' roles.

Associations between muscle-related cytokines and selected patient outcomes in the ICU.

Introduction: Systemic cytokines produced by contracting skeletal muscles may affect the onset and severity of intensive care unit (ICU)-acquired weakness after critical illness.

Aims: The purpose of this research was to determine the serum levels of interleukin (IL)-8, IL-15, and tumor necrosis factor-α (TNF-α) among patients receiving mechanical ventilation for >48 hr and examine the relationships of these myokines to outcomes of patient delirium, muscle strength, activities of daily living (ADLs), duration of mechanical ventilation, and length of ICU stay.

Methods: In this exploratory, repeated-measures interventional study, the 36 participants received 20 min of once-daily in-bed or out-of-bed activity using an established early progressive mobility protocol after physiologic stability had been demonstrated for >4 hr in the ICU.

Exploring the frequency of blood pressure documentation in emergency departments.

Purpose: One of the most commonly performed task in the emergency department (ED) is reported as the monitoring of vital signs, yet there are no published standards of care that provide guidelines for the frequency of obtaining vital signs in the ED. The purpose of this exploratory study was to determine the frequency of documentation of vital signs recorded during ED visits across Veterans Health Administration (VHA) facilities.

Methods: Deidentified patient level data from the VHA electronic health record (EHR) were abstracted for emergency department visits for 12 randomly selected days in calendar year 2011.