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Ullman AJ, Larsen E, Gibson V, Binnewies S, Ohira R, Marsh N, Mcbride C, Winterbourn K, Boyte F, Cunninghame J, Dufficy M, Plummer K, Roberts N, Takashima M, Cooke M, Byrnes J, Rickard CM, Kleidon TM. An mHealth application for chronic vascular access: A multi-method evaluation. J Clin Nurs 2024; 33:1762-1776. [PMID: 38413831 DOI: 10.1111/jocn.17034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/13/2023] [Accepted: 01/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Healthcare consumers require diverse resources to assist their navigation of complex healthcare interactions, however, these resources need to be fit for purpose. AIM In this study, we evaluated the utility, usability and feasibility of children, families and adults requiring long-term intravenous therapy using a recently developed mobile health application (App), intravenous (IV) Passport. DESIGN Multi-site, parallel, multi-method, prospective cohort study. METHODS A multi-site, multi-method study was carried out in 2020-2021, with 46 participants (20 adults, 26 children/family) reporting on their experiences surrounding the use of the IV Passport for up to 6 months. RESULTS Overall, utility rates were acceptable, with 78.3% (N = 36) using the IV Passport over the follow-up period, with high rates of planned future use for those still active in the project (N = 21; 73%), especially in the child/family cohort (N = 13; 100%). Acceptability rates were high (9/10; IQR 6.5-10), with the IV Passport primarily used for documenting new devices and complications. Thematic analysis revealed three main themes (and multiple subthemes) in the qualitative data: Advocacy for healthcare needs, Complexity of healthcare and App design and functionality. CONCLUSION Several recommendations were made to improve the end-user experience including 'how to' instructions; and scheduling functionality for routine care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The IV Passport can be safely and appropriately integrated into healthcare, to support consumers. IMPACT Patient-/parent-reported feedback suggests the Intravenous Passport is a useful tool for record-keeping, and positive communication between patients/parents, and clinicians. REPORTING METHOD Not applicable. PATIENT CONTRIBUTION Consumers reported their experiences surrounding the use of the IV Passport for up to 6 months.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Emily Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Sebastian Binnewies
- School of Information and Communication Technology, Griffith University, Gold Coast, Queensland, Australia
| | - Ryoma Ohira
- School of Information and Communication Technology, Griffith University, Gold Coast, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Craig Mcbride
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Karen Winterbourn
- Parenteral Nutrition Down Under, Randwick, New South Wales, Australia
| | - Francesca Boyte
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jacqueline Cunninghame
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Mitchell Dufficy
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Karin Plummer
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Natasha Roberts
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Metro North Health Service, Herston, Queensland, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Metro North Health Service, Herston, Queensland, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Gavin NC, Northfield S, Mihala G, Somerville M, Kleidon T, Marsh N, Larsen E, Campbell J, Rickard CM, Ullman AJ. Central Venous Access Device-Associated Skin Complications in Adults with Cancer: A Prospective Observational Study. Semin Oncol Nurs 2024:151618. [PMID: 38622044 DOI: 10.1016/j.soncn.2024.151618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To identify the prevalence and type of central venous access device-associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device-associated skin complications. METHODS A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital. RESULTS Twenty-seven percent (n = 168) of participants had a central venous access device-associated skin complication. In the final multivariable analysis, significant (P < .05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37). CONCLUSION Central venous access device-associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies. IMPLICATIONS FOR PRACTICE This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury.
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Affiliation(s)
- Nicole C Gavin
- Nurse Researcher, Cancer Care Services, Royal Brisbane and Women's Hospital, Herston; Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Adjunct Associate Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Senior Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Senior Research Fellow, School of Medicine, University of Queensland, Herston; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
| | - Sarah Northfield
- Clinical Nurse Consultant, Specialist Palliative Care Service, Toowoomba Hospital, Queensland, Australia
| | - Gabor Mihala
- Biostatistician, School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Margarette Somerville
- Clinical Nurse Research, Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Tricia Kleidon
- Paediatrics and Neonatal Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Research Fellow, School of Nursing and Midwifery, Griffith University, Nathan; Nurse Practitioner, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Nicole Marsh
- Acute/Critical Care Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Emily Larsen
- Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; School of Nursing and Midwifery, Griffith University, Nathan; Research Fellow, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jill Campbell
- Adjunct Senior Research Fellow, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Claire M Rickard
- Infection Prevention Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan; Professor, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus; and Herston Infectious Diseases Institute, Metro North Health, Herston, Queensland, Australia
| | - Amanda J Ullman
- Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
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DelRocco NJ, Loh ML, Borowitz MJ, Gupta S, Rabin KR, Zweidler-McKay P, Maloney KW, Mattano LA, Larsen E, Angiolillo A, Schore RJ, Burke MJ, Salzer WL, Wood BL, Carroll AJ, Heerema NA, Reshmi SC, Gastier-Foster JM, Harvey R, Chen IM, Roberts KG, Mullighan CG, Willman C, Winick N, Carroll WL, Rau RE, Teachey DT, Hunger SP, Raetz EA, Devidas M, Kairalla JA. Enhanced Risk Stratification for Children and Young Adults with B-Cell Acute Lymphoblastic Leukemia: A Children's Oncology Group Report. Leukemia 2024; 38:720-728. [PMID: 38360863 PMCID: PMC10997503 DOI: 10.1038/s41375-024-02166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
Current strategies to treat pediatric acute lymphoblastic leukemia rely on risk stratification algorithms using categorical data. We investigated whether using continuous variables assigned different weights would improve risk stratification. We developed and validated a multivariable Cox model for relapse-free survival (RFS) using information from 21199 patients. We constructed risk groups by identifying cutoffs of the COG Prognostic Index (PICOG) that maximized discrimination of the predictive model. Patients with higher PICOG have higher predicted relapse risk. The PICOG reliably discriminates patients with low vs. high relapse risk. For those with moderate relapse risk using current COG risk classification, the PICOG identifies subgroups with varying 5-year RFS. Among current COG standard-risk average patients, PICOG identifies low and intermediate risk groups with 96% and 90% RFS, respectively. Similarly, amongst current COG high-risk patients, PICOG identifies four groups ranging from 96% to 66% RFS, providing additional discrimination for future treatment stratification. When coupled with traditional algorithms, the novel PICOG can more accurately risk stratify patients, identifying groups with better outcomes who may benefit from less intensive therapy, and those who have high relapse risk needing innovative approaches for cure.
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Affiliation(s)
- N J DelRocco
- Department of Biostatistics, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
| | - M L Loh
- Department of Pediatrics and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - M J Borowitz
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - S Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - K R Rabin
- Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - K W Maloney
- Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | | | - E Larsen
- Department of Pediatrics, Maine Children's Cancer Program, Scarborough, ME, USA
| | | | - R J Schore
- Division of Pediatric Oncology, Children's National Hospital, Washington, DC and the George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - M J Burke
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W L Salzer
- Uniformed Services University, F. Edward Hebert School of Medicine, Bethesda, MD, USA
| | - B L Wood
- Children's Hospital Los Angeles, Pathology and Laboratory Medicine, Los Angeles, CA, USA
| | - A J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N A Heerema
- Department of Pathology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | - S C Reshmi
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital and Departments of Pathology and Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - J M Gastier-Foster
- Department of Pathology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - R Harvey
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - I M Chen
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - K G Roberts
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - C G Mullighan
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - C Willman
- Mayo Clinic, Cancer Center/Laboratory Medicine and Pathology, Rochester, NY, USA
| | - N Winick
- UTSouthwestern, Simmons Cancer Center, Dallas, TX, USA
| | - W L Carroll
- Perlmutter Cancer Center and Department of Pediatrics, NYU Langone Health, New York, NY, USA
| | - R E Rau
- Department of Pediatrics and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - D T Teachey
- Department of Pediatrics and The Center for Childhood Cancer Research, Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - S P Hunger
- Department of Pediatrics and The Center for Childhood Cancer Research, Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - E A Raetz
- Perlmutter Cancer Center and Department of Pediatrics, NYU Langone Health, New York, NY, USA
| | - M Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - J A Kairalla
- Department of Biostatistics, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Schults JA, Young ER, Marsh N, Larsen E, Corley A, Ware RS, Murgo M, Alexandrou E, McGrail M, Gowardman J, Charles KR, Regli A, Yasuda H, Rickard CM. Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial. J Intensive Care 2024; 12:12. [PMID: 38459599 PMCID: PMC10924392 DOI: 10.1186/s40560-024-00719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/04/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Arterial catheters (ACs) are critical for haemodynamic monitoring and blood sampling but are prone to complications. We investigated the incidence and risk factors of AC failure. METHODS Secondary analysis of a multi-centre randomised controlled trial (ACTRN 12610000505000). Analysis included a subset of adult intensive care unit patients with an AC. The primary outcome was all-cause device failure. Secondary outcomes were catheter associated bloodstream infection (CABSI), suspected CABSI, occlusion, thrombosis, accidental removal, pain, and line fracture. Risk factors associated with AC failure were investigated using Cox proportional hazards and competing-risk models. RESULTS Of 664 patients, 173 (26%) experienced AC failure (incidence rate [IR] 37/1000 catheter days). Suspected CABSI was the most common failure type (11%; IR 15.3/1000 catheter days), followed by occlusion (8%; IR 11.9/1,000 catheter days), and accidental removal (4%; IR 5.5/1000 catheter days). CABSI occurred in 16 (2%) patients. All-cause failure and occlusion were reduced with ultrasound-assisted insertion (failure: adjusted hazard ratio [HR] 0.43, 95% CI 0.25, 0.76; occlusion: sub-HR 0.11, 95% CI 0.03, 0.43). Increased age was associated with less AC failure (60-74 years HR 0.63, 95% CI 0.44 to 0.89; 75 + years HR 0.36, 95% CI 0.20, 0.64; referent 15-59 years). Females experienced more occlusion (adjusted sub-HR 2.53, 95% CI 1.49, 4.29), while patients with diabetes had less (SHR 0.15, 95% CI 0.04, 0.63). Suspected CABSI was associated with an abnormal insertion site appearance (SHR 2.71, 95% CI 1.48, 4.99). CONCLUSIONS AC failure is common with ultrasound-guided insertion associated with lower failure rates. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000); date registered: 18 June 2010.
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Affiliation(s)
- Jessica A Schults
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia.
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia.
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
| | - Emily R Young
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Amanda Corley
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Marghie Murgo
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia
| | - Evan Alexandrou
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matthew McGrail
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - John Gowardman
- Intensive Care Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Karina R Charles
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Medical School, The Notre Dame University, Fremantle, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, Saitama, Japan
- Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Claire M Rickard
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Ullman AJ, Gibson V, Kleidon TM, Binnewies S, Ohira R, Marsh N, McBride C, Winterbourn K, Boyte F, Cunninghame J, Roberts N, Xu GH, Takashima M, Cooke M, Rickard CM, Byrnes J, Larsen E. An mHealth application for chronic vascular access: Consumer led co-creation. J Pediatr Nurs 2024; 76:68-75. [PMID: 38364591 DOI: 10.1016/j.pedn.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Children with chronic and complex health conditions frequently need intravenous devices. The current approach to intravenous device selection, insertion, and monitoring is inconsistent, and healthcare consumers are often negatively affected by siloed health information, and poor future planning. Despite child- and family-centred care being recognised as a pillar of paediatric nursing care, limited implementation for vascular access device planning and management is evident. DESIGN AND METHODS To address this, we conducted a multi-phased approach to co-create, then evaluate, a mobile health (mHealth) application: IV Passport. Co-creation involved a prioritisation survey, followed by a Passport advisory panel consensus meeting. Following confirmation of the required content and features of the Passport, the mHealth application was designed and content validation achieved via survey. RESULTS The prioritisation survey yielded recommendations for seven features (e.g., graphical presentations of current/past devices). Content for nine device types (e.g., totally implanted ports) was suggested, each with 10 related items (e.g., insertion site). Content items for device-associated complications, future vascular access plans, and educational resources were also suggested. Following design, the application was released through Apple and Android platforms; and adapted to a paper version. Content validation was established; 100% strongly agreed the application was easy to use; 80% agreed/strongly agreed that they would recommend the Passport to others. CONCLUSION IV Passport embodies effective child- and family-centred care through consumer co-creation to empower patients and families manage vascular access devices. PRACTICE IMPLICATIONS IV Passport remains active; and can be utilised across many healthcare settings and patient populations.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Sebastian Binnewies
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Ryoma Ohira
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Craig McBride
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | | | - Francesca Boyte
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Jacqueline Cunninghame
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Natasha Roberts
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Grace Hui Xu
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Herston Infectious Disease Institute, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
| | - Emily Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
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Marsh N, Larsen E, O'Brien C, Peach H, Keogh S, Davies K, Mihala G, Hewer B, Booker C, McCarthy AL, Flynn J, Rickard CM. Controlling peripheral intravenous catheter failure by needleless connector design: A pilot randomised controlled trial. J Clin Nurs 2023; 32:7909-7919. [PMID: 37587796 DOI: 10.1111/jocn.16852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
AIM To test the feasibility of a study protocol that compared the efficacy of neutral- and negative-pressure needleless connectors (NCs). DESIGN A single-centre, parallel-group, pilot randomised control trial. METHODS Our study compared neutral-(intervention) and negative-pressure (control) NCs among adult patients in an Australian hospital. The primary feasibility outcome was measured against predetermined criteria (e.g. eligibility, attrition). The primary efficacy outcome was all-cause peripheral intravenous catheter failure, analysed as time-to-event data. RESULTS In total, 201 (100 control; 101 intervention) participants were enrolled between March 2020 and September 2020. All feasibility criteria were met except eligibility, which was lower (78%) than the 90% criterion. All-cause peripheral intravenous catheter failure was significantly higher in the intervention group (39%) compared to control (19%). CONCLUSION With minor modifications to participant screening for eligibility, this randomised control trial is feasible for a large multicentre randomised control trial. The neutral NC was associated with an increased risk of peripheral intravenous catheter failure. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE There are several NC designs available, often identified by their mechanism of pressure (positive, negative and neutral). However, NCs can contribute to peripheral intravenous catheter failure. This is the first randomised controlled trial to compare neutral and negative NC designs. Negative pressure NCs had lower PIVC failure compared to neutral NCs, however the results might not be generalisable to other brands or treatment settings. Further high-quality research is needed to explore NC design. REPORTING METHOD Study methods and results reported in adherence to the CONSORT Statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
| | - Emily Larsen
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Hannah Peach
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Samantha Keogh
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
| | - Karen Davies
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Barbara Hewer
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Catriona Booker
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alexandra L McCarthy
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Mater Research Institute, Brisbane, Queensland, Australia
| | - Julie Flynn
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
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Gavin NC, Larsen E, Runnegar N, Mihala G, Keogh S, McMillan D, Ray‐Barruel G, Rickard CM. Association between parenteral nutrition-containing intravenous lipid emulsion and bloodstream infections in patients with single-lumen central venous access: A secondary analysis of a randomized trial. JPEN J Parenter Enteral Nutr 2023; 47:783-795. [PMID: 37288612 PMCID: PMC10946626 DOI: 10.1002/jpen.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Distinguishing primary bloodstream infections (BSIs) related to central venous access devices (CVADs) from those that occur through other mechanisms, such as a damaged mucosal barrier, is difficult. METHODS Secondary analysis was conducted on data from patients with CVADs that were collected for a large, randomized trial. Patients were divided into two groups: those who received parenteral nutrition (PN)-containing intravenous lipid emulsion (ILE) and those who did not have PN-containing ILE. This study investigated the influence of PN-containing ILE (ILE PN) on primary BSIs in patients with a CVAD. RESULTS Of the 807 patients, 180 (22%) received ILE PN. Most (627/807; 73%) were recruited from the hematology and hematopoietic stem cell transplant unit, followed by surgical (90/807; 11%), trauma and burns (61/807; 8%), medical (44/807; 5%), and oncology (23/807; 3%). When primary BSI was differentiated as a central line-associated BSI (CLABSI) or mucosal barrier injury laboratory-confirmed BSI (MBI-LCBI), the incidence of CLABSI was similar in the ILE PN and non-ILE PN groups (15/180 [8%] vs 57/627 [9%]; P = 0.88) and the incidence of MBI-LCBI was significantly different between groups (31/180 [17%] ILE PN vs 41/627 [7%] non-ILE PN; P < 0.01). CONCLUSION Our data indicate that twice as many primary BSIs in ILE PN patients are due to MBIs than CVADs. It is important to consider the MBI-LCBI classification, as some CLABSI prevention efforts aimed at CVADs for the ILE PN population may be better directed to gastrointestinal tract protection interventions.
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Affiliation(s)
- Nicole C. Gavin
- Cancer Care ServicesRoyal Brisbane and Women's HospitalQueenslandAustralia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyQueenslandAustralia
- School of NursingQueensland University of TechnologyQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt LuciaQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandQueenslandAustralia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerstonAustralia
- Patient‐Centre Health Services, Menzies Health Institute QueenslandGriffith UniversityQueenslandAustralia
| | - Naomi Runnegar
- Faculty of MedicineUniversity of QueenslandQueenslandAustralia
- Infection Management ServicesPrincess Alexandra HospitalQueenslandAustralia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Medicine and DentistryGriffith UniversityQueenslandAustralia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyQueenslandAustralia
- School of NursingQueensland University of TechnologyQueenslandAustralia
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerstonAustralia
| | - David McMillan
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Science, Technology, Engineering and Education; Centre for BioInnovationUniversity of the Sunshine CoastQueenslandAustralia
| | - Gillian Ray‐Barruel
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt LuciaQueenslandAustralia
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerstonAustralia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt LuciaQueenslandAustralia
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerstonAustralia
- Herston Infectious Diseases InstituteMetro North HealthHerstonAustralia
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Corley A, O'Brien C, Larsen E, Peach H, Rickard C, Hewer B, Pearse I, Fenn M, Cocksedge R, Marsh N. Does longer peripheral intravenous catheter length optimise antimicrobial delivery? Protocol for the LEADER study. Br J Nurs 2023; 32:S24-S30. [PMID: 37027419 DOI: 10.12968/bjon.2023.32.7.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Hospitalised patients receiving intravenous antimicrobial therapy require a reliable device through which this is delivered. Short peripheral intravenous catheters (PIVCs) are the default device for antimicrobial therapy but up to half fail before therapy completion, leading to suboptimal drug dosing, patient distress from repeated insertions, and increased healthcare costs. This study will investigate the use of long PIVCs to determine if they are more reliable at delivering antimicrobial therapy. METHODS A two-arm, parallel randomised controlled trial of hospitalised adults requiring at least 3 days of peripherally compatible intravenous antimicrobials. Participants will be randomised to a short (<4 cm) or long (4.5-6.4 cm) PIVC. After interim analysis ( n=70) for feasibility and safety, 192 participants will be recruited. Primary outcome is disruption to antimicrobial administration from all-cause PIVC failure. Secondary outcomes include: number of devices to complete therapy, patient-reported pain and satisfaction, and a cost analysis. Ethical and regulatory approvals have been received.
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Affiliation(s)
- Amanda Corley
- Research Fellow (Clinician Researcher), School of Nursing and Midwifery, Griffith University, Nathan, Australia/Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Catherine O'Brien
- Nurse Researcher, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Emily Larsen
- Research Fellow (Vascular Access), School of Nursing and Midwifery, Griffith University/Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Hannah Peach
- Clinical Research Nurse, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Claire Rickard
- Professor of Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia/Herston Infectious Diseases Institute, Metro North Health, Herston, Australia
| | - Barbara Hewer
- Clinical Nurse Consultant, Vascular Access and Surveillance and Education, Royal Brisbane and Women's Hospital
| | - India Pearse
- Nurse Researcher, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Mary Fenn
- Senior Research Assistant, School of Nursing and Midwifery, Griffith University
| | - Ruth Cocksedge
- Senior Research Assistant, School of Medicine and Dentistry, Griffith University
| | - Nicole Marsh
- Nursing and Midwifery Director, Research, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital/Professor, School of Nursing and Midwifery, Griffith University
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Rickard CM, Larsen E, Walker RM, Mihala G, Byrnes J, Saiyed M, Cooke M, Finucane J, Carr PJ, Marsh N. Integrated versus nonintegrated peripheral intravenous catheter in hospitalized adults (OPTIMUM): A randomized controlled trial. J Hosp Med 2023; 18:21-32. [PMID: 36372995 PMCID: PMC10099685 DOI: 10.1002/jhm.12995] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One-third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures. OBJECTIVES We aimed to compare complications between integrated PIVCs (inbuilt extension sets, wings, and flattened bases) and traditional nonintegrated PIVCs. DESIGNS, SETTINGS AND PARTICIPANTS A centrally randomized, controlled, superiority trial (with allocation concealment until study entry) was conducted in three Australian hospitals. Medical-surgical patients (one PIVC each) requiring intravenous therapy for >24 h were studied. MAIN OUTCOME MEASURES The primary outcome was device failure (composite: occlusion, infiltration, phlebitis, dislodgement, local, or bloodstream infection). Infection endpoints were assessor-masked. The secondary outcomes were: failure type, first-time insertion success, tip colonization, insertion pain, dwell time, mortality, costs, health-related quality of life, clinician, and patient satisfaction. RESULTS Out of 1759 patients randomized (integrated PIVC, n = 881; nonintegrated PIVC, n = 878), 1710 (97%) received a PIVC and were in the modified intention-to-treat analysis (2269 PIVC-days integrated; 2073 PIVC-days nonintegrated). Device failure incidence was 35% (145 per 1000 device-days) nonintegrated, and 33% (124 per 1000 device-days) integrated PIVCs. INTERVENTION Integrated PIVCs had a significantly lower failure risk (adjusted [sex, infection, setting, site, gauge] hazard ratio [HR]: 0.82 [95% confidence interval, CI: 0.69-0.96], p = .015). The per-protocol analysis was consistent (adjusted HR: 0.80 [95% CI: 0.68-0.95], p = .010). Integrated PIVCs had significantly longer dwell (top quartile ≥ 95 vs. ≥84 h). Mean per-patient costs were not statistically different. CONCLUSIONS PIVC failure is common and complex. Significant risk factors include sex, infection at baseline, care setting, insertion site, catheter gauge, and catheter type. Integrated PIVCs can significantly reduce the burden of PIVC failure on patients and the health system.
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Affiliation(s)
- Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Emily Larsen
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Rachel M Walker
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Masnoon Saiyed
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Julie Finucane
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Metro South Hospitals and Health Service, Queen Elizabeth II Hospital, Nathan, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Marsh N, Larsen E, O'Brien C, Peach H, Keogh S, Davies K, Mihala G, Hewer B, Booker C, McCarthy A, Flynn J, Rickard C. 70. Comparing neutral and negative pressure needleless connectors - A pilot randomised controlled trial. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Rickard C, Larsen E, Marsh N, McGrail M, Ullman A, Kleidon T, Chan R, Byrnes J, Mollee P, Paterson D, Chopra V, Stone L, Tapsall D, Keogh S, Gavin N, McCarthy S, Alexandrou E, Choudhury M, Corley A, Schults J, Ray-Barruel G, Geoffrey Playford E. 76. “Gadgets and gizmos aplenty!” Dressing and securing peripherally inserted central catheters to prevent infection and failure. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Larsen E, August D, Keogh S, Flynn J, Ullman A, Marsh N, McCarthy A, Rickard C. 36. Nurses and needleless connectors: Where can we improve? A qualitative study. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Corley A, Marsh N, Larsen E, Cocksedge R, Rickard C. 40. Risk factors for central venous access device failure due to central line associated blood stream infection (CLABSI): A multivariable analysis of 1892 catheters. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zeuschner P, Haid M, Larsen E, Jaschkowitz G, Himbert D, Ayoubian H, Stöckle M, Junker K. PD-L1 expression on extracellular vesicles in urothelial carcinoma cell lines and primary tumor tissue. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01946-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Marsh N, Larsen E, O'Brien C, Ware R, Kleidon T, Groom P, Hewer B, Alexandrou E, Flynn J, Woollett K, Rickard C. Midline pilot randomised controlled trial: Managing peripheral intravenous devices among adult hospital patients with limited vascular access or prolonged therapy trial. Infect Dis Health 2021. [DOI: 10.1016/j.idh.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Corley A, Ullman A, Marsh N, Genzel J, Larsen E, Monteagle E, Booker C, Harris P. Securement bundles to prevent peripheral intravenous catheter failure – the SECURE-PIVC trial: A pilot randomised controlled trial. Infect Dis Health 2021. [DOI: 10.1016/j.idh.2021.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Millett CE, Perez-Rodriguez M, Shanahan M, Larsen E, Yamamoto HS, Bukowski C, Fichorova R, Burdick KE. C-reactive protein is associated with cognitive performance in a large cohort of euthymic patients with bipolar disorder. Mol Psychiatry 2021; 26:4096-4105. [PMID: 31740754 DOI: 10.1038/s41380-019-0591-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 01/09/2023]
Abstract
Data support the notion that 40-60% of patients with bipolar disorder (BD) have neurocognitive deficits. It is increasingly accepted that functioning in BD is negatively impacted by these deficits, yet they have not been a successful target for treatment. The biomarkers that predict cognitive deficits in BD are largely unknown, however recent evidence suggests that inflammation may be associated with poorer cognitive outcomes in BD. We measured C-reactive protein (CRP), a marker of systemic inflammation and risk of inflammatory disease, in 222 euthymic BD patients and 52 healthy controls. Within the patient sample, using multivariate analyses of covariance (MANCOVA) we compared cognitive performance of those with high CRP (≥5 mg/L) versus the remaining subjects (<5 mg/L) on a battery of cognitive tests. We evaluated relationships with several other relevant clinical features. We also examined the role of CRP in cognitive decline using a proxy cognitive decline metric, defined as the difference between premorbid and current IQ estimates, in a logistic regression analysis. Approximately 80% of our sample were BD-I, and the remainder were BD-II and 42.6% of our sample had a history of psychosis. We found a statistically significant effect of CRP on cognitive performance on a broad range of tests; participants with CRP ≥ 5 mg/L had worse performance on several measures of executive functioning, MATRICS processing speed and MATRICS reasoning and problem solving relative to those with lower CRP. We also identified CRP as a significant positive predictor of proxy cognitive decline. Our results indicate that elevated CRP is associated with a broad cognitive dysfunction in affectively remitted BD patients. These results may point to a subgroup of patients who might benefit from treatments to reduce inflammation.
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Affiliation(s)
- C E Millett
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - M Shanahan
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,James J. Peters Veterans Administration Hospital, Bronx, NY, USA
| | - E Larsen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - H S Yamamoto
- Laboratory of Genital Tract Biology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - C Bukowski
- Laboratory of Genital Tract Biology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - R Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - K E Burdick
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,James J. Peters Veterans Administration Hospital, Bronx, NY, USA.
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Marsh N, Larsen E, Hewer B, Monteagle E, Ware RS, Schults J, Rickard CM. 'How many audits do you really need?': Learnings from 5-years of peripheral intravenous catheter audits. Infect Dis Health 2021; 26:182-188. [PMID: 33795211 DOI: 10.1016/j.idh.2021.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are medical devices used to administer intravenous therapy but can be complicated by soft tissue or bloodstream infection. Monitoring PIVC safety and quality through clinical auditing supports quality infection prevention however is labour intensive. We sought to determine the optimal patient 'number' for clinical audits to inform evidence-based surveillance. METHODS We studied a dataset of cross-sectional PIVC clinical audits collected over five years (2015-2019) in a large Australian metropolitan hospital. Audits included adult medical, surgical, women's, cancer, emergency and critical care patients, with audit sizes of 69-220 PIVCs. The primary outcome was PIVC complications for one or more patient reported symptom/auditor observed sign of infection or other complications. Complication prevalence and 95% confidence interval (CI) were calculated. We modelled scenarios of low (10%), medium (20%) and high (50%) prevalence estimates against audit sizes of 20, 50, 100, 150, 200, 250, and 300. This was used to develop a decision-making tool to guide audit size. RESULTS Of 2274 PIVCs evaluated, 475 (21%) had a complication. Complication prevalence per round varied from 7.8% (95% CI, 4.2-12.9) to 39% (95% CI, 32.0-46.4). Precision improved with larger audit size and lower complication rates. However, precision was not meaningfully improved by auditing >150 patients at a complication rate of 20% (95% CI 13.9%-27.3%), nor >200 patients at a complication rate of 50% (95% CI 42.9%-57.1%). CONCLUSION Audit sizes should be 100 to 250 PIVCs per audit round depending on complication prevalence.
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Affiliation(s)
- Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia; School of Nursing, Queensland University of Technology, Brisbane, 4059, Australia.
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia
| | - Barbara Hewer
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
| | - Emily Monteagle
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Brisbane, 4111, Australia
| | - Robert S Ware
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Brisbane, 4111, Australia
| | - Jessica Schults
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia; Department of Anaesthesia, Queensland Children's Hospital, Brisbane, 4101, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia; Department of Anaesthesia, Queensland Children's Hospital, Brisbane, 4101, Australia
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Rickard CM, Flynn J, Larsen E, Mihala G, Playford EG, Shaw J, Keogh S, Ullman A, Zhang L, Gavin N, Kleidon T, Chopra V, McCarthy AL, Rocha PK, Marsh N. Needleless connector decontamination for prevention of central venous access device infection: A pilot randomized controlled trial. Am J Infect Control 2021; 49:269-273. [PMID: 32735809 DOI: 10.1016/j.ajic.2020.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022]
Abstract
Pilot randomized controlled trial (180 patients) of needleless connector decontamination. Central line-associated bloodstream infection occurred in 2% (1/61) of 70% isopropyl alcohol (IPA) wipe, 2% (1/59) of 70% IPA cap, and zero (0/58) infections in 2% chlorhexidine gluconate in 70% IPA wipe patients. Larger definitive trials are feasible and needed.
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20
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Gavin NC, Kleidon TM, Larsen E, O'Brien C, Ullman A, Northfield S, Mihala G, Runnegar N, Marsh N, Rickard CM. A comparison of hydrophobic polyurethane and polyurethane peripherally inserted central catheter: results from a feasibility randomized controlled trial. Trials 2020; 21:787. [PMID: 32928286 PMCID: PMC7489010 DOI: 10.1186/s13063-020-04699-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate the feasibility of an efficacy trial comparing a hydrophobic polyurethane peripherally inserted central catheter (PICC) with a standard polyurethane PICC. Methods This pilot randomised controlled trial (RCT) was conducted between May 2017 and February 2018. Adult participants (n = 111) were assigned to hydrophobic polyurethane PICC with proximal valve (intervention) or a polyurethane PICC with external clamp (standard care). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were central line-associated bloodstream infection, local infection, occlusion, thrombosis, fracture and dislodgement, phlebitis, local or systemic allergic reaction, and PICC dwell time. Results All feasibility outcomes were achieved, apart from eligibility criteria. In total, 338 patients were screened, 138 were eligible (41%), and of these 111 were randomised (80%). Patients received the allocated PICC in 106 (95%) insertions. No patients withdrew from the study and there was no missing data. PICC failure was 24% (13/55) in the intervention group and 22% (12/55) in the standard care group (p = 0.820). PICC failure per 1000 PICC days was 16.3 in the intervention group and 18.4 in the control group (p = 0.755). The average dwell time was 12 days in the intervention and 8 days in the control group. Conclusions This study demonstrates the feasibility of an efficacy trial of PICC materials in an adult population, once adjustments were made to include not only in-patients, but also patients being discharged to the Hospital in the Home service. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12616001578493. Prospectively registered on 16 November 2016. The trial protocol was published a priori (Kleidon et al., Vasc Access 3:15–21, 2017).
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Affiliation(s)
- Nicole C Gavin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia. .,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia. .,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia. .,Institute of Health and Biomendical Institute to Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia.
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Children's Hospital Queensland, South Brisbane, Queensland, 4101, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Children's Hospital Queensland, South Brisbane, Queensland, 4101, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Sarah Northfield
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, 4222, Australia.,Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland, 4102, Australia.,PA-Southside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, 4102, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
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21
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Flynn JM, Larsen E, Keogh S, Ullman A, Rickard CM. Response to the Letter to the Editor regarding "Methods for microbial needleless connector decontamination: A systematic review and meta-analysis". Am J Infect Control 2019; 47:1521-1522. [PMID: 31492555 DOI: 10.1016/j.ajic.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Julie M Flynn
- School of Nursing and Midwifery, Griffith University; Cancer Care Services, Royal Brisbane & Women's Hospital; Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
| | - Emily Larsen
- School of Nursing and Midwifery, Griffith University; Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Samantha Keogh
- Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University; School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amanda Ullman
- School of Nursing and Midwifery, Griffith University; Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University; Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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22
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Choudhury MA, Sidjabat HE, Zowawi HM, Marsh PhD N, Larsen E, Runnegar PhD N, Paterson DL, McMillan DJ, Rickard CM. Skin colonization at peripheral intravenous catheter insertion sites increases the risk of catheter colonization and infection. Am J Infect Control 2019; 47:1484-1488. [PMID: 31331714 DOI: 10.1016/j.ajic.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) break the skin barrier, and preinsertion antiseptic disinfection and sterile dressings are used to reduce risk of catheter-related bloodstream infection (CRBSI). In this study, the impact of PIVC skin site colonization on tip colonization and the development of CRBSI was investigated. METHODS A total of 137 patients' PIVC skin site swabs and paired PIVC tips were collected at catheter removal, cultured, and bacterial species and clonality were identified. RESULTS Of 137 patients, 45 (33%) had colonized skin sites and/or PIVC tips. Of 16 patients with paired colonization of both the skin site and PIVC tips, 11 (69%) were colonized with the same bacterial species. Of these, 77% were clonally related, including 1 identical clone of Pseudomonas aeruginosa in a patient with systemic infection and the same organism identified in blood culture. CONCLUSIONS The results demonstrate that opportunistic pathogen colonization at the skin site poses a significant risk for PIVC colonization and CRBSI. Further research is needed to improve current preinsertion antiseptic disinfection of PIVC skin site and the sterile insertion procedure to potentially reduce PIVC colonization and infection risk.
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Affiliation(s)
- Md Abu Choudhury
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia.
| | - Hanna E Sidjabat
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia
| | - Hosam M Zowawi
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia and World Health Organization Collaborating Centre for Infection Prevention and Control, Riyadh, Saudi Arabia
| | - Nicole Marsh PhD
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Naomi Runnegar PhD
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia
| | - David L Paterson
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia
| | - David J McMillan
- Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
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Marsh N, Larsen E, Tapp S, Sommerville M, Mihala G, Rickard CM. Management of Hospital In The Home (HITH) Peripherally Inserted Central Catheters: A Retrospective Cohort Study. Home Health Care Management & Practice 2019. [DOI: 10.1177/1084822319873334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Worldwide, there has been a shift in health care delivery, with an increasing emphasis on avoiding hospital admissions and providing treatment such as intravenous antibiotics for patients at home, using peripherally inserted central catheters (PICCs). However, there is inadequate data to demonstrate if rates of PICC failure are similar for hospital inpatients, currently understood to be between 7% and 36%, than those cared for at home. The objective of this study was to identify prevalence, dwell time, and complications associated with PICCs in the home setting. This single-center, retrospective cohort study of adults treated by the “Hospital in the Home” (HITH) program in Queensland, was conducted between June 1, 2017 and June 15, 2018. Clinical data were collected for patient and PICC characteristics. Variables were described as frequencies and proportions, means and standard deviations, or medians and interquartile ranges. In total, 304 patients treated by HITH during this timeframe, and 164 (54%) patients with 181 PICCs were included in this study. These patients were predominately male (n = 105, 64%), with a mean age of 54 years. The most common reason for admission was a wound infection and/or bone infection (n = 120, 33%). Most PICCs were single lumen (n = 120; 67%), inserted in the basilic vein (n = 137; 80%) by nurses (n = 122; 67%). Peripherally inserted central catheter failure occurred in 10% (n = 19); the most common complications were dislodgement (n = 9; 5%) and thrombosis (n = 4; 2%). There were no confirmed catheter-related blood stream infections. Peripherally inserted central catheter failure rates are similar between hospitalized inpatients and those cared for at home.
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Affiliation(s)
- Nicole Marsh
- Royal Brisbane and Women’s Hospital, Queensland, Australia
- Griffith University, Brisbane, Queensland, Australia
| | - Emily Larsen
- Royal Brisbane and Women’s Hospital, Queensland, Australia
- Griffith University, Brisbane, Queensland, Australia
| | - Sam Tapp
- Royal Brisbane and Women’s Hospital, Queensland, Australia
| | | | - Gabor Mihala
- Griffith University, Brisbane, Queensland, Australia
| | - Claire M. Rickard
- Royal Brisbane and Women’s Hospital, Queensland, Australia
- Griffith University, Brisbane, Queensland, Australia
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Abstract
Adult medical and surgical patients admitted to tertiary hospitals regularly have peripheral venous catheters (PVCs) inserted for their treatment. Anecdotally, patients report varying levels of pain and anxiety during the insertion procedure; however, lived experiences of patients are not well documented in the literature. The aim of this study was to gain an understanding of patients' experiences of PVC insertion. Some 10 participants were purposively sampled for semi-structured interviews, from the medical and surgical wards at a tertiary hospital in Queensland, Australia. Four key themes developed from the interview data: communication between the patient and the inserter; technique of device insertion; competence of the inserter; and location of the device. These themes informed practical ways that nurses might improve the patient experience, including: consultation with patients regarding device insertion preferences; siting the PVC in locations other than the antecubital fossa and hand; ensuring experienced and confident inserters are available to insert PVCs.
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Affiliation(s)
- Emily Larsen
- Senior Research Assistant, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland (MHIQ), Griffith University, Nathan Campus, Brisbane, Australia
| | - Samantha Keogh
- Professor, School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Australia
| | - Nicole Marsh
- Research Fellow in Vascular Access, Menzies Health Institute Queensland (MHIQ), Griffith University, Australia
| | - Claire Rickard
- Professor, School of Nursing and Midwifery, Griffith University, Australia
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25
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Moureau NL, Marsh N, Zhang L, Bauer MJ, Larsen E, Mihala G, Corley A, Lye I, Cooke M, Rickard CM. Evaluation of Skin Colonisation And Placement of vascular access device Exit sites (ESCAPE Study). J Infect Prev 2018; 20:51-59. [PMID: 30719089 DOI: 10.1177/1757177418805836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/14/2018] [Indexed: 01/08/2023] Open
Abstract
Background Skin microorganisms may contribute to the development of vascular access device (VAD) infections. Baseline skin microorganism type and quantity vary between body sites, yet there is little evidence to inform choice of VAD site selection. Objective To compare microorganisms present at different body sites used for VAD insertions and understand the effect of transparent dressings on skin microflora. Methods The ESCAPE observational study consisted of three phases: (1) skin swabs of four sites (mid-neck, base neck, chest, upper arm) from 48 hospital patients; (2) skin swabs of five body sites (mid-neck, base neck, chest, upper arm, lower arm) from 10 healthy volunteers; and (3) paired skin swabs (n = 72) under and outside of transparent dressings from 36 hospital patients (16 mid/base neck, 10 chest, upper arm). Specimens were cultured for 72 h, species identified and colony-forming units (CFU) counted. Ordinal logistic regression compared CFU categories between variables of interest. Results The chest and upper arm were significantly associated with fewer microorganisms compared to neck or forearm (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.25-0.65, P < 0.05). CFU levels under transparent dressings were not significantly different from outside (OR = 0.57, 95% CI = 0.22-1.45). Staphylococci were predominant at all sites. Other significant (P < 0.05) predictors of higher CFU count included prolonged hospitalisation and medical/surgical patient status. Discussion Skin microorganism load was significantly lower at the upper arm or chest, compared to the mid- or base neck. This may impact VAD site selection and subsequent infection risk.
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Affiliation(s)
- Nancy L Moureau
- PICC Excellence, Inc., Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland (MHIQ), Griffith University, Brisbane, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital, AVATAR, MHIQ, Griffith University, Brisbane, Australia
| | - Li Zhang
- AVATAR, MHIQ, Griffith University, Brisbane, Australia
| | | | - Emily Larsen
- AVATAR, MHIQ, Griffith University, Brisbane, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, MHIQ, Griffith University, Brisbane, Australia
| | - Amanda Corley
- AVATAR, MHIQ, Griffith University, Brisbane, Australia.,Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia
| | - India Lye
- AVATAR, MHIQ, Griffith University, Brisbane, Australia.,Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia
| | - Marie Cooke
- AVATAR, MHIQ, Griffith University, Brisbane, Australia
| | - Claire M Rickard
- AVATAR, MHIQ, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Brisbane, Australia
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26
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Rickard C, Larsen E, Marsh N, Webster J, Mihala G, Runnegar N. The incidence and cumulative risk of primary bloodstream and venous infections in 12,942 peripheral intravenous catheters in Australia. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Marsh N, Larsen E, Genzel J, Mihala G, Ullman AJ, Kleidon T, Cadigan S, Rickard CM. A novel integrated dressing to secure peripheral intravenous catheters in an adult acute hospital: a pilot randomised controlled trial. Trials 2018; 19:596. [PMID: 30376880 PMCID: PMC6208178 DOI: 10.1186/s13063-018-2985-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reported incidence of peripheral intravenous catheter (PIV) failure has been as high as 69%. This is in part due to inadequate stabilisation or securement to the skin, which allows micro-motion of the catheter within the vein. METHODS A pilot open randomised controlled trial of 300 patients was conducted in the medical and surgical wards of a large tertiary hospital. A superiority parallel pragmatic design was used. Eligible patients over the age of 16 years were randomised using a centralised service (randomly varied block sizes and 1:1 ratio) to have PIV dressings of either (i) a bordered polyurethane dressing (BPU, standard care) or (ii) the integrated securement device (ISD). Allocation was concealed until entry. The primary outcome of feasibility addressed eligibility, consent, protocol adherence and retention rates. All-cause PIV failure was an additional primary outcome. This was a composite of infection (laboratory-confirmed local or bloodstream infection), occlusion or infiltration, dislodgement, phlebitis and thrombosis. Group comparisons were by proportions, incidence rates per 1000 PIV days and hazard ratios. Secondary outcomes were local or bloodstream infection, occlusion or infiltration, dislodgement, phlebitis, thrombosis, PIV dwell time, safety and adverse events and patient satisfaction with study products. Analysis was by intention to treat and the patient was the unit of measurement. Multivariable modelling was undertaken. RESULTS Feasibility outcomes were 91% of screened patients were eligible, 98% of invited patients consented, 100% of randomised participants received the allocated intervention on insertion and 1/300 (< 1%) were lost to follow-up. In total, 792 PIV days were studied. PIV failure occurred in 43/150 BPU patients (29%) and 40/150 ISD patients (27%) (119 vs 93 per 1000 PIV days; incidence rate ratio 0.78, 95% confidence interval, CI 0.50-1.23). In the multivariate model, ISD (hazard ratio 0.51, 95% CI 0.29-0.89) and admission for a surgical emergency were significantly associated with decreased failure, while female gender, wound, hand insertion and more frequent PIV use were significantly associated with increased PIV failure. CONCLUSION ISDs were significantly associated with decreased failure in the multivariable modelling. Feasibility outcomes were supportive of the need to undertake a larger trial to confirm these results. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616000984493 . Registered 27 July 2016.
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Affiliation(s)
- Nicole Marsh
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Emily Larsen
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Jodie Genzel
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- School of Medicine, Griffith University, Brisbane, QLD Australia
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Amanda J. Ullman
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
| | - Sue Cadigan
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
| | - Claire M. Rickard
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
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Marsh N, Webster J, Larsen E, Genzel J, Cooke M, Mihala G, Cadigan S, Rickard CM. Expert versus generalist inserters for peripheral intravenous catheter insertion: a pilot randomised controlled trial. Trials 2018; 19:564. [PMID: 30333063 PMCID: PMC6192347 DOI: 10.1186/s13063-018-2946-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral intravenous catheters (PVCs) are essential invasive devices, with 2 billion PVCs sold each year. The comparative efficacy of expert versus generalist inserter models for successful PVC insertion and subsequent reliable vascular access is unknown. Methods A single-centre, parallel-group, pilot randomised controlled trial (RCT) of 138 medical/surgical patients was conducted in a large tertiary hospital in Australia to compare PVC insertion by (1) a vascular access specialist (VAS) or (2) any nursing or medical clinician (generalist model). The primary outcome was the feasibility of a larger RCT as established by predetermined criteria (eligibility, recruitment, retention, protocol adherence). Secondary outcomes were PVC failure: phlebitis, infiltration/extravasation, occlusion, accidental removal or partial dislodgement, local infection or catheter-related bloodstream infection; dwell time; insertion success, insertion attempts; patient satisfaction; and procedural cost-effectiveness. Results Feasibility outcomes were achieved: 92% of screened patients were eligible; two patients refused participation; there was no attrition or missing outcome data. PVC failure was higher with generalists (27/50, 54%) than with VASs (33/69, 48%) (228 versus 217 per 1000 PVC days; incidence rate ratio 1.05, 95% confidence interval 0.61–1.80). There were no local or PVC-related infections in either group. All PVCs (n = 69) were successfully inserted in the VAS group. In the generalist group, 19 (28%) patients did not have a PVC inserted. There were inadequate data available for the cost-effectiveness analysis, but the mean insertion procedure time was 2 min in the VAS group and 11 min in the generalist group. Overall satisfaction with the PVC was measured on an 11-point scale (0 = not satisfied and 10 = satisfied) and was higher in the VAS group (n = 43; median = 7) compared to the generalist group (n = 20; median = 4.5). The multivariable model identified medical diagnosis and bed-bound status as being significantly associated with higher PVC failure, and securement with additional non-sterile tape was significantly associated with lower PVC failure. Conclusion This pilot trial confirmed the feasibility and need for a large, multicentre RCT to test these PVC insertion models. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001675415. Registered on 6 December 2016.
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Affiliation(s)
- Nicole Marsh
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Joan Webster
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Emily Larsen
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Jodie Genzel
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Sue Cadigan
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Claire M Rickard
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia. .,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia. .,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia.
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Rickard CM, Marsh N, Webster J, Runnegar N, Larsen E, McGrail MR, Fullerton F, Bettington E, Whitty JA, Choudhury MA, Tuffaha H, Corley A, McMillan DJ, Fraser JF, Marshall AP, Playford EG. Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial. Lancet 2018; 392:419-430. [PMID: 30057103 DOI: 10.1016/s0140-6736(18)31380-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Two billion peripheral intravenous catheters (PIVCs) are used globally each year, but optimal dressing and securement methods are not well established. We aimed to compare the efficacy and costs of three alternative approaches to standard non-bordered polyurethane dressings. METHODS We did a pragmatic, randomised controlled, parallel-group superiority trial at two hospitals in Queensland, Australia. Eligible patients were aged 18 years or older and required PIVC insertion for clinical treatment, which was expected to be required for longer than 24 h. Patients were randomly assigned (1:1:1:1) via a centralised web-based randomisation service using random block sizes, stratified by hospital, to receive tissue adhesive with polyurethane dressing, bordered polyurethane dressing, a securement device with polyurethane dressing, or polyurethane dressing (control). Randomisation was concealed before allocation. Patients, clinicians, and research staff were not masked because of the nature of the intervention, but infections were adjudicated by a physician who was masked to treatment allocation. The primary outcome was all-cause PIVC failure (as a composite of complete dislodgement, occlusion, phlebitis, and infection [primary bloodstream infection or local infection]). Analysis was by modified intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000769987. FINDINGS Between March 18, 2013, and Sept 9, 2014, we randomly assigned 1807 patients to receive tissue adhesive with polyurethane (n=446), bordered polyurethane (n=454), securement device with polyurethane (n=453), or polyurethane (n=454); 1697 patients comprised the modified intention-to-treat population. 163 (38%) of 427 patients in the tissue adhesive with polyurethane group (absolute risk difference -4·5% [95% CI -11·1 to 2·1%], p=0·19), 169 (40%) of 423 of patients in the bordered polyurethane group (-2·7% [-9·3 to 3·9%] p=0·44), 176 (41%) of 425 patients in the securement device with poplyurethane group (-1·2% [-7·9% to 5·4%], p=0·73), and 180 (43%) of 422 patients in the polyurethane group had PIVC failure. 17 patients in the tissue adhesive with polyurethane group, two patients in the bordered polyurethane group, eight patients in the securement device with polyurethane group, and seven patients in the polyurethane group had skin adverse events. Total costs of the trial interventions did not differ significantly between groups. INTERPRETATION Current dressing and securement methods are commonly associated with PIVC failure and poor durability, with simultaneous use of multiple products commonly required. Cost is currently the main factor that determines product choice. Innovations to achieve effective, durable dressings and securements, and randomised controlled trials assessing their effectiveness are urgently needed. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia; The Prince Charles Hospital, Brisbane, QLD, Australia; Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Joan Webster
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Naomi Runnegar
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthew R McGrail
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia
| | - Fiona Fullerton
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Emilie Bettington
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Jennifer A Whitty
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia; University of East Anglia, Norwich, UK
| | - Md Abu Choudhury
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia
| | - Haitham Tuffaha
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; The Prince Charles Hospital, Brisbane, QLD, Australia
| | | | - John F Fraser
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia; The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Andrea P Marshall
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - E Geoffrey Playford
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia
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Ospina L, Nitzburg G, Shanahan M, Perez-Rodriguez M, Larsen E, Latifoglu A, Burdick K. Social cognition moderates the relationship between neurocognition and community functioning in bipolar disorder. J Affect Disord 2018; 235:7-14. [PMID: 29631204 PMCID: PMC6082404 DOI: 10.1016/j.jad.2018.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Schizophrenia (SZ) studies suggest that neurocognition predicts functional outcome and that social cognition mediates this relationship. Bipolar disorder (BD) patients also have cognitive, social, and functional impairments but the relationship among these factors in BD is not well established. We assessed whether social cognition modulates the influence of neurocognition on community functioning in BD, as found in SZ. METHODS 200 BD patients and 49 healthy controls (HC) were administered and compared on a battery of tests assessing neurocognition, social cognition, and community functioning. We conducted a series of regression analyses to investigate potential mediation or moderation of social cognition on the relationship between neurocognition and community functioning. RESULTS BD patients performed worse on neurocognitive domains of processing speed, attention, verbal learning, and global neurocognition. Also, BD patients performed worse on theory of mind, the social cognition composite score, and community functioning. Neurocognition did not significantly predict functional outcome in our BD sample. However, we found a moderating effect of social cognition: among patients with poor social cognition, better neurocognition was associated with better community functioning, a relationship not seen in BD patients with good social cognition. LIMITATIONS The study was limited by a relatively small HC group and assessing one subtype of functioning status. CONCLUSIONS The relationship between neurocognition and community functioning in BD may be dependent on social cognition status, implying the presence of social cognitive heterogeneity. Results may be relevant to choosing proper treatment interventions depending on the patient's social cognitive level.
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Affiliation(s)
- L.H. Ospina
- Icahn School of Medicine at Mount Sinai; Departments of Psychiatry and Neuroscience
| | - G.C. Nitzburg
- Icahn School of Medicine at Mount Sinai; Departments of Psychiatry and Neuroscience
| | - M. Shanahan
- Icahn School of Medicine at Mount Sinai; Departments of Psychiatry and Neuroscience
| | - M.M. Perez-Rodriguez
- Icahn School of Medicine at Mount Sinai; Departments of Psychiatry and Neuroscience
| | - E. Larsen
- Icahn School of Medicine at Mount Sinai; Departments of Psychiatry and Neuroscience
| | - A. Latifoglu
- Icahn School of Medicine at Mount Sinai; Departments of Psychiatry and Neuroscience
| | - K.E. Burdick
- Icahn School of Medicine at Mount Sinai; Departments of Psychiatry and Neuroscience,James J. Peters VA Medical Center, Bronx, NY, USA,Brigham and Women’s Hospital; Department of Psychiatry, Boston MA
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31
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Castillo MI, Larsen E, Cooke M, Marsh NM, Wallis MC, Finucane J, Brown P, Mihala G, Carr PJ, Byrnes J, Walker R, Cable P, Zhang L, Sear C, Jackson G, Rowsome A, Ryan A, Humphries JC, Sivyer S, Flanigan K, Rickard CM. Integrated versus nOn-integrated Peripheral inTravenous catheter. Which Is the most effective systeM for peripheral intravenoUs catheter Management? (The OPTIMUM study): a randomised controlled trial protocol. BMJ Open 2018; 8:e019916. [PMID: 29764876 PMCID: PMC5961612 DOI: 10.1136/bmjopen-2017-019916] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Peripheral intravenous catheters (PIVCs) are frequently used in hospitals. However, PIVC complications are common, with failures leading to treatment delays, additional procedures, patient pain and discomfort, increased clinician workload and substantially increased healthcare costs. Recent evidence suggests integrated PIVC systems may be more effective than traditional non-integrated PIVC systems in reducing phlebitis, infiltration and costs and increasing functional dwell time. The study aim is to determine the efficacy, cost-utility and acceptability to patients and professionals of an integrated PIVC system compared with a non-integrated PIVC system. METHODS AND ANALYSIS Two-arm, multicentre, randomised controlled superiority trial of integrated versus non-integrated PIVC systems to compare effectiveness on clinical and economic outcomes. Recruitment of 1560 patients over 2 years, with randomisation by a centralised service ensuring allocation concealment. Primary outcomes: catheter failure (composite endpoint) for reasons of: occlusion, infiltration/extravasation, phlebitis/thrombophlebitis, dislodgement, localised or catheter-associated bloodstream infections. SECONDARY OUTCOMES first time insertion success, types of PIVC failure, device colonisation, insertion pain, functional dwell time, adverse events, mortality, cost-utility and consumer acceptability. One PIVC per patient will be included, with intention-to-treat analysis. Baseline group comparisons will be made for potentially clinically important confounders. The proportional hazards assumption will be checked, and Cox regression will test the effect of group, patient, device and clinical variables on failure. An as-treated analysis will assess the effect of protocol violations. Kaplan-Meier survival curves with log-rank tests will compare failure by group over time. Secondary endpoints will be compared between groups using parametric/non-parametric techniques. ETHICS AND DISSEMINATION Ethical approval from the Royal Brisbane and Women's Hospital Human Research Ethics Committee (HREC/16/QRBW/527), Griffith University Human Research Ethics Committee (Ref No. 2017/002) and the South Metropolitan Health Services Human Research Ethics Committee (Ref No. 2016-239). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000089336.
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Affiliation(s)
- Maria Isabel Castillo
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marianne C Wallis
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Julie Finucane
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Peter Brown
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Rachel Walker
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Prudence Cable
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Li Zhang
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Candi Sear
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Gavin Jackson
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Anna Rowsome
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Alison Ryan
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Julie C Humphries
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Susan Sivyer
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Kathy Flanigan
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Rickard C, Marsh N, Larsen E, Corley A, Spooner A, Fraser J, Davis C, Lepelaar S, Long D, Roberts B, Baker S, Gill F, Gowardman J, Murgo M, Alexandrou E, Palermo A, Regli A, McGrail M, Runnegar N. Intravenous administration set (infusion tubing) replacement after 4 or 7 days is equally effective to prevent bloodstream infections (RSVP trial). Aust Crit Care 2018. [DOI: 10.1016/j.aucc.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Webster J, Larsen E, Booker C, Laws J, Marsh N. Prophylactic insertion of large bore peripheral intravenous catheters in maternity patients for postpartum haemorrhage: A cohort study. Aust N Z J Obstet Gynaecol 2017; 58:548-552. [DOI: 10.1111/ajo.12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/18/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Joan Webster
- Royal Brisbane and Women's Hospital; Herston Queensland Australia
- School of Nursing & Midwifery; Griffith University; Nathan Queensland Australia
- National Centre of Research Excellence in Nursing; Griffith University; Nathan Queensland Australia
| | - Emily Larsen
- Royal Brisbane and Women's Hospital; Herston Queensland Australia
- School of Nursing & Midwifery; Griffith University; Nathan Queensland Australia
- National Centre of Research Excellence in Nursing; Griffith University; Nathan Queensland Australia
| | - Catriona Booker
- Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Janelle Laws
- Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital; Herston Queensland Australia
- School of Nursing & Midwifery; Griffith University; Nathan Queensland Australia
- National Centre of Research Excellence in Nursing; Griffith University; Nathan Queensland Australia
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Russo M, Van Rheenen TE, Shanahan M, Mahon K, Perez-Rodriguez MM, Cuesta-Diaz A, Larsen E, Malhotra AK, Burdick KE. Neurocognitive subtypes in patients with bipolar disorder and their unaffected siblings. Psychol Med 2017; 47:2892-2905. [PMID: 28587689 PMCID: PMC5856455 DOI: 10.1017/s003329171700143x] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Our previous work revealed substantial heterogeneity in the cognitive profile of bipolar disorder (BD) due to the presence of three underlying cognitive subgroups characterized as: globally impaired, selectively impaired, or cognitively intact. In an effort to determine whether these subgroups are differentially related to genetic risk for the illness, we investigated whether cognitive deficits were more pronounced in unaffected siblings (UAS) of BD probands within identified clusters. METHODS Cluster analysis was used to identify cognitive clusters in BD (N = 60). UAS (N = 49) were classified into groups according to their proband sibling's cluster assignment; comparisons were made across all clusters and healthy controls (HCs; N = 71). RESULTS Three cognitive clusters in BD emerged: a globally impaired (36.7%), a selectively impaired (30%), and a cognitively intact cluster (33.3%). UAS showed a qualitatively similar pattern to their BD siblings; UAS of the globally impaired BD cluster showed verbal memory and general cognitive impairments relative to HCs. In contrast, UAS of the other two clusters did not differ from HCs. CONCLUSIONS This study corroborates findings from prior work regarding the presence of cognitive heterogeneity in BD. UAS of subjects in the globally impaired BD cluster presented with a qualitatively similar cognitive profile to their siblings and performed worse than all other BD clusters and UAS groups. This suggests that inherited risk factors may be contributing to cognitive deficits more notably in one subgroup of patients with BD, pointing toward differential causes of cognitive deficits in discrete subgroups of patients with the disorder.
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Affiliation(s)
- M. Russo
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY, USA
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
| | - T. E. Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Brain and Psychological Sciences Research Centre, School of Health Sciences, Swinburne University, Melbourne, Australia
- Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - M. Shanahan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY, USA
| | - K. Mahon
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY, USA
| | - M. M. Perez-Rodriguez
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY, USA
| | - A. Cuesta-Diaz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY, USA
| | - E. Larsen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY, USA
| | - A. K. Malhotra
- Zucker Hillside Hospital – Northwell Health System, Glen Oaks, NY, USA
| | - K. E Burdick
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY, USA
- James J Peters Veteran Administration (VA) Hospital, Bronx, NY, USA
- Brigham and Women’s Hospital, Boston, MA, USA
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Rickard C, Marsh N, Larsen E, Runnegar N, Gavin N, Mihala G, Playford G, Webster J. Administration sets/infusion tubing: How often should they be changed to prevent CRBSI? Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chan RJ, Northfield S, Larsen E, Mihala G, Ullman A, Hancock P, Marsh N, Gavin N, Wyld D, Allworth A, Russell E, Choudhury MA, Flynn J, Rickard CM. Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial. Trials 2017; 18:458. [PMID: 28978332 PMCID: PMC5628427 DOI: 10.1186/s13063-017-2207-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Peripherally inserted central catheters (PICCs) are commonly used for delivering intravenous therapy. PICC failure is unacceptably high (up to 40%) due to mechanical, infectious and thrombotic complications. Poor securement potentiates all complication types. This randomised controlled trial (RCT) aimed to examine the feasibility of a large RCT of four dressing and securement methods to prevent PICC failure. Methods This single-centre pilot RCT included 124 admitted medical/surgical/cancer patients aged ≥ 16 years with a PICC. Interventions were: (i) standard polyurethane dressing and sutureless securement device (SPU + SSD, control); (ii) polyurethane with absorbent lattice pad dressing (PAL + Tape); (iii) combination securement-dressing (CSD); and (iv) tissue adhesive (TA + SPU). All groups except TA + SPU had a chlorhexidine-gluconate (CHG) impregnated disc. Feasibility outcomes were recruitment and safety/acceptability of the interventions. The primary outcome was PICC failure, a composite of PICC removal for local infection, catheter-associated bloodstream infection, dislodgement, occlusion, and/or catheter fracture. Secondary outcomes included individual complications, dressing failure and dwell time, PICC dwell time, skin complications/phlebitis indicators, product costs, and patient and staff satisfaction. Qualitative feedback was also collected. Results PICC failure incidence was: PAL + CHG + Tape (1/5; 20%; 17.4/1000 days), SPU + SSD + CHG (control) (4/39; 10%; 9.0/1000 days), TA + SPU (3/35; 9%; 9.6/1000 days), and CSD + CHG (3/42; 7%; 9.4/1000 days). Recruitment to PAL + CHG + Tape was ceased after five participants due to concerns of PICC dislodgement when removing the dressing. CSD + CHG, TA + SPU (TA applied only at PICC insertion time), and control treatments were acceptable to patients and health professionals. Conclusion A large RCT of CSD + CHG and TA + SPU (but not PAL + CHG + Tape) versus standard care is feasible. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12616000027415. Registered on 15 January 2016.
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Affiliation(s)
- Raymond J Chan
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia. .,School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, 4059, Australia. .,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia.
| | - Sarah Northfield
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.,School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, 4059, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
| | - Emily Larsen
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
| | - Gabor Mihala
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, 4059, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
| | - Amanda Ullman
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
| | - Peter Hancock
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
| | - Nicole Gavin
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.,School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, 4059, Australia.,School of Medicine, University of Queensland, Herston, Brisbane, Queensland, 4029, Australia
| | - Anthony Allworth
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia
| | - Emily Russell
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia
| | - Md Abu Choudhury
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
| | - Julie Flynn
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
| | - Claire M Rickard
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR) Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Queensland, 4111, Australia
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Sviatoslavsky I, Kulcinski G, Moses G, Sawan M, Engelstad R, Larsen E, Lovell E, MacFarlane J, Mogahed E, Peterson R, Powers J, Wittenberg L. SIRIUS-T, an Advanced Tritium Production Facility Utilizing Symmetrically Illuminated Inertial Confinement Fusion. ACTA ACUST UNITED AC 2017. [DOI: 10.13182/fst91-a29416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- I.N. Sviatoslavsky
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - G.L. Kulcinski
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - G.A. Moses
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - M.E. Sawan
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - R.L. Engelstad
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - E. Larsen
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - E. Lovell
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - J. MacFarlane
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - E. Mogahed
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - R.R. Peterson
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - J.W. Powers
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
| | - L.J. Wittenberg
- Fusion Technology Institute University of Wisconsin-Madison 1500 Johnson Drive Madison, WI 53706 (608) 263-6974
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Webster J, Larsen E, Marsh N, Choudhury A, Harris P, Rickard C. Chlorhexidine gluconate or polyhexamethylene biguanide disc dressing to reduce the incidence of central-line-associated bloodstream infection: a feasibility randomized controlled trial (the CLABSI trial). J Hosp Infect 2017; 96:223-228. [DOI: 10.1016/j.jhin.2017.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/09/2017] [Indexed: 01/02/2023]
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Rickard CM, Marsh NM, Webster J, Gavin NC, Chan RJ, McCarthy AL, Mollee P, Ullman AJ, Kleidon T, Chopra V, Zhang L, McGrail MR, Larsen E, Choudhury MA, Keogh S, Alexandrou E, McMillan DJ, Mervin MC, Paterson DL, Cooke M, Ray-Barruel G, Castillo MI, Hallahan A, Corley A, Geoffrey Playford E. Peripherally InSerted CEntral catheter dressing and securement in patients with cancer: the PISCES trial. Protocol for a 2x2 factorial, superiority randomised controlled trial. BMJ Open 2017; 7:e015291. [PMID: 28619777 PMCID: PMC5734285 DOI: 10.1136/bmjopen-2016-015291] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Around 30% of peripherally inserted central catheters (PICCs) fail from vascular, infectious or mechanical complications. Patients with cancer are at highest risk, and this increases morbidity, mortality and costs. Effective PICC dressing and securement may prevent PICC failure; however, no large randomised controlled trial (RCT) has compared alternative approaches. We designed this RCT to assess the clinical and cost-effectiveness of dressing and securements to prevent PICC failure. METHODS AND ANALYSIS Pragmatic, multicentre, 2×2 factorial, superiority RCT of (1) dressings (chlorhexidine gluconate disc (CHG) vs no disc) and (2) securements (integrated securement dressing (ISD) vs securement device (SED)). A qualitative evaluation using a knowledge translation framework is included. Recruitment of 1240 patients will occur over 3 years with allocation concealment until randomisation by a centralised service. For the dressing hypothesis, we hypothesise CHG discs will reduce catheter-associated bloodstream infection (CABSI) compared with no CHG disc. For the securement hypothesis, we hypothesise that ISD will reduce composite PICC failure (infection (CABSI/local infection), occlusion, dislodgement or thrombosis), compared with SED. SECONDARY OUTCOMES types of PICC failure; safety; costs; dressing/securement failure; dwell time; microbial colonisation; reversible PICC complications and consumer acceptability. Relative incidence rates of CABSI and PICC failure/100 devices and/1000 PICC days (with 95% CIs) will summarise treatment impact. Kaplan-Meier survival curves (and log rank Mantel-Haenszel test) will compare outcomes over time. Secondary end points will be compared between groups using parametric/non-parametric techniques; p values <0.05 will be considered to be statistically significant. ETHICS AND DISSEMINATION Ethical approval from Queensland Health (HREC/15/QRCH/241) and Griffith University (Ref. No. 2016/063). Results will be published. TRIAL REGISTRATION Trial registration number is: ACTRN12616000315415.
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Affiliation(s)
- Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Joan Webster
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Nicole C Gavin
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Raymond J Chan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Alexandra L McCarthy
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Peter Mollee
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Patient Safety Enhancement Program, University of Michigan Health System and VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Li Zhang
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Matthew R McGrail
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Rural Health, Monash University, Churchill, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Md Abu Choudhury
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Evan Alexandrou
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Western Sydney University and Liverpool Hospital, Sydney, Australia
| | - David J McMillan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Merehau Cindy Mervin
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - David L Paterson
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Maria Isabel Castillo
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andrew Hallahan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - E Geoffrey Playford
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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Karol SE, Larsen E, Cheng C, Cao X, Yang W, Ramsey LB, Fernandez CA, McCorkle JR, Paugh SW, Autry RJ, Lopez-Lopez E, Diouf B, Jeha S, Pui CH, Raetz EA, Winick NJ, Carroll WL, Hunger SP, Loh ML, Devidas M, Evans WE, Yang JJ, Relling MV. Genetics of ancestry-specific risk for relapse in acute lymphoblastic leukemia. Leukemia 2017; 31:1325-1332. [PMID: 28096535 PMCID: PMC5462853 DOI: 10.1038/leu.2017.24] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 02/06/2023]
Abstract
The causes of individual relapses in children with acute lymphoblastic leukemia (ALL) remain incompletely understood. We evaluated the contribution of germline genetic factors to relapse in 2,225 children treated on Children’s Oncology Group trial AALL0232. We identified 302 germline single nucleotide polymorphisms (SNPs) associated with relapse after adjusting for treatment and ancestry and 715 additional SNPs associated with relapse in an ancestry-specific manner. We tested for replication of these relapse-associated SNPs in external data sets of antileukemic drug pharmacokinetics and pharmacodynamics and an independent clinical cohort. 224 SNPs were associated with rapid drug clearance or drug resistance, and 32 were replicated in the independent cohort. The adverse risk associated with black and Hispanic ancestries was attenuated by addition of the 4 SNPs most strongly associated with relapse in these populations [for blacks: model without SNPs hazard ratio (HR) =2.32, P=2.27×10−4, model with SNPs HR=1.07, P=0.79; for Hispanics: model without SNPs HR=1.7, P=8.23×10−5, model with SNPs HR=1.31, P=0.065]. Relapse SNPs associated with asparaginase resistance or allergy were overrepresented among SNPs associated with relapse in the more asparaginase intensive treatment arm (20/54 in Capizzi-methorexate arm vs. 8/54 in high-dose methotrexate arm, P=0.015). Inherited genetic variation contributes to race-specific and treatment-specific relapse risk.
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Affiliation(s)
- S E Karol
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - E Larsen
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
| | - C Cheng
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - X Cao
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - W Yang
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - L B Ramsey
- Department of Pharmacy Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - C A Fernandez
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - J R McCorkle
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - S W Paugh
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - R J Autry
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - E Lopez-Lopez
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - B Diouf
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - S Jeha
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - C-H Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - E A Raetz
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - N J Winick
- Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - W L Carroll
- Perlmutter Cancer Center, Department of Pediatrics and Pathology, New York University Langone Medical Center, New York, NY, USA
| | - S P Hunger
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M L Loh
- Department of Pediatrics, University of California School of Medicine, San Francisco, CA, USA
| | - M Devidas
- Department of Biostatistics, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - W E Evans
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - J J Yang
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - M V Relling
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
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Zhang L, Cao S, Marsh N, Ray-Barruel G, Flynn J, Larsen E, Rickard CM. Infection risks associated with peripheral vascular catheters. J Infect Prev 2016; 17:207-213. [PMID: 28989482 DOI: 10.1177/1757177416655472] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/18/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Peripheral vascular catheters (PVC) are the most frequently used invasive medical devices in hospitals, with 330 million sold each year in the USA alone. One in three UK inpatients at any one time has at least one PVC in situ according to the Scottish National Prevalence survey. METHOD A narrative review of studies describing the infection risks associated with PVCs. RESULTS It is estimated that 30-80% of hospitalised patients receive at least one PVC during their hospital stay. Despite their prevalence, PVCs are not benign devices, and the high number of PVCs inserted annually has resulted in serious catheter-related bloodstream infections and significant morbidity, prolonged hospital stay and increased healthcare system costs. To date, PVC infections have been under-evaluated. Most studies focus on central venous catheter rather than PVC-associated bloodstream infections. Risks associated with PVC infection must be addressed to reduce patient morbidity and associated costs of prolonged hospital admission and treatment. DISCUSSION This article discusses the sources and routes of PVC-associated infection and outlines known effective prevention and intervention strategies.
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Affiliation(s)
- Li Zhang
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Siyu Cao
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Nicole Marsh
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Gillian Ray-Barruel
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Julie Flynn
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Emily Larsen
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Claire M Rickard
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
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42
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Martiny K, Larsen E, Licht R, Nielsen C, Damkier P, Refsgaard E, Lunde M, Straasø B, Christensen E, Lolk A, Holmskov J, Sørensen C, Brødsgaard I, Eftekhari S, Bendsen B, Klysner R, Terp I, Larsen J, Vestergaard P, Buchholtz P, Gram L, Bech P. Relapse Prevention in Major Depressive Disorder After Successful Acute Electroconvulsive Treatment: a 6-month Double-blind Comparison of Three Fixed Dosages of Escitalopram and a Fixed Dose of Nortriptyline – Lessons from a Failed Randomised Trial of the Danish University Antidepressant Group (DUAG-7). Pharmacopsychiatry 2015; 48:274-8. [DOI: 10.1055/s-0035-1565063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- K. Martiny
- Intensive Outpatient Unit for Affective Disorders (IAA), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E. Larsen
- Department of Affective Disorders Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - R. Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - C. Nielsen
- Department of Mental Health Services, Esbjerg, Denmark
| | - P. Damkier
- Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - E. Refsgaard
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - M. Lunde
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - B. Straasø
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - E. Christensen
- The Mood Disorder Clinic, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A. Lolk
- Department of Psychiatry, Odense University Hospital, Odense, Denmark
| | - J. Holmskov
- Department of Psychiatry, Odense University Hospital, Odense, Denmark
| | - C. Sørensen
- Department of Psychiatry, Odense University Hospital, Odense, Denmark
| | - I. Brødsgaard
- Department of Affective Disorders Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - S. Eftekhari
- Psychiatric Center Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | - B. Bendsen
- Psychiatric Center Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark
| | - R. Klysner
- Psychiatric Center Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark
| | - I. Terp
- Psychiatric Center Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | - J. Larsen
- Psychiatric Center Gentofte, Copenhagen University Hospital, Copenhagen, Denmark
| | - P. Vestergaard
- Department of Affective Disorders Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - P. Buchholtz
- Department of Affective Disorders Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - L. Gram
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - P. Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark
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Rickard CM, Marsh N, Webster J, Playford EG, McGrail MR, Larsen E, Keogh S, McMillan D, Whitty JA, Choudhury MA, Dunster KR, Reynolds H, Marshall A, Crilly J, Young J, Thom O, Gowardman J, Corley A, Fraser JF. Securing All intraVenous devices Effectively in hospitalised patients--the SAVE trial: study protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5:e008689. [PMID: 26399574 PMCID: PMC4593168 DOI: 10.1136/bmjopen-2015-008689] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Over 70% of all hospital admissions have a peripheral intravenous device (PIV) inserted; however, the failure rate of PIVs is unacceptably high, with up to 69% of these devices failing before treatment is complete. Failure can be due to dislodgement, phlebitis, occlusion/infiltration and/or infection. This results in interrupted medical therapy; painful phlebitis and reinsertions; increased hospital length of stay, morbidity and mortality from infections; and wasted medical/nursing time. Appropriate PIV dressing and securement may prevent many cases of PIV failure, but little comparative data exist regarding the efficacy of various PIV dressing and securement methods. This trial will investigate the clinical and cost-effectiveness of 4 methods of PIV dressing and securement in preventing PIV failure. METHODS AND ANALYSIS A multicentre, parallel group, superiority randomised controlled trial with 4 arms, 3 experimental groups (tissue adhesive, bordered polyurethane dressing, sutureless securement device) and 1 control (standard polyurethane dressing) is planned. There will be a 3-year recruitment of 1708 adult patients, with allocation concealment until randomisation by a centralised web-based service. The primary outcome is PIV failure which includes any of: dislodgement, occlusion/infiltration, phlebitis and infection. Secondary outcomes include: types of PIV failure, PIV dwell time, costs, device colonisation, skin colonisation, patient and staff satisfaction. Relative incidence rates of device failure per 100 devices and per 1000 device days with 95% CIs will summarise the impact of each dressing, and test differences between groups. Kaplan-Meier survival curves (with log-rank Mantel-Cox test) will compare device failure over time. p Values of <0.05 will be considered significant. Secondary end points will be compared between groups using parametric or non-parametric techniques appropriate to level of measurement. ETHICS AND DISSEMINATION Ethical approval has been received from Queensland Health (HREC/11/QRCH/152) and Griffith University (NRS/46/11/HREC). Results will be published according to the CONSORT statement and presented at relevant conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN); 12611000769987.
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Affiliation(s)
- Claire M Rickard
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Joan Webster
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - E Geoffrey Playford
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Matthew R McGrail
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Rural Health, Monash University, Churchill, Victoria, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David McMillan
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Jennifer A Whitty
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Md Abu Choudhury
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Kimble R Dunster
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
- Biomedical Engineering and Medical Physics, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Heather Reynolds
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Andrea Marshall
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Jeanine Young
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Ogilvie Thom
- Nambour General Hospital, Nambour, Queensland, Australia
- Sunshine Coast Clinical School, The University of Queensland, Nambour, Queensland, Australia
| | - John Gowardman
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - John F Fraser
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
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Liu Z, Larsen E, Bahamondes S, Choi M, Li J, Cranford K, Hayes C, Grow A, Zheng Y, Wu X, Pai S, Kennedy A. SU-E-J-244: Development and Validation of a Knowledge Based Planning Model for External Beam Radiation Therapy of Locally Advanced Non-Small Cell Lung Cancer. Med Phys 2015. [DOI: 10.1118/1.4924330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Liu Z, Larsen E, Salmon H, Grow A, Hayes C, Balamucki C, Thompson M, Kennedy A. SU-E-T-332: Dosimetric Impact of Photon Energy and Treatment Technique When Knowledge Based Auto-Planning Is Implemented in Radiotherapy of Localized Prostate Cancer. Med Phys 2015. [DOI: 10.1118/1.4924693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Rickard CM, Marsh NM, Webster J, Gavin NC, McGrail MR, Larsen E, Corley A, Long D, Gowardman JR, Murgo M, Fraser JF, Chan RJ, Wallis MC, Young J, McMillan D, Zhang L, Choudhury MA, Graves N, Playford EG. Intravascular device administration sets: replacement after standard versus prolonged use in hospitalised patients-a study protocol for a randomised controlled trial (The RSVP Trial). BMJ Open 2015; 5:e007257. [PMID: 25649214 PMCID: PMC4322194 DOI: 10.1136/bmjopen-2014-007257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Vascular access devices (VADs), such as peripheral or central venous catheters, are vital across all medical and surgical specialties. To allow therapy or haemodynamic monitoring, VADs frequently require administration sets (AS) composed of infusion tubing, fluid containers, pressure-monitoring transducers and/or burettes. While VADs are replaced only when necessary, AS are routinely replaced every 3-4 days in the belief that this reduces infectious complications. Strong evidence supports AS use up to 4 days, but there is less evidence for AS use beyond 4 days. AS replacement twice weekly increases hospital costs and workload. METHODS AND ANALYSIS This is a pragmatic, multicentre, randomised controlled trial (RCT) of equivalence design comparing AS replacement at 4 (control) versus 7 (experimental) days. Randomisation is stratified by site and device, centrally allocated and concealed until enrolment. 6554 adult/paediatric patients with a central venous catheter, peripherally inserted central catheter or peripheral arterial catheter will be enrolled over 4 years. The primary outcome is VAD-related bloodstream infection (BSI) and secondary outcomes are VAD colonisation, AS colonisation, all-cause BSI, all-cause mortality, number of AS per patient, VAD time in situ and costs. Relative incidence rates of VAD-BSI per 100 devices and hazard rates per 1000 device days (95% CIs) will summarise the impact of 7-day relative to 4-day AS use and test equivalence. Kaplan-Meier survival curves (with log rank Mantel-Cox test) will compare VAD-BSI over time. Appropriate parametric or non-parametric techniques will be used to compare secondary end points. p Values of <0.05 will be considered significant. ETHICS AND DISSEMINATION Relevant ethical approvals have been received. CONSORT Statement recommendations will be used to guide preparation of any publication. Results will be presented at relevant conferences and sent to the major organisations with clinical practice guidelines for VAD care. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000).
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Affiliation(s)
- Claire M Rickard
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Nicole M Marsh
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Joan Webster
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nicole C Gavin
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Emily Larsen
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Amanda Corley
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Debbie Long
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Lady Cilento Children's Hospital, Brisbane, Australia
| | - John R Gowardman
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Marghie Murgo
- Clinical Excellence Commission, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
| | - John F Fraser
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Raymond J Chan
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Marianne C Wallis
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- School of Nursing and Midwifery, University of the Sunshine Coast, Maroochydore, Australia
| | - Jeanine Young
- Lady Cilento Children's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, University of the Sunshine Coast, Maroochydore, Australia
| | - David McMillan
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Li Zhang
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Md Abu Choudhury
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - E Geoffrey Playford
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
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Larsen E, Rise J, Lund KE. Risk and protective factors of adolescent exclusive snus users compared to non-users of tobacco, exclusive smokers and dual users of snus and cigarettes. Addict Behav 2013; 38:2288-94. [PMID: 23583834 DOI: 10.1016/j.addbeh.2013.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/11/2013] [Accepted: 02/19/2013] [Indexed: 11/29/2022]
Abstract
The use of snus is increasing in Norway. In this study we examined differences between adolescents who were exclusive snus users, and adolescent non-users, smokers and dual users of snus and cigarettes on a number of psychosocial factors, categorized as risk variables and protective variables associated with involvement in health compromising behavior. We applied separate logistic regression models, where exclusive snus users (n=740) were compared with non-users (n=904), smokers (n=219), and dual users (n=367). Compared to non-users, the group of exclusive snus users was associated with variables traditionally predicting health risk behavior, such as smoking friends (OR=1.74, SD 1.27-2.38) and truancy (OR=2.12, SD 1.65-2.78). Compared to smokers, exclusive snus users were related to variables traditionally associated with protection against involvement in health risk behavior, e.g. higher academic orientation (OR=1.66, SD 1.12-2.45). Associations with protective factors were also observed when exclusive snus users were compared with dual users. While the group of exclusive snus users was associated with a pattern of psychosocial risk compared to non-users, they showed a more conventional pattern when compared to smokers and dual users. The group of exclusive snus users may be described on a continuum varying from psychosocial risk factors to protective factors of risk involvement depending on the group of comparison.
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Affiliation(s)
- E Larsen
- Norwegian Institute for Alcohol and Drug Research, Postboks 565 Sentrum, 0105 Oslo, Norway.
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Chan RJ, Larsen E, Chan P. Re-examining the evidence in radiation dermatitis management literature: an overview and a critical appraisal of systematic reviews. Int J Radiat Oncol Biol Phys 2012; 84:e357-62. [PMID: 22713836 DOI: 10.1016/j.ijrobp.2012.05.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 05/03/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To provide an overview and a critical appraisal of systematic reviews (SRs) of published interventions for the prevention/management of radiation dermatitis. METHODS AND MATERIALS We searched Medline, CINAHL, Embase, and the Cochrane Library. We also manually searched through individual reference lists of potentially eligible articles and a number of key journals in the topic area. Two authors screened all potential articles and included eligible SRs. Two authors critically appraised and extracted key findings from the included reviews using AMSTAR (the measurement tool for "assessment of multiple systematic reviews"). RESULTS Of 1837 potential titles, 6 SRs were included. A number of interventions have been reported to be potentially beneficial for managing radiation dermatitis. Interventions evaluated in these reviews included skin care advice, steroidal/nonsteroidal topical agents, systemic therapies, modes of radiation delivery, and dressings. However, all the included SRs reported that there is insufficient evidence supporting any single effective intervention. The methodological quality of the included studies varied, and methodological shortfalls in these reviews might create biases to the overall results or recommendations for clinical practice. CONCLUSIONS An up-to-date high-quality SR in the prevention/management of radiation dermatitis is needed to guide practice and direction for future research. We recommend that clinicians or guideline developers critically evaluate the information of SRs in their decision making.
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Kandula NR, Malli T, Zei CP, Larsen E, Baker DW. Literacy and retention of information after a multimedia diabetes education program and teach-back. J Health Commun 2011; 16 Suppl 3:89-102. [PMID: 21951245 DOI: 10.1080/10810730.2011.604382] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Few studies have examined the effectiveness of teaching strategies to improve patients' recall and retention of information. As a next step in implementing a literacy-appropriate, multimedia diabetes education program (MDEP), the present study reports the results of two experiments designed to answer (a) how much knowledge is retained 2 weeks after viewing the MDEP, (b) does knowledge retention differ across literacy levels, and (c) does adding a teach-back protocol after the MDEP improve knowledge retention at 2-weeks' follow-up? In Experiment 1, adult primary care patients (n = 113) watched the MDEP and answered knowledge-based questions about diabetes before and after viewing the MDEP. Two weeks later, participants completed the knowledge assessment a third time. Methods and procedures for Experiment 2 (n = 58) were exactly the same, except that if participants answered a question incorrectly after watching the MDEP, they received teach-back, wherein the information was reviewed and the question was asked again, up to two times. Two weeks later, Experiment 2 participants completed the knowledge assessment again. Literacy was measured using the S-TOFHLA. After 2 weeks, all participants, regardless of their literacy levels, forgot approximately half the new information they had learned from the MDEP. In regression models, adding a teach-back protocol did not improve knowledge retention among participants and literacy was not associated with knowledge retention at 2 weeks. Health education interventions must incorporate strategies that can improve retention of health information and actively engage patients in long-term learning.
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Affiliation(s)
- Namratha R Kandula
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Larsen E, Johansen A. Primary superficial carcinomas of the duodenum. Acta Pathol Microbiol Scand 2009; 74:487-94. [PMID: 4313505 DOI: 10.1111/j.1699-0463.1968.tb03503.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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