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Friedland A, Hernandez AF, Anstrom KJ, Chen-Lim ML, Cohen LW, Currier JS, Forrest CB, Fraser R, Fraulo E, George A, Handberg E, Jackman J, Koellhoffer J, Lawrence D, Leverty R, McAdams P, McCourt B, Mickley B, Naqvi SH, O'Brien EC, Olson R, Prater C, Rothman RL, Shenkman E, Shostak J, Turner KB, Webb L, Woods C, Naggie S. Design of the healthcare worker exposure response and outcomes (HERO) research platform. Contemp Clin Trials 2021; 109:106525. [PMID: 34371163 PMCID: PMC8349387 DOI: 10.1016/j.cct.2021.106525] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/24/2021] [Accepted: 08/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The SARS CoV-2 virus has caused one of the deadliest pandemics in recent history, resulting in over 170 million deaths and global economic disruption. There remains an urgent need for clinical trials to test therapies for treatment and prevention. DESIGN An online research platform was created to support a registry community of healthcare workers (HCWs) to understand their experiences and conduct clinical studies to address their concerns. The first study, HERO-HCQ, was a double-blind, multicenter, randomized, pragmatic trial to evaluate the superiority of hydroxychloroquine (HCQ) vs placebo for pre-exposure prophylaxis (PrEP) of COVID-19 clinical infection in HCWs. Secondary objectives were to assess the efficacy of HCQ in preventing viral shedding of COVID-19 among HCWs and to assess the safety and tolerability of HCQ. METHODS HCWs joined the Registry and were pre-screened for trial interest and eligibility. Trial participants were randomized 1:1 to receive HCQ or placebo. On-site baseline assessment included a COVID-19 nasopharyngeal PCR and blood serology test. Weekly follow-up was done via an online portal and included screening for symptoms of COVID-19, self-reported testing, adverse events, and quality of life assessments. The on-site visit was repeated at Day 30. DISCUSSION The HERO research platform offers an approach to rapidly engage, screen, invite and enroll into clinical studies using a novel participant-facing online portal interface and remote data collection, enabling limited onsite procedures for conduct of a pragmatic clinical trial. This platform may be an example for future clinical trials of common conditions to enable more rapid evidence generation.
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Affiliation(s)
- Anne Friedland
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Mei Lin Chen-Lim
- Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Lauren W Cohen
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Judith S Currier
- University of California Los Angeles, Los Angeles, CA, United States of America
| | | | - Ryan Fraser
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Elizabeth Fraulo
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Anoop George
- Temple University Hospital, Philadelphia, PA, United States of America
| | - Eileen Handberg
- University of Florida, Gainesville, FL, United States of America
| | - Jennifer Jackman
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | | | - Daryl Lawrence
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Renee Leverty
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Patty McAdams
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Brian McCourt
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Brenda Mickley
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | | | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Rachel Olson
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Clyde Prater
- Williamson Medical Center, Franklin, TN, United States of America
| | - Russell L Rothman
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | | | - Jack Shostak
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Kisha Batey Turner
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Laura Webb
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Chris Woods
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Susanna Naggie
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America.
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Froh EB, Brodecki D, Chen-Lim ML, Frankenberger WD, DiGerolamo K, Ten Have ED, McCabe MA. Advancing Opportunities for Clinical Inquiry and Professional Development During a Pandemic. J Pediatr Nurs 2021; 58:36-38. [PMID: 33310283 PMCID: PMC8815103 DOI: 10.1016/j.pedn.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
A notable challenge faced by pediatric hospitals during the COVID-19 pandemic included the need to decrease inpatient census and socially distant non-clinical hospital employees to alternative work arrangements. In doing so, nurses and other clinical care services employees were reassigned to new roles, while others continue to work from home. This paper aims to describe how during the COVID-19 pandemic, a pediatric hospital-based center for nursing research and evidence-based practice used this opportunity to virtually engage staff across the department in topics of clinical inquiry through education sessions, office hours, and individualized/team consultation. Therefore, elevating and increasing the presence of nursing research and evidence-based practice while providing opportunities for the continued professional development of nurses, respiratory therapists, clinical dietitians, child life specialists and employees in neurodiagnostics.
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Affiliation(s)
- Elizabeth B Froh
- Department of Nursing & Clinical Care Services, PA, USA; School of Nursing, University of Pennsylvania, PA, USA.
| | | | | | - Warren D Frankenberger
- Department of Nursing & Clinical Care Services, PA, USA; School of Nursing, University of Pennsylvania, PA, USA
| | | | | | - Margaret A McCabe
- Department of Nursing & Clinical Care Services, PA, USA; School of Nursing, University of Pennsylvania, PA, USA
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DiGerolamo KA, Chen-Lim ML. An Educational Intervention to Improve Staff Collaboration and Enhance Knowledge of Fall Risk Factors and Prevention Guidelines. J Pediatr Nurs 2021; 57:43-49. [PMID: 33221696 DOI: 10.1016/j.pedn.2020.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/15/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Magnet®-designated hospitals are seeking to reduce the frequency of falls that lead to injury, which is considered a hospital-acquired condition. Patients with cancer are at high risk to fall, due to multiple factors. Synthesis of the literature supports team efforts and shared learning sessions for patient-care staff as part of the fall prevention process. The purpose was to improve collaboration between Registered Nurses (RNs) and Senior Nurse Aides (SNAs), as well as to enhance their knowledge of fall risk factors and evidence-based prevention guidelines for pediatric oncology patients. METHODS An evidence-based practice project was implemented using a quality improvement pilot based on the Magnet® framework. Oncology RNs and SNAs at a large pediatric hospital were invited to attend one of five educational sessions. Pre-and post-session learning was assessed based on an adapted fall risk knowledge assessment tool. FINDINGS Thirty participants attended an educational session with 27 (25 RNs and 2 SNAs) matched pre- and post-session assessments. Median post-session assessment scores were statistically significantly higher than pre-session scores (Z = -3.11, p = 0.001). Overall knowledge scores increased for 63% of participants. DISCUSSION An educational intervention focused on pediatric oncology nursing enhanced knowledge of patient-care roles and fall prevention efforts, leading to improved fall outcomes. APPLICATION TO PRACTICE Ensuring that RNs and SNAs fully embrace their shared role in harm prevention is vital when considering the complexity of delivering nursing care in our current healthcare environment.
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Affiliation(s)
- Kimberly A DiGerolamo
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. Philadelphia, PA 19104, United States of America.
| | - Mei Lin Chen-Lim
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. Philadelphia, PA 19104, United States of America
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Froh EB, Frankenberger W, Lebet R, Chen-Lim ML, McCabe M. Implementation of a Centralized Mechanism to Enrich the Quality of Nursing Research within a Children's Hospital. J Pediatr Nurs 2020; 50:131-133. [PMID: 31759749 DOI: 10.1016/j.pedn.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Elizabeth B Froh
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, Philadelphia, PA, United States of America; University of Pennsylvania, Philadelphia, PA, United States of America
| | - Warren Frankenberger
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, Philadelphia, PA, United States of America; University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ruth Lebet
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, Philadelphia, PA, United States of America; University of Pennsylvania, Philadelphia, PA, United States of America
| | - Mei Lin Chen-Lim
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, Philadelphia, PA, United States of America
| | - Margaret McCabe
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, Philadelphia, PA, United States of America; University of Pennsylvania, Philadelphia, PA, United States of America.
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Chen-Lim ML, Zarnowsky C, Green R, Shaffer S, Holtzer B, Ely E. Optimizing the assessment of pain in children who are cognitively impaired through the quality improvement process. J Pediatr Nurs 2012; 27:750-9. [PMID: 22497741 DOI: 10.1016/j.pedn.2012.03.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [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: 09/16/2011] [Revised: 02/29/2012] [Accepted: 03/12/2012] [Indexed: 12/28/2022]
Abstract
Pain assessment in children with cognitive impairment (CI) is challenging. A quality improvement (QI) project involving evidence-based review of pain assessment tools, feedback from the Family Advisory Council, trialing of selected tools within clinical settings including obtaining feedback from nurses, and parents caring for nonverbal children with developmental delay was reported. Synthesized evidence supported the adoption of revised Faces, Legs, Activity, Cry, and Consolability pain assessment tool into clinical practice. Results of postimplementation audit and challenges of staff nurse involvement in the QI process were also discussed. The 24-month-long QI process and its impact on changing practice were described in detail.
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Ely E, Chen-Lim ML, Zarnowsky C, Green R, Shaffer S, Holtzer B. Finding the evidence to change practice for assessing pain in children who are cognitively impaired. J Pediatr Nurs 2012; 27:402-10. [PMID: 22703688 DOI: 10.1016/j.pedn.2011.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 02/11/2011] [Revised: 05/09/2011] [Accepted: 05/23/2011] [Indexed: 10/17/2022]
Abstract
We report on a quality improvement project whose purpose was to systematically review behavioral pain assessment tools for children who are cognitively impaired, with the goal of identifying a valid and reliable tool for clinical practice. In addition, we sought to partner with parents and/or caregivers to expand their role in pain assessment. The project team conducted an extensive synthesis of the literature to examine the availability and quality of published pain assessment tools for use with children with cognitive impairment (CI) or developmental disability. Once completed, we identified 2 of the available 10 tools to test in the clinical setting. Data from this quality improvement project provided evidence to support the adoption of the revised Faces, Legs, Activity, Cry, and Consolability pain assessment tool for children with CI into clinical practice.
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Affiliation(s)
- Elizabeth Ely
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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