The Experts below are selected from a list of 6090 Experts worldwide ranked by ideXlab platform

Charlotte Woodshill - One of the best experts on this subject based on the ideXlab platform.

  • harnessing implementation science to optimize harm prevention in critically ill children a pilot study of bedside nurse clabsi bundle performance in the pediatric intensive care unit
    American Journal of Infection Control, 2020
    Co-Authors: Charlotte Woodshill, Kelly Papili, Eileen Nelson, Kathryn Lipinski, Judy A Shea, Rinad S Beidas, Meghan B Lanefall
    Abstract:

    Objective Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. We explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses. Methods Single-center cross-sectional electronic survey of PICU bedside nurses in an academic tertiary care center; using the COM-B (capability, opportunity, motivation) and TDF (theoretical domains framework) behavioral models to explore CLABSI bundle performance and identify barriers to compliance. Results We analyzed 160 completed surveys from 226 nurses (71% response rate). CLABSI knowledge was strong (capability). However, challenges related to opportunity were identified: 71% reported that patient care requirements impact bundle completion; 32% described the bundle as stressful; and CLABSI was viewed as the most difficult of all bundles. Seventy-five percent reported being highly impacted by Physician Attitude toward the CLABSI bundle (motivation). Conclusions PICU nurses are knowledgeable and motivated to prevent CLABSI, but face challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle. Interventions that address these challenges may improve bundle performance and prevent CLABSI in critically ill children.

Philippe Chassagne - One of the best experts on this subject based on the ideXlab platform.

  • underuse of oral anticoagulation for individuals with atrial fibrillation in a nursing home setting in france comparisons of resident characteristics and Physician Attitude
    Journal of the American Geriatrics Society, 2015
    Co-Authors: Oarda Bahri, Frederic Roca, Tarik Lechani, L Druesne, P Jouanny, Jean Marie Serot, Eric Boulanger, Francois Puisieux, Philippe Chassagne
    Abstract:

    Objectives To describe the characteristics of nursing home residents diagnosed with atrial fibrillation (AF) and eligible for oral anticoagulants who did not receive these drugs and to detail the conditions that Physicians who decide not to prescribe anticoagulants take into account. Design Cross-sectional. Setting Nursing home. Participants Nursing home residents with a history of AF (N = 1,085). Measurements Data were collected on clinical characteristics, geriatric syndromes, and antithrombotic regimen. Multivariate logistic regression was used to identify factors associated with nonprescription of anticoagulants. A standardized questionnaire was submitted to Physicians in charge of patients with AF, to detail conditions associated with their medical decision not to prescribe anticoagulants. Results History of AF was present in 1,085 nursing home residents (10.1%), mean age 87, with a mean CHA2DS2-VASc score of 5.1 ± 1.4. Of these residents with AF, 544 (50.1%) did not receive anticoagulants. Recurrent falls (odds ratio (OR) = 4.9, 95% confidence interval (CI) = 2.4–9.9, P < .001), past history of bleeding (OR = 3.62, 95% CI = 1.54–8.51, P = .003), paroxysmal AF (OR = 3.5, 95% CI = 1.83–6.66, P < .001), and advanced age (OR = 1.1, 95% CI = 1.01–1.17, P = .02) were significantly associated with not prescribing anticoagulants. Recurrent falls (47%), cognitive impairment (22.6%), and advanced age (16.4%) were the main reasons for not prescribing anticoagulants. Conclusion The prevalence of AF in a cohort of very old nursing home residents was 10%. Anticoagulation was prescribed in fewer than 50% of eligible cases despite high individual risk of stroke. Geriatric syndromes, especially falls and cognitive disorders, were the main reported contraindications for prescribing anticoagulants. Physicians caring for those residents wrongly thought that paroxysmal AF caused fewer thromboembolic events than permanent AF, which explains lower rates of anticoagulant prescription in individuals with paroxysmal AF.

Meghan B Lanefall - One of the best experts on this subject based on the ideXlab platform.

  • harnessing implementation science to optimize harm prevention in critically ill children a pilot study of bedside nurse clabsi bundle performance in the pediatric intensive care unit
    American Journal of Infection Control, 2020
    Co-Authors: Charlotte Woodshill, Kelly Papili, Eileen Nelson, Kathryn Lipinski, Judy A Shea, Rinad S Beidas, Meghan B Lanefall
    Abstract:

    Objective Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. We explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses. Methods Single-center cross-sectional electronic survey of PICU bedside nurses in an academic tertiary care center; using the COM-B (capability, opportunity, motivation) and TDF (theoretical domains framework) behavioral models to explore CLABSI bundle performance and identify barriers to compliance. Results We analyzed 160 completed surveys from 226 nurses (71% response rate). CLABSI knowledge was strong (capability). However, challenges related to opportunity were identified: 71% reported that patient care requirements impact bundle completion; 32% described the bundle as stressful; and CLABSI was viewed as the most difficult of all bundles. Seventy-five percent reported being highly impacted by Physician Attitude toward the CLABSI bundle (motivation). Conclusions PICU nurses are knowledgeable and motivated to prevent CLABSI, but face challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle. Interventions that address these challenges may improve bundle performance and prevent CLABSI in critically ill children.

Oarda Bahri - One of the best experts on this subject based on the ideXlab platform.

  • underuse of oral anticoagulation for individuals with atrial fibrillation in a nursing home setting in france comparisons of resident characteristics and Physician Attitude
    Journal of the American Geriatrics Society, 2015
    Co-Authors: Oarda Bahri, Frederic Roca, Tarik Lechani, L Druesne, P Jouanny, Jean Marie Serot, Eric Boulanger, Francois Puisieux, Philippe Chassagne
    Abstract:

    Objectives To describe the characteristics of nursing home residents diagnosed with atrial fibrillation (AF) and eligible for oral anticoagulants who did not receive these drugs and to detail the conditions that Physicians who decide not to prescribe anticoagulants take into account. Design Cross-sectional. Setting Nursing home. Participants Nursing home residents with a history of AF (N = 1,085). Measurements Data were collected on clinical characteristics, geriatric syndromes, and antithrombotic regimen. Multivariate logistic regression was used to identify factors associated with nonprescription of anticoagulants. A standardized questionnaire was submitted to Physicians in charge of patients with AF, to detail conditions associated with their medical decision not to prescribe anticoagulants. Results History of AF was present in 1,085 nursing home residents (10.1%), mean age 87, with a mean CHA2DS2-VASc score of 5.1 ± 1.4. Of these residents with AF, 544 (50.1%) did not receive anticoagulants. Recurrent falls (odds ratio (OR) = 4.9, 95% confidence interval (CI) = 2.4–9.9, P < .001), past history of bleeding (OR = 3.62, 95% CI = 1.54–8.51, P = .003), paroxysmal AF (OR = 3.5, 95% CI = 1.83–6.66, P < .001), and advanced age (OR = 1.1, 95% CI = 1.01–1.17, P = .02) were significantly associated with not prescribing anticoagulants. Recurrent falls (47%), cognitive impairment (22.6%), and advanced age (16.4%) were the main reasons for not prescribing anticoagulants. Conclusion The prevalence of AF in a cohort of very old nursing home residents was 10%. Anticoagulation was prescribed in fewer than 50% of eligible cases despite high individual risk of stroke. Geriatric syndromes, especially falls and cognitive disorders, were the main reported contraindications for prescribing anticoagulants. Physicians caring for those residents wrongly thought that paroxysmal AF caused fewer thromboembolic events than permanent AF, which explains lower rates of anticoagulant prescription in individuals with paroxysmal AF.

Judy A Shea - One of the best experts on this subject based on the ideXlab platform.

  • harnessing implementation science to optimize harm prevention in critically ill children a pilot study of bedside nurse clabsi bundle performance in the pediatric intensive care unit
    American Journal of Infection Control, 2020
    Co-Authors: Charlotte Woodshill, Kelly Papili, Eileen Nelson, Kathryn Lipinski, Judy A Shea, Rinad S Beidas, Meghan B Lanefall
    Abstract:

    Objective Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. We explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses. Methods Single-center cross-sectional electronic survey of PICU bedside nurses in an academic tertiary care center; using the COM-B (capability, opportunity, motivation) and TDF (theoretical domains framework) behavioral models to explore CLABSI bundle performance and identify barriers to compliance. Results We analyzed 160 completed surveys from 226 nurses (71% response rate). CLABSI knowledge was strong (capability). However, challenges related to opportunity were identified: 71% reported that patient care requirements impact bundle completion; 32% described the bundle as stressful; and CLABSI was viewed as the most difficult of all bundles. Seventy-five percent reported being highly impacted by Physician Attitude toward the CLABSI bundle (motivation). Conclusions PICU nurses are knowledgeable and motivated to prevent CLABSI, but face challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle. Interventions that address these challenges may improve bundle performance and prevent CLABSI in critically ill children.