IntroductionSurgical site infections (SSIs) are implicated in poor outcomes in orthopedic surgical patients. Decreasing foot traffic in orthopedic surgical suites is correlated with the reduction of SSI risk. This review aims to understand the background and significance of the problem, isolate factors contributing to the movement in and out of operating rooms, and identify interventions that decrease traffic in procedure areas.MethodsA comprehensive search was completed using the databases Embase and Medline (Ovid). A PICOT question was used in the literature search to evaluate the efficacy of a standardized guideline on operating room door opening frequency. The Mixed Methods Appraisal Tool was used to appraise the literature critically, and conventional content analysis methodology identified themes within the publications.ResultsThe literature search yielded 18 articles providing 3 different themes of evidence: airborne bacterial counts and their association with foot traffic; specific personnel, namely, nurses demonstrating the greatest amount of foot traffic; and interventions aimed at minimizing this foot traffic.ConclusionsImplementing multiple evidence-based interventions can decrease foot traffic and reduce the risk of SSIs in orthopedic patients. Further studies are needed to directly link airborne bacterial counts to SSIs, increase the level of evidence, and isolate interventions.
Background: This concept analysis presents a scholarly epistemological approach to defining the attributes, empirical referents, antecedents, and consequences of a knowledge maintenance approach-known as longitudinal assessment-to professional certification.Aim: The analysis reports on the efforts of the National Board of Certification and Recertification for Nurse Anesthetists to explore this educational method as an approach to meet requirements for continued professional certification.Method: Using the classical approach to concept analysis, the authors explore the structure and function of longitudinal assessment and define the characteristics of the concept in a way that is meaningful to the continued certification of nursing and medical professionals. Conclusion:This analysis establishes a link between the goal and outcome of the continued certification process, including continuing education in nursing and medical practice, and the desirable characteristics of longitudinal assessment, which include proven principles of educational psychology. Through exploring model and borderline cases, the authors seek to demonstrate that longitudinal assessment is the best approach to foster lifelong learning of continuously evolving scientific, theoretical, and clinical knowledge in support of safe care for patients.
Introduction: Persistent pain after stroke significantly impacts patients’ function, ability to participate in rehabilitation, and quality of life. We examined characteristics of stroke survivors discharged with pain. Methods: The sample consisted of 824 stroke patients admitted to a large, urban university based acute care facility in Texas with a completed pain assessment (numeric rating scale or Behavior Pain Scale) at discharge. Descriptive analysis of means and frequency distributions was conducted using a two-sided t-test for continuous variables and a Chi-squared test for categorical variables. Univariable and multivariable logistic regression models were used to determine the association between pain at discharge and type of stroke, adjusting for age, sex, race, smoking status, prevalent hypertension, BMI, and length of stay (LOS). We also tested for statistical interactions between stroke type and age, sex, and race. Results: The mean age was 64 years, with 56% (n=462) being males. Of the 824 stroke patients, 584 (71%) had ischemic stroke while 237 (29%) had hemorrhagic (ICH) stroke. At discharge, 43% (n=358) reported pain. In unadjusted analyses, those reporting pain were younger (p<0.001), had a higher BMI (p=0.009), had longer LOS (p<0.001), and were less likely to have ischemic stroke (p<0.001). Only sex modified the association between stroke type and pain at discharge (p=0.002; AUC=0.716). In sex-stratified analysis females with ischemic stroke had lowered odds of reporting pain at discharge by 75% compared to those having ICH (OR=0.25; 95% CI: 0.15-0.41). Conclusions: Our study finds that 43% of stroke survivors reported pain at discharge. Younger females with an increased BMI and an increased LOS were more likely to report pain. Our model AUC suggests that post stroke pain may be a complicated phenomenon that requires more complex models.
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