Kelly T. Gleason

A Systematic Review of mHealth-Based Heart Failure Interventions.

Background:The popularity of mobile phones and similar mobile devices makes it an ideal medium for delivering interventions. This is especially true with heart failure (HF) interventions, in which mHealth-based HF interventions are rapidly replacing their telephone-based predecessors. Purpose:This systematic review examined the impact of mHealth-based HF management interventions on HF outcomes. The specific aims of the systematic review are to (1) describe current mHealth-based HF interventions and (2) discuss the impact of these interventions on HF outcomes. Methods:PubMed, CINAHL Plus, EMBASE, PsycINFO, and Scopus were systematically searched for randomized controlled trials or quasi-experimental studies that tested mHealth interventions in people with HF using the terms Heart Failure, Mobile Health, mHealth, Telemedicine, Text Messaging, Texting, Short Message Service, Mobile Applications, and Mobile Apps. Conclusions:Ten articles, representing 9 studies, were included in this review. The majority of the studies utilized mobile health technology as part of an HF monitoring system, which typically included a blood pressure–measuring device, weighing scale, and an electrocardiogram recorder. The impact of the mHealth interventions on all-cause mortality, cardiovascular mortality, HF-related hospitalizations, length of stay, New York Heart Association functional class, left ventricular ejection fraction, quality of life, and self-care were inconsistent at best. Implications:Further research is needed to conclusively determine the impact of mHealth interventions on HF outcomes. The limitations of the current studies (eg, inadequate sample size, quasi-experimental design, use of older mobile phone models, etc) should be taken into account when designing future studies.

Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action

Abstract Nurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error. We offer a conceptual model to formalize and expand nurses’ engagement in the diagnostic process through education, maximize effectiveness of interprofessional teamwork and communication through culture change, and leverage the nursing mission to empower patients to become active members of the diagnostic team. We describe the primary barriers, including culture, education, operations, and regulations, to nurses participating as full, equal members of the diagnostic team, and illustrate our approach to addressing these barriers. Nurses already play a major role in diagnosis and increasingly take ownership of this role, removing barriers will strengthen nurses’ ability to be equal, integral diagnostic team members. This model should serve as a foundation for increasing the role of the nurse in the diagnostic process, and calling nurses to take action in leading efforts to reduce diagnostic error.

The new diagnostic team

Abstract The National Academy of Medicine (NAM) in the recently issued report Improving Diagnosis in Health Care outlined eight major recommendations to improve the quality and safety of diagnosis. The #1 recommendation was to improve teamwork in the diagnostic process. This is a major departure from the classical approach, where the physician is solely responsible for diagnosis. In the new, patient-centric vision, the core team encompasses the patient, the physician and the associated nursing staff, with each playing an active role in the process. The expanded diagnostic team includes pathologists, radiologists, allied health professionals, medical librarians, and others. We review the roles that each of these team members will need to assume, and suggest “first steps” that each new team member can take to achieve this new dynamic.

Academic-clinical service partnerships are innovative strategies to advance patient safety competence and leadership in prelicensure nursing students

Nurse-graduates today must be prepared to practice in a complicated healthcare system with numerous safety challenges. Although patient safety and quality competencies are a priority in nursing education, effective strategies for applying this knowledge into practice are needed. To meet this challenge, the Helene Fuld Leadership Program for the Advancement of Patient Safety and Quality at Johns Hopkins School of Nursing has developed an academic-clinical service partnership. Students are assigned to mentored, quality improvement projects in which they complete 100 hours over 2 semesters. This partnership links the Fuld Fellows with an interprofessional network of Johns Hopkins Medical Entity clinical Quality Improvement leaders. The partnerships have lead to manuscripts, professional job opportunities, and quality networking for both our students and mentors. Our strategic, academic-service partnership has improved student knowledge of patient safety principles and promoted nursing competence in patient safety with the development of future patient safety and QI nurse leaders.

Development and preliminary evaluation of a patient portal messaging for research recruitment service

Introduction We developed a service to identify potential study participants through electronic medical records and deliver study invitations through patient portals. Methods The service was piloted in a cohort study that used multiple recruitment methods. Results Patient portal messages were sent to 1303 individuals and the enrollment rate was 10% (n=127). The patient portal enrollment rate was significantly higher than email and post mail (4%) strategies. Conclusion Patient portal messaging was an effective recruitment strategy.

Capturing diagnostic errors in incident reporting systems: value of a specific “DX Tile” for diagnosis-related concerns

Background: Diagnostic errors, the most common and deadly of medical errors, remain largely unmeasured by health care organizations and are vastly underreported by health care professionals [1]. Most incident reporting systems used to report errors, near misses, and latent system flaws are not designed to specifically identify diagnostic concerns. The lack of a designated place to report diagnostic errors and process failures creates significant additional work to identify these reports and patterns, and impedes the identification of systems based problems that are specific to diagnosis. Incident reporting systems allow any staff member within an institution, including physicians, nurses, allied health professionals, and even non-clinical staff to report errors and potential errors. Nurses are the principal incident reporters in hospital settings [2, 3] and are well-positioned to identify and act on diagnostic errors, though they often do not. Adding a designated mechanism to report diagnostic concerns in incident reporting systems reinforces that it is everyone’s job to improve the diagnostic process and is aligned with a core value of making diagnosis a “team sport”, highlighted in the 2015 National Academy of Medicine report Improving Diagnosis in Healthcare [1].

Atrial Fibrillation Symptoms and Sex, Race, and Psychological Distress: A Literature Review

Background:Atrial fibrillation (AF) symptoms are a major component of treatment decisions for patients with AF and impact quality of life and functional ability yet are poorly understood. Objective:This review aimed to determine what is known about the prevalence of symptoms and the association of symptoms to AF characteristics, psychological distress, sex, and race. Methods:We performed a structured review of AF symptoms as of March 2016 using PubMed, EMBASE, and CINAHL and reference searches of retrieved articles. Full-text, published, peer-reviewed, English-language articles were examined. Articles were included if they reported original research data on symptom prevalence and type among patients with AF. Results:The 3 most common symptoms were dyspnea, palpitations, and fatigue. The results suggested that, although AF characteristics are not a significant predictor of symptoms, tachycardia, female sex, race, and psychological distress have a positive association to symptoms. Conclusions:There is a scarcity of research examining symptoms in AF. Furthermore, the inconsistency in measurement methods and the failure to include diverse populations in AF research make it difficult to draw definitive conclusions from the current literature. Given the prevalence of AF in the United States and the impact of symptoms on quality of life and healthcare use, further research examining predictors of symptoms and interventions to alleviate symptoms is crucial.

The Association of Socioeconomic Conditions and Readiness to Learn New Ways of Performing Daily Activities in Older Adults With Functional Difficulties

Behavioral interventions for older adults can reduce difficulties in performing daily activities, hospitalizations, and mortality risk. The success of behavior change interventions, however, can be affected by a participant’s readiness to adopt changes. This study evaluates whether socioeconomic conditions, particularly financial strain affording food, are associated with readiness to change. We conducted a cross-sectional, descriptive study of baseline data from disabled older adults (N = 147) participating in an intervention to reduce physical disability. Readiness to change score was rated at the start of the intervention by interventionists as either pre-action (precontemplation = 1, contemplation = 2, preparation = 3) or action (=4). Participants reporting high financial strain affording food were more likely to have high readiness at the start of intervention; the association of this specific socioeconomic condition with readiness may be an important consideration in implementing interventions to reduce disability.