Sue M. Nyberg

Near-infrared spectroscopy measurement of sacral tissue oxygen saturation in healthy volunteers immobilized on rigid spine boards.

Abstract Introduction. Immobilization of patients utilizing rigid spine boards (RSBs) is standard practice in the management of trauma patients. Pressure ulcers have been associated with prolonged immobilization, and the possibility exists that formation may begin when the patient is initially immobilized on the RSB. The effects may not be fully recognized because of limited research on the direct tissue effects of prolonged immobilization. Near-infrared spectroscopy is an emerging tool to measure peripheral tissue oxygen saturation (StO2). The purpose of this research was to study the effects of prolonged spinal immobilization on an RSB on sacral tissue oxygenation of healthy volunteers. Methods. This experimental study measured StO2 in healthy volunteers at baseline and again after 30 minutes of immobilization on an RSB at two sites: the sacral area (intervention) and 8–10 cm above the buttocks (control). Tissue oxygenation was measured with the InSpectra Tissue Oxygenation Monitor (Hutchinson Technology, Hutchinson, MN) by placing the probe at the measurement site and waiting for 15 seconds for equilibration prior to recording StO2. Data were analyzed utilizing mixed-model and within-subjects analysis of variance (ANOVA), chi-square, and t-tests. Results. Seventy-three participants were included in the analysis. A slight majority of participants were female (55%), the average age was 38 years, the average height was 170 cm, and the average weight was 82 kg. There was a significant increase in the StO2 percentage at the sacral (intervention) area following immobilization, p < 0.001, point biserial correlation (rpb) = 0.48. Significant changes in oxygenation were not noted at the control site. Conclusion. An increase in sacral tissue oxygenation following immobilization was a finding consistent with other research. This is likely a result of initial, rapid tissue reperfusion at the time of pressure release. Rapid reperfusion indicates that a period of previous hypoperfusion has occurred. This research indicates that there are detrimental effects of spine board immobilization in healthy volunteers, which suggests that pressure ulcer formation may begin prior to hospital admission with immobilization on an RSB.

Kansas Physician Assistants’ Attitudes and Beliefs Regarding Spirituality and Religiosity in Patient Care

Research indicates patients want to discuss spirituality/religious (S/R) beliefs with their healthcare provider. This was a cross-sectional study of Kansas physician assistants (PA) regarding S/R in patient care. Surveys included questions about personal S/R beliefs and attitudes about S/R in patient care. Self-reported religious respondents agreed (92%) they should be aware of patient S/R; 82% agreed they should address it. Agreement with incorporating S/R increased significantly based on patient acuity. This research indicates Kansas PAs’ personal S/R beliefs influence their attitudes toward awareness and addressing patient S/R.

Evaluation of Process Variations in Noncompliance in the Implementation of Evidence‐Based Sepsis Care

Introduction: Sepsis is recognized as an often‐lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis‐focused RT and standard care. Methods: This retrospective chart review categorized septic patients based on treatment by a sepsis response team (SRT) versus standard care (non‐SRT). Guideline compliance was based upon the Surviving Sepsis evaluation and treatment guidelines. Results: Patient records for 123 identified septic patients post first‐year implementation were evaluated. Overall, compliance rates were low and there were variations in compliance between the treatment providers. The SRT was more compliant than the non‐SRT. SRT noncompliance was more often due to failure to achieve therapeutic goals within the recommended time. Mortality benefit was not statistically significant between groups; however mortality was higher in the non‐SRT group. Conclusion: Noncompliance is more complex than simple failure to initiate, especially in time‐dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis‐focused therapies over standard care.

Trauma patient satisfaction with physician assistants: testing a structural equation model.

Objective: Physician assistants (PAs) are increasingly utilized in the health care workforce and should be aware of how their interpersonal and technical skills are perceived by patients. The purpose of this study was to test associations among Perceived Interpersonal Care, Perceived Technical Care, and Global Satisfaction. Methods: This cross‐sectional telephone survey of recently discharged trauma patients tested a structural equation model which hypothesized that interpersonal satisfaction ratings predicted technical care and global satisfaction ratings. Results: A total of 251 completed surveys were analyzed. Results indicated a relationship among interpersonal care, technical care, and global satisfaction. Satisfaction with interpersonal care predicted satisfaction with technical care. Conclusion: In this study of how satisfied recently discharged trauma patients are with care by physician assistants, perceptions of technical care were associated with perceptions of interpersonal care, or how the patient was treated as a person. Since physician assistants have direct patient contact, this association demonstrates the strength of the PA‐patient relationship as an asset to the health care organization.

A national survey: Acceptance of physician assistants and nurse practitioners in trauma centers

ABSTRACT Objective: Census data published by professional organizations indicate an upward trend in the number of physician assistants (PAs) working in many specialty fields, including the subspecialty of trauma surgery. As the role of hospitalbased PAs and nurse practitioners (NPs) continues to evolve, greater understanding of these roles will help identify future employment trends for these professions. The purpose of this study is to determine the prevalence of PAs and NPs in US trauma centers, to document their roles, and to identify their potential future utilization by trauma centers. Methods: A survey was mailed to 464 directors of major trauma centers in the United States. The survey was designed to evaluate trauma centers’ utilization of PAs/NPs. Respondents were asked to identify specific daily tasks of PAs/NPs and to indicate potential for their future utilization. Results: Two hundred forty‐six (246) of 464 surveys were returned, for a response rate of 53%. Approximately onethird of reporting major trauma centers reported utilizing PAs/NPs. More American College of Surgeons (ACS)‐verified trauma facilities utilized PAs/NPs than did nonverified facilities; and Level I trauma centers used significantly more PAs/NPs than did Level II trauma centers. Nineteen percent (19%) of respondents who did not currently utilize PAs/NPs indicated that they intended to do so in the future. The majority of facilities utilized PAs/NPs to assist with trauma resuscitation and in performing traditional tasks, including obtaining and dictating histories and physical findings, participating in rounds on the general medical floor, and dictating discharge summaries. Fewer than half of reporting facilities indicated that PAs/NPs performed more invasive procedures, such as inserting arterial lines, central lines, chest tubes, and intracranial pressure monitors. Conclusions: PAs and NPs are increasingly utilized as clinicians in the surgical subspecialty of trauma. In most trauma centers, PAs/NPs are utilized to complete the traditional duties of a surgical PA/NP, with fewer performing invasive procedures. Finally, 19% of responding trauma centers who do not currently utilize PAs/NPs state that they intend to in the future, indicating the potential for continued job growth for PAs/NPs in trauma care. This evaluation of the utilization of PAs/NPs in direct care to trauma patients indicates acceptance of PAs/NPs in trauma staffing models.