Terry Throckmorton

Measurement of Fatigue: Determining Minimally Important Clinical Differences

The purpose was to determine the minimally important clinical difference (MICD) in fatigue as measured by the Profile of Mood States, Schwartz Cancer Fatigue Scale (SCFS), General Fatigue Scale, and a 10-point single-item fatigue measure. The MICD is the smallest amount of change in a symptom (e.g., fatigue) measure that signifies an important change in that symptom. Subjects rated the degree of change in their fatigue over 2 days on a Global Rating Scale. 103 patients were enrolled on this multisite prospective repeated measures design. MICD was determined following established procedures at two time points. Statistically significant changes were observed for moderate and large changes in fatigue, but not for small changes. The scales were sensitive to increases in fatigue over time. The MICD, presented as mean change, for each scale and per item on each scale is: POMS = 5.6, per item = 1.1, SCFS = 5.0, per item = 0.8, GFS = 9.7, per item = 1.0, and the single item measure of fatigue was 2.4 points. This information may be useful in interpreting scale scores and planning studies using these measures.

Recommendations for enhancing clinical trials education: a review of the literature.

This study aims to apply the evidence-based practice (EBP) process to determine the factors that influence patients’ understanding of, participation in, and satisfaction with clinical trials, the informed consent process, and treatment decisions and to make recommendations for improving clinical trials education. Beginning with evidence retrieval, the authors identified key search terms and searched MEDLINE—Ovid, MEDLINE—PubMed, and the Cumulative Index to Nursing and Allied Health Literature to identify articles published between July 2001 and July 2006 that highlighted clinical trials education. The articles were reviewed for clinical trials patient education information, clinician methods of communicating clinical trial information to patients, and patient satisfaction with the clinical trials process, including the informed consent process. As a result, practice changes were recommended for the patient/family, staff/community, and institution. From the literature review, 81 articles were identified. Recurring themes included decision-making, patient education, staff education, and pediatrics. Most articles focused on methods and strategies aimed at improving education at the patient/family, staff/community, and institutional levels. The issues surrounding clinical trial education are complex due to multiple variables interfering with poor patient understanding of, participation in, and satisfaction with clinical trial treatment decisions. On the basis of our findings, we recommend that clinicians involved in educating patients, families, staff, and communities about clinical trials have an awareness of and understanding for very complex issues.

Barriers to reporting medication errors: a measurement equivalence perspective

Objectives To demonstrate a statistical analysis for testing the measurement equivalence of a patient safety survey instrument. The survey instrument examined in the present study is the Medication Administration Error Reporting Survey. Methods Surveys were posted to a random sample of registered nurses in the State of Texas, with 435 nurses completing the survey. The surveys contained questions about various error reporting issues, including the 16-item, Medication Administration Error Reporting scale. Nurses were divided into one of two samples—calibration and holdout—to ensure replicability of the results. Within each sample, two groups were created based on nurse tenure on the job. Results Multiple Group Confirmatory Factor Analysis was conducted across nurses with varying levels of experience for the calibration and holdout samples. For each sample, a baseline model was estimated, where model parameters were allowed to vary across the nursing groups, and compared with more restrictive models. The results provided support for the factor structure of the Medication Administration Error Reporting System but yielded mixed results concerning the equivalence of the measure across nursing groups. Conclusions The present study provides an explanation of how to examine the measurement equivalence of survey instruments and demonstrated that the Medication Administration Error Reporting scale might not be equivalent across nurses who differ with respect to experience levels.

Evidenced-based case management practice, part 1: the systematic review.

Objectives This article aims to (1) describe the steps in the development of a systematic review, (2) discuss the use of systematic reviews in developing an evidence base for case management practice, and (3) present listings of agencies that provide systematic reviews on clinical topics and resources to evaluate systematic reviews for application to practice. Primary Practice Settings Evidence-based practice is mandated for all healthcare professionals regardless of setting. For nonacademic settings, a lack of library resources may make this mandate difficult to accomplish. Systematic reviews are available through agency Web sites and, therefore, are accessible to anyone with Internet access. Findings/Conclusions Evidence-based practice supports professionalism, patient safety, and quality care. However, most case managers, have heavy workloads and limited time to complete literature reviews adequate to provide a basis for clinical decision making. For that reason, systematic reviews are developed and published by a variety of professional groups, including clinicians, academics, researchers, and library systems. This article focuses on the systematic review and includes definitions, a comparison of types of reviews, the process for completing systematic reviews, sources of systematic reviews, and tools used to critique them. Implications for Case Management Practice Systematic reviews can be helpful tools to allow busy case managers to provide the safest and most effective care to their patients. They can support the development of guidelines specific to case management such as transitioning care to other institutions or to the patients home, management of the patient in the community, and prevention of recidivism or unplanned return to an acute care setting.

Evidence-based case management practice-part II: meta-analysis: a primer for case managers.

Objectives This article aims to (1) describe the steps in the development of a meta-analysis, (2) discuss the use of meta-analysis in developing an evidence base for case management practice, and (3) provide some basic guidelines for evaluating the meta-analysis. Primary practice settings Evidence-based practice (EBP) is a mandate for all healthcare professionals, regardless of setting. Although many institutions lack library resources, systematic reviews and meta-analyses are available from multiple sites on the Internet. Findings/conclusions EBP is an essential element for professionals in the provision of safe, quality patient care. However, most healthcare professionals, including case managers, have little time to complete the extensive literature reviews and analyses required for evidence-based practice. Literature reviews completed by professional teams provide a solution for caregivers in their efforts to base practice on the best evidence. This article describes the quantitative literature review, meta-analysis, including definitions of terms, a description of the process, sources of meta-analyses, and basic guidelines for determining the quality of the review and applicability of the results to practice. Implications for case management Meta-analyses can provide access to the latest evidence for case managers with little time but great need for the most effective approaches to managing care. Meta-analyses provide a statistical analysis of multiple studies pooled to provide the most definitive interpretation of the data. Correctly analyzed and interpreted, meta-analyses can provide a sound basis for management of patient transitions from hospital to home and community. Meta-analyses describing the impact of various treatments allow the case manager to better prepare the patient and family for the healthcare issues the patient may face in recovering from a diagnosis and/or treatment.

Preoperative Patient Preparation to Reduce Surgical Site Infections

Patients that attend class and/or are evaluated by the anesthesia preoperative evaluation clinic are provided CHG to shower the night before and the morning of surgery. Preoperative patients are also provided a prescription for Mupirocin ointment and instructed to apply it for 5 days: 2 days prior to surgery, the day of surgery and 2 days postoperatively. As a teaching aid for each patient, a personalized surgery checklist is provided to instruct them on each step of the process.

Measurement of fatigue: Determining minimally important clinical differences

The purpose was to determine the minimally important clinical difference (MICD) in fatigue as measured by the Profile of Mood States, Schwartz Cancer Fatigue Scale (SCFS), General Fatigue Scale, and a 10-point single-item fatigue measure. The MICD is the smallest amount of change in a symptom (e.g., fatigue) measure that signifies an important change in that symptom. Subjects rated the degree of change in their fatigue over 2 days on a Global Rating Scale. 103 patients were enrolled on this multisite prospective repeated measures design. MICD was determined following established procedures at two time points. Statistically significant changes were observed for moderate and large changes in fatigue, but not for small changes. The scales were sensitive to increases in fatigue over time. The MICD, presented as mean change, for each scale and per item on each scale is: POMS = 5.6, per item = 1.1, SCFS = 5.0, per item = 0.8, GFS = 9.7, per item = 1.0, and the single item measure of fatigue was 2.4 points. This information may be useful in interpreting scale scores and planning studies using these measures.