Research Spotlight

Jordan, S., J. Karcher, R. Rogers, K. Kennedy, A. Lawrence and J. Adams (2017). “Measurement of functional capacity requirements of farmers: Implications for a cardiac rehabilitation training program.” J Cardiopulm Rehabil Prev 37(2): 119-123.

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PURPOSE: Updated cardiac rehabilitation (CR) and return-to-work guidelines from the American College of Sports Medicine (ACSM) now include specificity of training for industrial athletes (exercise training that involves the muscle groups, movements, and energy systems that these patients use during occupational tasks). However, many CR facilities do not apply this principle, relying instead on the traditional protocol that consists primarily of aerobic exercise. This study was conducted to measure the metabolic cost of typical farming tasks and to compare 2 methods of calculating training intensities. METHODS: Metabolic data were collected from 28 participants (23 men and 5 women, aged 18 to 57 years) while they loaded 10 hay bales, dug a fence posthole, filled 8 seed hoppers, and shoveled grain. RESULTS: Mean metabolic equivalent levels during these activities were 5.9 to 7.6 and participants reached 60% to 70% of heart rate reserve (HRR). By comparison, their mean resting heart rate + 30 beats per minute (RHR+30, a traditional CR intensity level) represented only 28% of HRR. CONCLUSIONS: Participants in the current study performed farming tasks within the ACSM’s recommended range of 40% to 80% of HRR, and the results suggest that training at RHR+30 would have been inadequate for helping a farmer return to work after a cardiac event. Using the study tasks as a basis, we described exercises that would be appropriate for the supervised resistance training of farmers in a CR setting.

Huddleston, P., M. E. Mancini and J. Gray (2017). “Measuring nurse leaders’ and direct care nurses’ perceptions of a healthy work environment in acute care settings, part 3: Healthy work environment scales for nurse leaders and direct care nurses.” J Nurs Adm 47(3): 140-146.

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BACKGROUND: Survey items on the Healthy Work Environment Scales (HWES) for nurse leaders (NLs) and direct care nurses (DCNs) were developed using statements from 2 qualitative research studies conducted in a healthcare system. PURPOSE: The purposes of 2 quantitative studies were to develop items on the HWES for NLs and DCNs, to assess the validity and reliability of these new tools, and to describe the NLs and DCNs perceptions of a healthy work environment (HWE) using nonexperimental descriptive designs. METHODS: Each research study had 2 separate phases. In phase 1 of the studies, NLs and DCNs assigned each item to 1 of the 8 characteristics of an HWE to assess face validity. Content validity was determined by calculating the scale content validity and item content validity indices. Based on these results, the items were revised or deleted to obtain version 3 of both tools. In phase 2 of the studies, principal component analysis (PCA) assessed the validity of the tools, Cronbach’s alpha served as the test for reliability, and the NLs and DCNs perceptions of an HWE were measured. RESULTS: Samples included 314 subjects for the HWES for NL study and 986 subjects for the HWES for DCN study. Principal component analysis for the HWES for NLs (version 3) revealed 40 items comprising 4 components, and PCA for the HWES for DCNs (version 3) revealed 39 items comprising 5 components. Internal consistencies of the tools were 0.974 and 0.957, respectively. Based on the findings of these studies, the tools demonstrated promising psychometric properties to measure a HWE in acute care settings.

Hanley, D., L. S. Prichep, J. Bazarian, J. S. Huff, R. Naunheim, J. Garrett, E. Jones, D. Wright, J. O’Neill, N. Badjatia, D. Gandhi, K. C. Curley, R. Chiacchierini, B. O’Neil and D. C. Hack (2017). “Emergency department triage of traumatic head injury using brain electrical activity biomarkers: A multisite prospective observational validation trial.” Acad Emerg Med: 2017 Feb [Epub ahead of print].

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OBJECTIVES: A brain electrical activity biomarker for identifying traumatic brain injury (TBI) in Emergency Department (ED) patients presenting with high GCS after sustaining a head injury has shown promise for objective, rapid, triage. The main objective of this study was to prospectively evaluate the efficacy of an automated classification algorithm to determine the likelihood of being CT positive, in high functioning TBI patients in the acute state. METHODS: Adult patients admitted to the ED for evaluation within 72 hours of sustaining a closed head injury with GCS 12-15were candidates for study. 720 patients (18-85 years) meeting inclusion/exclusion criteria were enrolled in this observational, prospective validation trial, at 11 US Emergency Departments. Glasgow Coma Scale was 15 in 97%, with the first and third quartile being 15 (IQR=0) in the study population at the time of the evaluation. Standard clinical evaluations were conducted and 5-10 minutes of EEG was acquired from frontal and frontal-temporal scalp locations. Using an a priori derived EEG based classification algorithm developed on an independent population and applied to this validation population prospectively, the likelihood of each subject being CT+ was determined, and performance metrics were computed relative to adjudicated CT findings. RESULTS: Sensitivity of the binary classifier (CT+ or CT-) was 92.3% (87.8%, 95.5%) for detection of any intracranial injury visible on CT (CT+), with specificity of 51.6% (48.1%, 55.1%) and negative predictive value of 96.0% (93.2%, 97.9%). Using ternary classification (CT+, Equivocal, CT-) demonstrated enhanced sensitivity to traumatic hematomas (>/=1cc of blood), 98.6% (92.6%, 100.0%) and negative predictive value of 98.2% (95.5%, 99.5%). CONCLUSIONS: Using an EEG-based biomarker high accuracy of predicting the likelihood of being CT+ was obtained, with high NPV and sensitivity to any traumatic bleeding and to hematomas. Specificity was significantly higher than standard CT decision rules. The short time to acquire results and the ease of use in the ED environment suggests that EEG based classifier algorithms have potential to impact triage and clinical management of head injured patients.

Grover, F. L., S. Vemulapalli, J. D. Carroll, F. H. Edwards, M. J. Mack, V. H. Thourani, R. G. Brindis, D. M. Shahian, C. E. Ruiz, J. P. Jacobs, G. Hanzel, J. E. Bavaria, E. M. Tuzcu, E. D. Peterson, S. Fitzgerald, M. Kourtis, J. Michaels, B. Christensen, W. F. Seward, K. Hewitt and D. R. Holmes, Jr. (2017). “2016 annual report of the society of thoracic surgeons/american college of cardiology transcatheter valve therapy registry.” Ann Thorac Surg 103(3): 1021-1035.

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BACKGROUND: The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry captures all procedures with Food and Drug Administration-approved transcatheter valve devices performed in the United States, and is mandated as a condition of reimbursement by the Centers for Medicaid & Medicare Services. OBJECTIVES: This annual report focuses on patient characteristics, trends, and outcomes of transcatheter aortic and mitral valve catheter-based valve procedures in the United States. METHODS: We reviewed data for all patients receiving commercially approved devices from 2012 through December 31, 2015, that are entered in the TVT Registry. RESULTS: The 54,782 patients with transcatheter aortic valve replacement demonstrated decreases in expected risk of 30-day operative mortality (STS Predicted Risk of Mortality [PROM]) of 7% to 6% and transcatheter aortic valve replacement PROM (TVT PROM) of 4% to 3% (both p < 0.0001) from 2012 to 2015. Observed in-hospital mortality decreased from 5.7% to 2.9%, and 1-year mortality decreased from 25.8% to 21.6%. However, 30-day post-procedure pacemaker insertion increased from 8.8% in 2013 to 12.0% in 2015. The 2,556 patients who underwent transcatheter mitral leaflet clip in 2015 were similar to patients from 2013 to 2014, with hospital mortality of 2% and with mitral regurgitation reduced to grade

Garmon, E. H., E. M. Stock, A. C. Arroliga and J. D. Bean-Lijewski (2017). “Effects of training on resident physician emergency airway management skills.” Can J Anaesth: 2017 Feb [Epub ahead of print].

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Emergency airway management is necessary when patients develop acute cardiopulmonary failure. Early intubation prevents hypoxemia from a poor bag-mask seal, but multiple intubation attempts increase the risk of complications.1, 2, 3 The Canadian Airway Focus Group summarizes the adverse effects associated with multiple intubation attempts in Table 3 of their 2013 publication on difficult tracheal intubation in the unconscious patient.4 Highly trained residents in supervised intensive care settings have previously been studied. 1, 2, 3