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Knowledge about the three different types of IV connectors (negative, positive, and neutral) is imperative to cancer care as specific and distinct interventions can help prevent occlusions and catheter-related bloodstream infections that can lead to increased morbidity with infections and loss of treatment time and mortality. Nurses have responsibilities associated with nursing research, education, and evidence-based practice that should support the outcomes of best patient care when using IV connectors. [ABSTRACT FROM AUTHOR]

Handling such complications as phlebitis and catheter fracture. [ABSTRACT FROM AUTHOR]

Background: Obesity is a chronic problem in Canada and although the Canadian Medical Association recognizes obesity as a disease, health care professionals (HCPs) are not necessarily proactively managing it as one. This study aimed to assess current obesity management knowledge and practices of Canadian family physicians (FPs) and evaluate the feasibility of an online self-directed learning platform, i-ACT™ in Obesity, in delivering learning and changing practice intentions to advance obesity management., Methods: i-ACT™ in Obesity is an online self-directed learning program designed by Canadian obesity medicine experts to provide individualized learning curricula to participants. One hundred FPs, with an interest in weight management and managing patients with obesity, were recruited across Canada to participate in a pilot study. FP education was delivered in a stepwise manner. Each participant completed a practice profile assessment to determine knowledge gaps and educational needs. Learners then watched didactic videos across disciplines on topics assigned to their curriculum by the program algorithm based on the relative difference between indicated and desired current knowledge. FPs also completed 10 retrospective patient assessments to assess clinical management practices and planned behaviour change. Feasibility, acceptability, and satisfaction of the learning program were assessed to formulate the rationale for a more widespread deployment in the future. Survey responses and related data were analyzed using comparative measures and descriptive statistics., Results: The program was piloted by ninety-one Canadian FPs, where 900 patients were assessed. FPs showed distinct differences between their current and desired levels of comfort in a variety of obesity-related topics. Participation was associated with an intention to use more obesity treatment interventions moving forward. The program received an overall satisfaction rating of 8.6 out of 10 and 100% of the evaluators indicated that they would recommend it to their colleagues., Conclusion: The program was overall well received and successfully changed obesity management intentions among participating FPs, thus setting the stage for a larger more comprehensive study to examine the efficacy of i-ACT™ in Obesity in addressing knowledge gaps and advancing evidence-based, guidelines-aligned approach to obesity treatment., (© 2022. The Author(s).)

Competing Interests: Intérêts concurrents: Sean Wharton signale avoir reçu des honoraires et le remboursement de frais de voyage et participé à des comités consultatifs universitaires pour Novo Nordisk, Bausch Health, Eli Lilly et Janssen. Sean Wharton est aussi le directeur médical d’une clinique spécialisée en gestion du poids et du diabète. David Lau signale avoir reçu des subventions et un soutien à la recherche d’AstraZeneca, de Novo Nordisk et des Instituts de recherche en santé du Canada (IRSC); des honoraires de conférencier d’AstraZeneca, Bausch Health, Boehringer Ingelheim, Diabète Canada, Eli Lilly, Merck et Novo Nordisk; et des honoraires de consultant d’Amgen, AstraZeneca, Bausch Health, Boehringer Ingelheim, Gilead, HLS Therapeutics, Janssen, Eli Lilly et Novo Nordisk. Michael Vallis est membre de comités consultatifs pour Novo Nordisk, Bausch Health et LifeScan. Michael Vallis a aussi reçu des honoraires de consultant de Bausch Health, LifeScan, Novo Nordisk et Sanofi et des honoraires de conférencier de Novo Nordisk, Sanofi, Bausch Health, Abbott et AbbVie. Arya Sharma signale avoir reçu des honoraires de conférencier et de consultant de Novo Nordisk, Bausch Pharmaceuticals et AstraZeneca. Laurent Biertho signale avoir reçu des subventions de Johnson and Johnson et de Medtronic, et il est membre de comités consultatifs pour Novo Nordisk et Bausch Health, en dehors des travaux soumis. Denise Campbell-Scherer est à l’emploi de l’Université de l’Alberta (professeure au Département de médecine familiale). Elle ne signale aucun autre lien de nature financière, mais mentionne avoir reçu des subventions de recherche de la part des organisations suivantes au cours des trois dernières années : Novo Nordisk Alberta Diabetes Fund (NOVAD), une subvention conjointe accordée après examen par les pairs, en partenariat avec la Fondation de l’Hôpital universitaire, Novo Nordisk et Alberta Innovates; Alberta Innovates Health Solutions (concours lancés par Cancer Prevention Research Opportunity and Collaborative Research et par Innovation Opportunities), les IRSC (concours Stratégie de recherche axée sur le patient du Canada et Des connaissances à la pratique); le Northern Alberta Family Medicine Fund; et l’Alberta Cancer Prevention and Legacy Fund. Elle signale aussi avoir reçu du financement pour le transfert des connaissances des sources suivantes au cours des trois dernières années : subvention à la formation versée sans restriction par Obésité Canada, financée par Novo Nordisk Global; bourse aux fins de réunion du Réseau mondial d’universités; subvention de l’Agency for Healthcare Research and Quality R13 pour une recherche sur l’efficacité des soins de santé et les résultats; une subvention pour la formation médicale des Services de santé de l’Alberta et de l’Association médicale de l’Alberta. Angela Alberga signale avoir reçu les subventions suivantes : bourse Santé du Fonds de recherche du Québec, bourse Accélération du programme MITACS, et bourse d’entrepreneuriat de l’Université Concordia, en dehors des travaux soumis. Jennifer Brown signale avoir reçu un soutien non financier de Novo Nordisk, et des honoraires personnels de Bausch Health, Diététistes du Canada, Obésité Canada et l’Association canadienne des médecins et chirurgiens bariatriques. Yoni Freedhoff est copropriétaire du Bariatric Medical Institute et de Constant Health, qui fournissent des services de gestion du poids; Constant Health a reçu une subvention de Novo Nordisk. Yoni Freedhoff est aussi l’auteur de The diet fix : Why diets fail and how to make them work publié par Crown Publishing Group, et il reçoit des droits d’auteur pour ce livre. Il est également le seul auteur du blogue intitulé Weighty Matters et d’une rubrique pour Medscape et plusieurs autres lettres d’opinion et articles dans lesquels il a exprimé ouvertement ses positions concernant le traitement, la gestion et la prévention de l’obésité. Yoni Freedhoff s’exprime en outre régulièrement au sujet de l’obésité et il reçoit des honoraires et le remboursement de frais de déplacement pour ces activités. Michel Gagner signale avoir reçu des honoraires de conférencier d’Ethicon, WL Gore et Medtronic; des honoraires de consultant de Novo Nordisk, Bausch Health et Lexington Medical; et il détient des options d’achat d’actions de Lexington Medical. Margaret Hahn signale avoir reçu des honoraires de consultation d’Alkermes. Marie-France Langlois signale avoir reçu des honoraires personnels de Novo Nordisk, Valeant, Merck Canada, Sanofi, Eli Lilly et Boehringer Ingelheim; une subvention de Merck Canada et d’autres honoraires d’AstraZeneca et du groupe d’étude TIMI (Thrombolysis in Myocardial Infarction) pour la recherche clinique sur le diabète à titre de chercheuse principale, tous en dehors des travaux soumis. David Macklin signale avoir reçu des honoraires personnels de Novo Nordisk et Bausch Health, en dehors des travaux soumis. Priya Manjoo signale avoir reçu des honoraires personnels de Novo Nordisk, Bausch Health et Sanofi; et des subventions de Boehringer Ingelheim, Sanofi et AstraZeneca, en dehors des travaux soumis. Marie-Philippe Morin signale avoir reçu des honoraires de conférencière de Novo Nordisk, Bausch Health, Eli Lilly, Boehringer Ingelheim, Nestlé Health Science, Janssen et AstraZeneca; une subvention de recherche de Novo Nordisk et Sanofi; et des honoraires de consultante de Novo Nordisk, Bausch Health, Eli Lilly, Boehringer Ingelheim, Janssen et AstraZeneca. Sue Pedersen signale avoir reçu des honoraires personnels de Novo Nordisk, Bausch Health, Janssen, Eli Lilly, Merck, AstraZeneca, Boehringer Ingelheim, Sanofi et Pfizer; des subventions d’Eli Lilly, AstraZeneca, Boehringer Ingelheim et Sanofi; et un soutien non financier de Novo Nordisk, Bausch Health, Janssen, Eli Lilly, AstraZeneca, Boehringer Ingelheim et Sanofi, en dehors des travaux soumis. Megha Poddar signale avoir reçu des honoraires pour de la formation médicale continue (FMC) de Novo Nordisk, Bausch Health, Boehringer Ingelheim, Eli Lilly, Jenssen, Merck, du Canadian Collaborative Research Network et d’Antibody Network; des subventions à la formation de Novo Nordisk et Bausch Health; des honoraires de mentorat de Novo Nordisk; des honoraires de participation à des comités consultatifs de Novo Nordisk et Bausch Health; et une bourse pour un projet d’amélioration de la qualité de Boehringer Ingelheim. Paul Poirier signale avoir reçu des honoraires de consultation et de formation médicale continue d’AstraZeneca, Boehringer Ingelheim, Janssen, Eli Lilly, Novo Nordisk, Valeant et Bausch Health, en dehors des travaux soumis. Judy Shiau signale avoir reçu des honoraires personnels de Novo Nordisk de Bausch Health, en dehors des travaux soumis. Diana Sherifali signale avoir reçu des honoraires de consultante pour son avis sur la gestion de la maladie chronique et du diabète de Merck, et une subvention d’Obésité Canada pour soutenir le processus de revue de la documentation durant la conduite de l’étude. John Sievenpiper signale avoir reçu des subventions des IRSC, du Nutrition Trialists Fund de l’Université de Toronto, de l’International Nut and Dried Fruit Council Foundation, du Tate and Lyle Nutritional Research Fund de l’Université de Toronto, de l’American Society for Nutrition, du Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund de l’Université de Toronto, de la National Dried Fruit Trade Association, une bourse d’application des connaissances de la Fondation PSI Graham Farquharson, la bourse du clinicien-chercheur de Diabète Canada, la bourse du jeune chercheur Sun Life Financial Banting & Best Diabetes Centre, une bourse de la Fondation canadienne pour l’innovation et la bourse du Fonds ontarien de recherche du ministère de la Recherche et de l’Innovation de l’Ontario. Le Dr Sievenpiper a reçu des honoraires personnels des entités suivantes : Perkins Coie LLP, Tate & Lyle, Producteurs laitiers du Canada, PepsiCo, FoodMinds LLC, European Fruit Juice Association, International Sweeteners Association, Nestlé Health Science, Société canadienne d’endocrinologie et métabolisme, GI Foundation, Pulse Canada, Wirtschaftliche Vereinigung Zucker e.V., Abbott, Biofortis, Autorité européenne de sécurité des aliments, Physicians Committee for Responsible Medicine, Soy Nutrition Institute, Comité européen des fabricants de sucre. Le Dr Sievenpiper a reçu un soutien non financier de Tate & Lyle, PepsiCo, FoodMinds LLC, European Fruit Juice Association, International Sweeteners Association, Nestlé Health Science, Wirtschaftliche Vereinigung Zucker e.V., Abbott, Biofortis, Autorité européenne de sécurité des aliments, Physicians Committee for Responsible Medicine, Kellogg Canada, American Peanut Council, Barilla, Unilever, Unico Primo, Compagnies Loblaw, WhiteWave Foods, Quaker, California Walnut Commission, Almond Board of California, en dehors des travaux soumis. Le Dr Sievenpiper est membre de l’International Carbohydrate Quality Consortium et des comités d’experts en pratique clinique pour la rédaction des lignes directrices de Diabète Canada, European Association for the Study of Diabetes, Société canadienne de cardiologie et d’Obésité Canada, et il occupe les postes de membre de l’exécutif du Groupe d’étude sur le diabète et la nutrition de l’European Association for the Study of Diabetes et de directeur de la Toronto 3D Knowledge Synthesis and Clinical Trials Foundation. Il est aussi conseiller scientifique non rémunéré pour le programme de sécurité alimentaire, nutrition et réglementation et le comité sur les glucides de l’International Life Science Institute en Amérique du Nord. Il est en relation conjugale avec une personne qui travaille pour Anheuser-Busch InBev. Sanjeev Sockalingam signale avoir reçu des honoraires de Bausch Health Canada au cours des 36 derniers mois. Valerie Taylor signale avoir reçu des honoraires de conférencière de Sunovion. Shahebina Walji signale avoir reçu des honoraires de consultation ou de participation à des comités consultatifs pour Novo Nordisk, Bausch Health et Takeda et des honoraires de conférencière de Novo Nordisk et Bausch Health. Shahebina Walji signale aussi avoir vendu les substituts de repas Optifast à partir d’un centre de gestion du poids. Optifast est un produit fabriqué et vendu par Nestlé. Aucun autre intérêt concurrent n’a été déclaré.

Competing Interests: Competing interests: Sean Wharton reports receiving honoraria and travel expenses and has participated in academic advisory boards for Novo Nordisk, Bausch Health, Eli Lilly and Janssen. Sean Wharton is also the medical director of a medical clinic specializing in weight management and diabetes. David Lau reports receiving grants and research support from AstraZeneca, Novo Nordisk and the Canadian Institutes of Health Research (CIHR); speaker bureau fees from AstraZeneca, Bausch Health, Boehringer Ingelheim, Diabetes Canada, Eli Lilly, Merck and Novo Nordisk; and consulting fees from Amgen, AstraZeneca, Bausch Health, Boehringer Ingelheim, Gilead, HLS Therapeutics, Janssen, Eli Lilly and Novo Nordisk. Michael Vallis is a member of advisory boards for Novo Nordisk, Bausch Health and LifeScan. Michael Vallis has also received consulting fees from Bausch Health, LifeScan, Novo Nordisk and Sanofi, and speaking fees from Novo Nordisk, Sanofi, Bausch Health, Abbott and AbbVie. Arya Sharma reports receiving speaker’s bureau and consulting fees from Novo Nordisk, Bausch Pharmaceuticals and Astra-Zeneca. Laurent Biertho reports receiving grants from Johnson and Johnson and Medtronic, and is a member of advisory boards for Novo Nordisk and Bausch Health, outside the submitted work. Denise Campbell-Scherer has no personal financial relationships, but reports receiving research funding from the following sources in the past 3 years: Novo Nordisk Alberta Diabetes Fund (NOVAD), a peer-reviewed grant that is a partnership between the University Hospital Foundation, Novo Nordisk and Alberta Innovates joint funders; Alberta Innovates Health Solutions (Cancer Prevention Research Opportunity and Collaborative Research and Innovation Opportunities competitions), CIHR (Strategy for Patient-Oriented Research and Knowledge-to-Action competitions); Northern Alberta Family Medicine Fund; and the Alberta Cancer Prevention and Legacy Fund. She also reports receiving knowledge transfer funding from the following sources in the past 3 years: an unrestricted education grant from Obesity Canada, funded by Novo Nordisk Global; a Worldwide University Network Meeting Grant; an Agency for Healthcare Research and Quality R13 grant for a Healthcare Effectiveness and Outcomes Research; and a Physician Learning Program grant from Alberta Health and the Alberta Medical Association. Angela Alberga reports receiving the following grants: the Santé Award from Fonds de Recherche du Quebec, the Mitacs Accelerate Grant, and the Concordia University Start-up Team Grant, outside the submitted work. Jennifer Brown reports receiving nonfinancial support from Novo Nordisk, and personal fees from Bausch Health, Dietitians of Canada, Obesity Canada and the Canadian Association of Bariatric Physicians & Surgeons. Yoni Freedhoff is the co-owner of the Bariatric Medical Institute and Constant Health, which provide weight management services; Constant Health has received a grant from Novo Nordisk. Yoni Freedhoff is also the author of The Diet Fix: Why Diets Fail and How to Make Yours Work published by Crown Publishing Group, and receives royalties for the book. In addition, he is the sole author of the Weighty Matters blog and a column for Medscape and many other op-eds and articles in which he has publicly expressed opinions about the treatment, management and prevention of obesity. Yoni Freedhoff also regularly speaks on topics related to obesity and receives honoraria and travel costs and expenses for same. Michel Gagner reports receiving speaker honoraria from Ethicon, WL Gore and Medtronic; consulting fees from Novo Nordisk, Bausch Health and Lexington Medical; and holds stock options with Lexington Medical. Margaret Hahn reports receiving consulting fees from Alkermes. Marie-France Langlois reports receiving personal fees from Novo Nordisk, Valeant, Merck Canada, Sanofi, Eli Lilly and Boehringer Ingelheim; a grant from Merck Canada; and other fees from AstraZeneca and from TIMI (Thrombolysis in Myocardial Infarction) Study Group for diabetes clinical research as a principal investigator, all outside the submitted work. David Macklin reports receiving personal fees from Novo Nordisk and Bausch Health, outside the submitted work. Priya Manjoo reports receiving personal fees from Novo Nordisk, Bausch Health and Sanofi; and grants from Boehringer Ingelheim, Sanofi and AstraZeneca, outside the submitted work. Marie-Philippe Morin reports receiving speaker honoraria from Novo Nordisk, Bausch Health, Eli Lilly, Boehringer Ingelheim, Nestlé Health Science, Janssen and AstraZeneca; research subvention from Novo Nordisk and Sanofi; and consultation honoraria from Novo Nordisk, Bausch Health, Eli Lilly, Boehringer Ingelheim, Janssen and AstraZeneca. Sue Pedersen reports receiving personal fees from Novo Nordisk, Bausch Health, Janssen, Eli Lilly, Merck, AstraZeneca, Boehringer Ingelheim, Sanofi, Pfizer; grants from Eli Lilly, AstraZeneca, Boehringer Ingelheim and Sanofi; and nonfinancial support from Novo Nordisk, Bausch Health, Janssen, Eli Lilly, AstraZeneca, Boehringer Ingelheim and Sanofi, outside the submitted work. Megha Poddar reports receiving honoraria for continuing medical education (CME) from Novo Nordisk, Bausch Health, Boehringer Ingelheim, Eli Lilly, Jenssen, Merck, the Canadian Collaborative Research Network and the Antibody Network; education grants from Novo Nordisk and Bausch Health; fees for mentorship from Novo Nordisk; fees for membership of advisory boards from Novo Nordisk and Bausch Health; and a quality improvement project grant from Boehringer Ingelheim. Paul Poirier reports receiving fees for consulting and continuing medical education from AstraZeneca, Boehringer Ingelheim, Janssen, Eli Lilly, Novo Nordisk, Valeant and Bausch Health, outside the submitted work. Judy Shiau reports receiving personal fees from Novo Nordisk and Bausch Health, outside the submitted work. Diana Sherifali reports receiving consulting fees for advice regarding chronic disease and diabetes management from Merck, and a grant from Obesity Canada to support the literature review process, during the conduct of the study. John Sievenpiper reports receiving grants from CIHR, the Nutrition Trialists Fund at the University of Toronto, the International Nut and Dried Fruit Council Foundation, the Tate & Lyle Nutritional Research Fund at the University of Toronto, the American Society for Nutrition, the Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto, the National Dried Fruit Trade Association, PSI Graham Farquharson Knowledge Translation Fellowship, the Diabetes Canada Clinician Scientist award, the Banting & Best Diabetes Centre Sun Life Financial New Investigator Award, the Canada Foundation for Innovation, and the Ministry of Research and Innovation’s Ontario Research Fund. Dr. Sievenpiper has received personal fees from Perkins Coie LLP, Tate & Lyle, Dairy Farmers of Canada, PepsiCo, Food-Minds LLC, European Fruit Juice Association, International Sweeteners Association, Nestlé Health Science, Canadian Society for Endocrinology and Metabolism, GI Foundation, Pulse Canada, Wirtschaftliche Vereinigung Zucker e.V., Abbott, Biofortis, the European Food Safety Authority, the Physicians Committee for Responsible Medicine, the Soy Nutrition Institute and the Comité Européen des Fabricants de Sucre. Dr. Sievenpiper has received nonfinancial support from Tate & Lyle, PepsiCo, FoodMinds LLC, European Fruit Juice Association, International Sweeteners Association, Nestlé Health Science, Wirtschaftliche Vereinigung Zucker e.V., Abbott, Biofortis, the European Food Safety Authority and the Physicians Committee for Responsible Medicine, Kellogg Canada, American Peanut Council, Barilla, Unilever, Unico Primo, Loblaw Companies, WhiteWave Foods, Quaker, California Walnut Commission, Almond Board of California, outside the submitted work. Dr. Sievenpiper is a member of the International Carbohydrate Quality Consortium and the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the Study of Diabetes, Canadian Cardiovascular Society, and Obesity Canada, and holds appointments as an Executive Board Member of the Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes, and as Director of the Toronto 3D Knowledge Synthesis and Clinical Trials Foundation. He is also an unpaid scientific adviser for the Program in Food Safety, Nutrition and Regulatory Affairs and the Carbohydrates Committee of the International Life Science Institute North America. He has a spousal relationship with an employee of Anheuser-Busch InBev. Sanjeev Sockalingam reports receiving honoraria from Bausch Health Canada within the last 36 months. Valerie Taylor reports receiving speaker fees from Sunovion. Shahebina Walji reports receiving consulting or advisory board fees from Novo Nordisk, Bausch Health and Takeda and speaker’s bureau fees from Novo Nordisk and Bausch Health. Shahebina Walji also reports selling Optifast Meal replacements through a weight management centre Optifast is a product produced and sold by Nestlé. No other competing interests were declared.

Catheter-related bloodstream infections (CR-BSIs) are bloodstream infections that, through specific laboratory testing, identify the intravascular catheter as the source of the bloodstream infection. By 2015, the rate of elderly patients 80 years of age and older admitted to the intensive care unit (ICU) will represent 1 in 4 admissions. Approximately 80 000 CR-BSIs occur in ICUs annually, potentially resulting in as many as 56 000 CR-BSIs occurring in the geriatric ICU patient, with 20% of these cases resulting in death. To minimize the occurrence of CR-BSIs in these patients, specific knowledge about the geriatric patient will have to be factored into the ICU health care professional's practice, including the development of a vascular access plan, which includes selection of the correct device and proper insertion of that device along with an evidence-based care and maintenance program. Intensive care unit health care professionals may be at a loss when it comes to navigating the vast array of vascular access medical devices available today. The Healthcare and Technology Synergy framework can assist the ICU health care professional to logically review each vascular access device and select those devices that best meet patient needs.

This was a multicenter, quasiexperimental, 140-month, acute care study comparing central line-associated bloodstream infection rates associated with positive or negative intravenous connectors to a zero fluid displacement connector. A decrease in central line-associated bloodstream infections was found after changing from either negative or positive intravenous connectors to the zero fluid displacement connector (P = .004) with total cost savings of over $3 million., (Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

By educating their clients (especially prescribing physicians, nurses, and home healthcare aides) about the advantages of using needle-free devices to administer intravenous medications, compounding pharmacists can help prevent complications associated with vascular access devices and needlestick injuries. Despite state and federal efforts to reduce the incidence of sharps injuries among healthcare workers, percutaneous needle-stick injuries remain a source of emotional stress, morbidity, and possible mortality in those individuals. According to the Centers for Disease Control and Prevention, 50% or more of surveyed healthcare personnel do not report their occupational percutaneous injuries, and an estimated 385,000 sharps-related injuries occur annually among healthcare workers in hospitals alone. Because sharps injuries are associated with the transmission of more than 20 pathogens, including hepatitis B and C viruses and the human immunodeficiency virus, the potential burden of disease is great. For the intgravenous administration of medications, however, devices safer than those requiring the use of needles are available, and pharmacists have a key role in educating caregivers about needle-free equipment and its use. In this article, we explain the types of intravenous needle-free devices of interest to compounding pharmacists and the clients they serve, and we answer frequently asked questions about that equipment. Compounders who understand the design features and capabilities of such products, their clients' intended use of those devices, patients' specific needs can improve treatment outcomes and protect healthcare workers against needlestick injury.

Objectives: To review the care and maintenance of the central venous access device (VAD), including dressing management, practice of accessing, swabbing, deaccessing and flushing, specific IV connectors, and practice considerations when sampling blood and VAD removal., Data Sources: Journal articles, compendiums and standards, case reports, manufacturers' product information, personal experience., Conclusion: The available data on VAD care and maintenance depends on data from a variety of sources. VAD care is product-dependent and, while some basic actions are universal to dressing management, septum swabbing, and catheter flushing, it is important to understand the idiosyncrasies of various products to provide the best and safest care., Implications for Nursing Practice: Critical thinking skills and individualized care planning are necessary for the care and maintenance of VADs, which is a primary role of the nurse., (Copyright 2010 Elsevier Inc. All rights reserved.)

Purpose/objectives: To describe computer experience and preferences for multimedia design., Design: Prospective, descriptive., Setting: Physician office and outpatient cancer centers in an urban area in the southeastern United States., Sample: Convenience sample of 22 volunteer patients with cancer from four racial groups., Methods: A questionnaire on computer experiences was followed by a hands-on computer session with questions regarding preferences for seven interface items. Data termination occurred when sample size was obtained., Main Research Variables: Design of Internet education site for patients. Variables include preferences, computer, cancer, multimedia, and education., Findings: Eighty-two percent had personal computers, 41% used a computer daily, and 95% believed that computers would be a good avenue for learning about cancer care. Preferences included display colors in blue and green hues; colored buttons; easy-to-read text; graphics with a simple design and large, clear pictures; serif font in dark type; light-colored background; and larger photo size in a rectangle shape. Most popular graphic icons as metaphors were 911 for emergency, picture of skull and crossbones for danger, and a picture of a string on an index finger representing reminder. The simple layout most preferred for appearances was one that included text and pictures, read from left to right, and was symmetrical in its placement of pictures and text on the page., Conclusions: Preferences are necessary to maintain interest and support navigation through computer designs to enhance the translation of knowledge to patients., Implications for Nursing: Development of multimedia based on patient preferences will enhance education, learning, and, ultimately, quality patient care.

Vaccine-preventable diseases were a major cause of mortality and morbidity in the United States in the 20th century. With the advent of immunizations, there have been dramatic rates of decline in these diseases. Clinical studies have shown vaccines to be efficacious and cost effective. Despite the simplification of the immunization schedule, vaccination rates are still suboptimal because of missed opportunities. Although several controversies have arisen about the safety of childhood immunizations, they are yet to be validated. There have been recent concerns about the stability of the infrastructure that supports the U.S. immunization program. Research has established strong evidence that certain interventions can increase vaccination coverage rates. The American College of Preventive Medicine outlines recommendations for childhood immunizations.

Standardization of performance expectations and accountability for nursing care have been an integral part of nursing departments for many years. The Joint Commission on Accreditation of Hospitals (JCAHO) has used the nursing standards manual to evaluate a nursing division's capability to provide quality care. In this article, the way in which a meaningful quality assurance system is developed is discussed. The aspects discussed in depth are (1) development of standards that define performance; and (2) quality assurance measures that audit performance. By following the steps outlined, a nursing department will have progressed from describing the nurse's capability to provide optimum care to demonstrating optimum performance.