Leesburg, VA, United States
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Lee C.K.,INOVA Loudoun Hospital | Tefera E.,MedStar Research Institute | Colice G.,Washington Hospital Center | Colice G.,George Washington University
Respiration | Year: 2014

Background: The effect of obesity on outcomes in critically ill patients requiring invasive mechanical ventilation in a medical intensive care unit (ICU) is uncertain. Objectives: This study was intended to further explore the relationship between outcomes and obesity in patients admitted to a medical ICU who required invasive mechanical ventilation. Methods: All adult patients admitted to the medical ICU at Washington Hospital Center requiring intubation and invasive mechanical ventilation for at least 24 h between January 1 and December 31, 2009, were retrospectively studied. Patients were categorized as nonobese (BMI <30) and obese (BMI ≥30). The primary outcome measure was 30-day mortality following intubation. Secondary outcomes included ICU length of stay (LOS), hospital LOS and duration of mechanical ventilation. Results: There were 504 eligible patients: 306 nonobese and 198 (39%) obese. Obese patients had significantly higher rates of diabetes (43 vs. 30%, p = 0.004), hyperlipidemia (32 vs. 24%, p = 0.04), asthma (16 vs. 8%, p = 0.004) and obstructive sleep apnea requiring continuous positive airway pressure treatment (12 vs. 1%, p < 0.001). Nonobese patients had a significantly higher rate of HIV infection (10 vs. 5%, p = 0.05) and malignancy (21 vs. 13%, p = 0.03). There were no significant differences in mortality up to 30 days following intubation and secondary outcomes between obese and nonobese patients. Multivariate analysis using logistic regression showed no significant relationship between mortality rate at 30 days following intubation and obesity. Outcomes were similar for the black obese (n = 153) and nonobese (n = 228) patients and the obese (n = 85) and very obese (n = 113) patients. Conclusions: Obesity did not influence outcomes in critically ill patients requiring invasive mechanical ventilation in a medical ICU. Black obese patients had similar outcomes to black nonobese patients, and very obese patients also had similar outcomes to obese patients. © 2014 S. Karger AG, Basel.


PubMed | Inova Health System, University of Virginia, Inova Loudoun Hospital, Handcrafted Health and Inova Learning Network
Type: Journal Article | Journal: Journal of holistic nursing : official journal of the American Holistic Nurses' Association | Year: 2016

Given the current transformation of traditional health care to provide more integrative and complementary modalities, health systems are implementing new programs and services to meet consumer and provider needs. One such integrative modality, Healing Touch, with a foundation in holistic nursing, is a gentle therapy that uses touch to promote health and well-being by balancing the human energy system. This article describes the perceptions of registered nurses regarding the implementation of a Healing Touch training program at a multihospital health system. Five themes were identified: benefit to the patient, benefit to the nurse, holism beyond task orientation, integrating Healing Touch into acute care, and barriers and challenges. Nurses recognize the importance of creating caring-healing relationships and a holistic approach to care. Training in Healing Touch provides one avenue for nurses and health care providers to provide compassionate care.


Speroni K.G.,Inova Loudoun Hospital | Speroni K.G.,Inova Fair Oaks Hospital | Williams D.A.,Inova Fair Oaks Hospital | Seibert D.J.,Inova Loudoun Hospital | And 3 more authors.
Nursing Administration Quarterly | Year: 2013

BACKGROUND:: More than half of United States nurses are estimated to be overweight or obese. Interventions are needed that help nurses live healthier lifestyles. With most registered nurses being female and with an average age of 45.5 years in the category most likely to be obese, it is not promising that US nurses will become healthier over time without intervention. The Nurses Living Fit (NLF) program, an exercise- and nutrition-based intervention innovated by nurses, was developed to decrease body mass index in nurse participants and to help nurse's care for themselves and their families and patients. SUBJECTS:: A total of 217 nurses self-selected to the NLF intervention (n = 108) or contrast (no intervention; n = 109) groups. METHODS:: The NLF program included exercise (12 once-weekly sessions, 1 hour each), yoga (4 once-monthly sessions, 1 hour each), nutrition education (4 once-monthly sessions, 1 hour each taught by registered dietitians), diary completion (completed daily for 4 weeks specifying time spent on exercise/yoga, types and amount of food consumed, amount of water consumed, and hours slept), and healthy lifestyle principles education. Evaluation of the NLF program components was also completed. RESULTS:: The NLF participants had significant decreases in body mass index (NLF = -0.5 kg/m; contrast = -0.2 kg/m) and waist circumference (NLF = -0.9 in; contrast = -0.2 in). Overall, program component evaluation demonstrated that participants wanted more personalized exercise, more nutrition education, and year-round program provision. As a result of the NLF program, nurses specified they exercised more and improved nutrition. CONCLUSIONS:: Evidence-based intervention or programs are needed to educate nurses on healthy lifestyles. Nurse leaders need to promote healthy workplace environments, which can be done in part through the facilitation of exercise- and nutrition-based programs, such as NLF, to help nurses better care for themselves and their families and patients. Copyright © 2013 Lippincott Williams & Wilkins.


O'Neil S.,Inova Loudoun Hospital | Speroni K.G.,Inova Loudoun Hospital | Dugan L.,Inova Loudoun Hospital | Daniel M.G.,Inova Loudoun Hospital
Quality Management in Health Care | Year: 2010

As a safety initiative, Inova Loudoun Hospital implemented a Red Rule policy and educated 100% of its staff. The policy consisted of 2 Red Rules: critical requirements for safety associated with an activity or a procedure. The purpose of tier 1 of this 2-tier survey research project was to determine the effectiveness of the educational effort in 13 departments of the hospital. Of the 128 participants, 61% provided a correct or partially correct definition for Red Rule 1 and 12% for Red Rule 2. From an evidence-based practice viewpoint, study results concluded that the Red Rule Education Project required reinforcement. The purpose of tier 2 was to quantify factors that contributed to safety events in the departments of the hospital. Employees violating a Red Rule were asked to complete a survey identifying the factors influencing their behavior. Of the 13 participants (RNs = 100%), the order of frequency of factors influencing errors was interruptions (77%), rushing (69%), inadequate staffing (39%), fatigue (31%), and poor communication (38%). Respondents did not report an awareness of committing an error during the time of the error occurrence. Awareness of specific factors contributing to an error can facilitate process improvement and future counseling and educational efforts. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Waldrop R.D.,Inova Loudoun Hospital | Felter R.A.,Inova Loudoun Hospital
Pediatric Emergency Care | Year: 2010

Two cases illustrating intentional withholding of information by noncitizen parents of children with major trauma are described. The difficulties and the results of not obtaining an accurate history in the initial assessment of accidental trauma victims are discussed. The core problem in these cases seems to be a fear of health care providers and a false perception that emergency medical services and emergency department personnel are extensions of law enforcement. These cases illustrate potential issues in managing the children of noncitizen immigrants. Copyright © 2010 by Lippincott Williams & Wilkins.


Speroni K.G.,Inova Loudoun Hospital | Fitch T.,Inova Loudoun Hospital | Dawson E.,Inova Loudoun Hospital | Dugan L.,Inova Loudoun Hospital | Atherton M.,Inova Loudoun Hospital
Journal of Emergency Nursing | Year: 2014

Introduction: Workplace violence against nurses is a serious problem. Nurses from a US urban/community hospital system employing more than 5,000 nurses researched the incidence of workplace violence against nurses perpetrated by patients or visitors in their hospital system. Methods: Survey research and retrospective database review methods were used. Nurse participants (all system-employed nurse types) completed a 34-item validated survey in electronic format. Retrospective database review provided annual nurse workplace violence injury treatment and indemnity charges. Institutional review board approval was received. Results: Survey research participants (N = 762) were primarily white female registered nurses, aged 26 to 64 years, with more than 10 years of experience. Over the past year, 76.0% experienced violence (verbal abuse by patients, 54.2%; physical abuse by patients, 29.9%; verbal abuse by visitors, 32.9%; and physical by visitors, 3.5%), such as shouting or yelling (60.0% by patients and 35.8% by visitors), swearing or cursing (53.5% by patients and 24.9% by visitors), grabbing (37.8% by patients and 1.1% by visitors), and scratching or kicking (27.4% by patients and 0.8% by visitors). Emergency nurses (12.1%) experienced a significantly greater number of incidents (P < .001). Nurses noted more than 50 verbal (24.3%) and physical (7.3%) patient/visitor violence incidents over their careers. Most serious career violence incidents (n = 595, 78.1%) were physical (63.7%) (60.8% by patients and 2.9% by visitors), verbal (25.4%) (18.3% by patients and 7.1% by visitors), and threatened physical assault (10.9%) (6.9% by patients and 4.0% by visitors). Perpetrators were primarily white male patients, aged 26 to 35 years, who were confused or influenced by alcohol or drugs. Per database review, annual workplace violence charges for the 2.1% of nurses reporting injuries were $94,156 ($78,924 for treatment and $15,232 for indemnity). Discussion: Nurses are too commonly exposed to workplace violence. Hospitals should enhance programs for training and incident reporting, particularly for nurses at higher risk of exposure, caring for patients with dementia or Alzheimer disease, patients with drug-seeking behavior, or drug- or alcohol-influenced patients. © 2014 Emergency Nurses Association.


Healy M.F.,Inova Loudoun Hospital | Speroni K.G.,Inova Loudoun Hospital | Eugenio K.R.,St Lukes And Tobey Hospitals | Murphy P.M.,Inova Heart and Vascular Institute
Annals of Pharmacotherapy | Year: 2012

Background: Because of the renal elimination and increased risk for bleeding events at supratherapeutic doses of eptifibatide, the manufacturer recommends dosing adjustment in patients with renal dysfunction. Methods commonly used to estimate renal dysfunction in hospital settings may be inconsistent with those studied and recommended by the manufacturer. Objective: To compare hypothetical renal dosing adjustments of eptifibatide using both the recommended method and several other commonly used formulas for estimating kidney function. Methods: Sex, age, weight, height, serum creatinine, and estimated glomerular filtration rate (eGFR) were obtained retrospectively from the records of patients who received eptifibatide during a 12-month period. Renal dosing decisions were determined for each patient based on creatinine clearance (CrCl) estimates via the Cockcroft-Gault formula (CG) with actual body weight (ABW), ideal body weight (IBW) or adjusted weight (ADJW), and eGFR from the Modification of Diet in Renal Disease formula. Percent agreement and Cohen k were calculated comparing dosing decisions for each formula to the standard CG-ABW. Results: In this analysis of 179 patients, percent agreement as compared to CG-ABW varied (CG-IBW: 90.50%, CG-ADJW: 95.53%, and eGFR: 93.30%). All κ coefficients were categorized as good. In the 20% of patients receiving an adjusted dose by any of the methods, 68.6% could have received a dose different from that determined using the CG-ABW formula. Conclusions: In the patients with renal impairment (CrCl <50 mL/min) in this study, two thirds would have received an unnecessary 50% dose adjustment discordant from the manufacturer's recommendation. Because failure to adjust eptifibatide doses in patients with renal impairment has led to increased bleeding events, practitioners may be inclined to err on the side of caution. However, studies have shown that suboptimal doses of eptifibatide lead to suboptimal outcomes. Therefore, correct dosing of eptifibatide is important to both patient safety and efficacy.


Wood E.B.,Inova Loudoun Hospital
The West Indian medical journal | Year: 2010

To describe HIV-related sexual risk behaviours among late-adolescent Jamaican girls and examine whether having an age-discordant male sexual partner (> or = 2 years older) was associated with a decrease in condom use at last coitus. Utilizing an expanded Theory of Planned Behaviour a survey was designed to capture HIV-related sexual risk behaviours. Descriptive and inferential statistics were used to analyse the final sample of one hundred and eighty-four late-adolescent girls (18-21 years) in Kingston, Jamaica. At first coitus, 70.3 per cent of the survey participants had done so with an older partner. At the time of the survey, 58.7 per cent of the sample reported being in an age-discordant relationship, with age differences between 2 and 39 years. While only 12 per cent of the sample reported having more than one sexual partner 40 per cent of the sample reported that their older male partner had multiple sexual partners. Slightly more than half (58%) of late-adolescent girls reported condom use at last coitus. No significant differences were found in condom use between girls who had age-discordant partners and girls who had similar aged-partners. Sexual relationships with older male partners are common among late-adolescent Jamaican girls, and may put girls at risk for acquiring HIV through unprotected coitus and coitus with someone who has multiple partners. As Jamaica and the broader Caribbean struggle to curtail the emergent HIV epidemic among adolescent girls, age-discordant relationships are a significant area for research and prevention efforts of clinicians and public health professionals.


PubMed | Inova Health System, University of Virginia, Handcrafted Health LLC, Inova Loudoun Hospital and Inova Fair Oaks Hospital
Type: Evaluation Studies | Journal: Explore (New York, N.Y.) | Year: 2015

Given the growth in the number of bariatric surgeries, it is important for healthcare practitioners to maximize symptom management for these patients, including the option of complementary therapies such as Healing Touch.A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery.Following surgery, a nurse administered the Healing Touch intervention once daily. Study participants reported levels of pain, nausea, and anxiety immediately before and after the Healing Touch intervention using separate numeric rating scales.Significant decreases in pain, nausea, and anxiety were observed immediately following the intervention on post-operative days one and two, and in pain and anxiety on post-operative day three compared with pre-intervention levels. These findings indicate that the Healing Touch intervention is feasible and acceptable to patients undergoing bariatric surgery, and significantly improved pain, nausea, and anxiety in these patients.


PubMed | Inova Loudoun Hospital
Type: Journal Article | Journal: Nursing administration quarterly | Year: 2013

More than half of United States nurses are estimated to be overweight or obese. Interventions are needed that help nurses live healthier lifestyles. With most registered nurses being female and with an average age of 45.5 years in the category most likely to be obese, it is not promising that US nurses will become healthier over time without intervention. The Nurses Living Fit (NLF) program, an exercise- and nutrition-based intervention innovated by nurses, was developed to decrease body mass index in nurse participants and to help nurses care for themselves and their families and patients.A total of 217 nurses self-selected to the NLF intervention (n = 108) or contrast (no intervention; n = 109) groups.The NLF program included exercise (12 once-weekly sessions, 1 hour each), yoga (4 once-monthly sessions, 1 hour each), nutrition education (4 once-monthly sessions, 1 hour each taught by registered dietitians), diary completion (completed daily for 4 weeks specifying time spent on exercise/yoga, types and amount of food consumed, amount of water consumed, and hours slept), and healthy lifestyle principles education. Evaluation of the NLF program components was also completed.The NLF participants had significant decreases in body mass index (NLF = -0.5 kg/m; contrast = -0.2 kg/m) and waist circumference (NLF = -0.9 in; contrast = -0.2 in). Overall, program component evaluation demonstrated that participants wanted more personalized exercise, more nutrition education, and year-round program provision. As a result of the NLF program, nurses specified they exercised more and improved nutrition.Evidence-based intervention or programs are needed to educate nurses on healthy lifestyles. Nurse leaders need to promote healthy workplace environments, which can be done in part through the facilitation of exercise- and nutrition-based programs, such as NLF, to help nurses better care for themselves and their families and patients.

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