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To maintain their quality of life and avoid hospitalization and early mortality, patients with heart failure must recognize and respond to symptoms of exacerbation. A promising method for engaging patients in their self-care is through mobile health applications (mHealth apps). However, for mHealth to have its greatest chance for improving patient outcomes, the app content must be readable, provide useful functions and be based in evidence. The study aimed to determine: (1) readability, (2) types of functions, and (3) linkage to authoritative sources of evidence for self-care focused mHealth apps targeting heart failure patients that are available in the Apple and Google Play Stores. We systematically searched for mHealth apps targeting patients with heart failure in the Apple and Google Play Stores and applied selection criteria. Readability of randomly selected informational paragraphs were determined using Flesch-Kincaid grade level test tool in Microsoft Word. Ten mHealth apps met our criteria. Only one had a reading grade level at or below the recommended 6th grade reading level (average 9.35). The most common functions were tracking, clinical data feedback, and non-data-based reminders and alerts. Only three had statements that clearly linked the mHealth app content to trustworthy, evidence-based sources. Only two had interoperability with the electronic health record and only one had a communication feature with clinicians. Future mHealth designs that are tailored to patients' literacy level and have advanced functions may hold greater potential for improving patient outcomes.

Background: Physician Orders for Life-Sustaining Treatments (POLST) is an advance care planning (ACP) tool that is designed to facilitate End-of-Life (EoL) care discussions between a medical provider and a terminally ill patient. It is often used as a tool to translate care wishes into a medical order, which can be honored across healthcare settings. With an increased utilization of the POLST paradigm in various healthcare settings along with continued dissemination across the nation, it is critical to examine whether documented wishes on POLST are concordant with subsequent care delivered. Purpose of this article was to examine concordance rate between POLST and subsequent care delivered in any care settings and communities. Design: Systematic review. Results: Of 1,406 articles identified, 10 articles met inclusion criteria. Together, included studies represent 5,688 POLST forms reviewed from individuals residing in a total of 126 nursing care facilities, 9 elderly care centers, 4 community settings, and 2 hospitals. Preference for cardiopulmonary resuscitation and actual delivery/ withholding of resuscitation was the most observed intervention in study of concordance (n = 8). It is also where highest concordance rate (97.5%) was reported. Seven studies compared care provided during EoL and the level of medical intervention requested on POLST forms (91.17% concordance). Preference to use artificial nutrition/ hydration, and actual delivery was 93.0% (n = 4 studies), and antibiotics use preference and delivery was 96.5% (reported in 4 studies). Conclusion: Published literature evidence suggests that EoL care wishes documented on POLST forms were largely concordant with subsequent care delivered. Additional research is needed to evaluate concordance between POLST documentation and care received among POLST users, who experienced multiple care transitions across healthcare settings, or across state during EoL care journey.

Objective: Knowledge of one’s gene status for adult onset conditions provides opportunity to make advance end-of-life (EOL) plans. The purposes of these analyses were to (1) determine the prevalence of EOL plans, including advance directives (ADs) among persons across 3 stages of Huntington disease (HD) and (2) examine factors associated with having ADs in this sample. Methods: Data are from 503 participants in the HD Quality of Life study. Participants completed an online health-related quality-of-life survey that included questions regarding EOL planning and self-reported HD symptoms. Frequencies were calculated for EOL planning by the HD stage. Bivariate analysis and logistic regression were used to identify variables associated with having ADs. Results: A total of 38.2% of participants stated they had ADs and fewer than half had other EOL plans. Being older, increased HD stage, more years of education, lower anxiety, more swallowing symptoms, and higher meaning and purpose were associated with having ADs. Conclusion: The prevalence of ADs in our sample is comparable to the general US population, but surprisingly low, considering the severity and long disease course of HD. Practice Implications: Health-care providers should develop specific interventions early in the disease process to increase ADs in this population.

The purpose of this integrative review is to synthesize recent literature that used NANDA International diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) to determine the effectiveness of nursing interventions and cost-analysis and to identify the direction for future effectiveness research using standardized nursing terminologies (SNTs). A search was performed using the Cumulative Index to Nursing and Allied Health Literature, Scopus, and KoreaMed, covering the period from 2003 to 2018. A total 267 articles were identified, and 24 articles were analyzed for this review. Eighteen studies evaluated the effectiveness of nursing interventions based on outcomes, and of those 18 studies, four examined the effectiveness based on the development of NNN linkages. Six studies analyzed the cost of nursing interventions. Integrating SNTs into electronic health records (EHRs), developing NNN linkages, and further effectiveness studies using SNTs are required to determine the value of nursing care to improve patient outcomes.

130 Background: Cancer-related symptoms are associated with decreased quality of life, increased health care utilization, and shorter life expectancy. There is limited understanding of how multiple chronic conditions (MCC) contribute to variability in symptoms experienced in the context of cancer. Data mining the EHR will allow us to use real clinical data to identify multimorbidity phenotypes based on the clinical similarity of patients. Purpose of this study is to identify distinct subgroups of patients based on the MCC and cancer diagnoses and describe differences across these subgroups. Methods: EHR data was extracted from adult patients (n=2977) newly diagnosed with cancer in 2017 at one academic medical center. The SEER cancer site/histology list was used to group cancer diagnosis. MCC present for >6 months on the problem list or ICD-10 billing data were used. K-Means and K-Modes clustering procedures, with K equaling 7, were used to cluster patients based on MCC. Results: The sample consisted of 58% women, 93% white, with mean age of 62.4 (16.1) years. The most frequent cancers were GI (17%), gynecological (14%), and pulmonary (10%). The most frequent MCC were hypertension (33%), anemia (24%), and metabolic diseases (21%). Seven clusters correspond to following primary cancer sites: GI, pulmonary, urinary, gynecological, breast, endocrine, and skin. The MCC rates varied significantly across different primary sites with hypertension being present in call clusters, but anemia was present only in GI and urinary system cancers clusters. Conclusions: K-Means and K-Modes clustering procedures, with K equaling 7, produced similar clusters of cancer primary sites and MCCs, indicating our findings are stable and replicable. Our data extraction methods and clustering techniques worked well and can be expanded upon. Our next step is to repeat the data extraction and clustering analysis with the full data from the data warehouse (>30,000 records). The identified multimorbidity phenotypes will be used as inclusion criteria for prospective research with patients to explore the relationships among MCCs and symptoms in the context of cancer.

Purpose : To determine whether warming of irrigation fluids (32°C-40°C) compared with using room-temperature irrigation fluids (20°C-22°C) decreases the risk of perioperative hypothermia (

Purpose: This was a correlational study to identify effects of perception of clinical ladder system on job satisfaction and intention to leave in perioperative nurses. Methods: Participants were 154 of perioperative nurses from larger general hospitals in Seoul. Data were collected from April, 16 to 22, 2013 using self-report questionnaires which included items on perception of clinical ladder system, job satisfaction, and intention to leave. Data were analyzed