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Background: Patients are the most frequent perpetrators of physical violence against nurses. In the United States, most states have established laws designating assault against nurses a felony, or serious crime. It is unknown what reasons nurses have for pressing charges or not pressing charges against patients. Purpose: The purpose of this study was to examine nurses’ decisions regarding pressing charges when patients exhibit violent behavior. Methods: This study used a mixed-method, cross-sectional, descriptive design. Three unfolding case studies were presented in an electronic survey. Twelve versions of the survey were randomly assigned to participants. Each described an adolescent, adult, and geriatric patient. The narrative descriptions were identical, but the visual representations of the patients differed. Results: A total of 499 nurses from seven hospitals in the western United States responded. Most nurses indicated that they would not press charges against any of the hypothetical patients. An injury occurring and an assumption of intentionality contributed to nurses’ decisions to press charges. Participants were more likely to press charges against the adolescent and adult patients than the geriatric patient. The hypothetical adolescent and geriatric patients were more likely to have charges pressed against them if presented as female than if presented as male. The hypothetical adult patient was more likely to have charges pressed against them if presented as white than if presented as black. Conclusions: There is no consensus regarding when a nurse ought to pursue legal action against a patient who exhibits violent behavior. In addition to the presence of injury and the assumption of intentionality, it is possible that implicit bias may also play a role in these decisions. More investigation into this is needed.
Background The AGENT IDE trial demonstrated superiority of a paclitaxel-coated balloon over an uncoated balloon in treating patients with coronary in-stent restenosis (ISR). Whether the efficacy and safety of paclitaxel-coated vs uncoated balloon differ based on diabetes status remains unclear. Methods A total of 600 patients with ISR were randomized (2:1) to paclitaxel-coated or uncoated balloon. The primary end point was target lesion failure (TLF), which was defined as a composite of ischemia-driven target lesion revascularization, target vessel-related myocardial infarction (MI), or cardiac death at 1 year. In this longer-term analysis from AGENT IDE, patients with vs without diabetes were compared using time-to-first event and repeat events methods through 2 years. Results Among the 598 patients with known diabetes status, 51% had diabetes. At 2 years, rates of target vessel-related MI were higher among patients with vs without diabetes. There were no significant differences in 2-year TLF with paclitaxel-coated vs uncoated balloon angioplasty in patients with ISR and diabetes (29.3% vs 35.9%; hazard ratio, 0.78; 95% CI, 0.51-1.19) or those without diabetes (24.2% vs. 32.2%; hazard ratio, 0.66; 95% CI, 0.42-1.04) (Pint = .62). Paclitaxel-coated balloon angioplasty was associated with a trend toward lower rates of ischemia-driven target lesion revascularization regardless of diabetes status. There were no instances of stent thrombosis in patients undergoing paclitaxel-coated balloon angioplasty. Conclusions Among patients undergoing percutaneous coronary intervention for ISR, the presence vs absence of diabetes was associated with higher rates of total target vessel-related MI and TLF. Diabetes did not appear to modify the treatment effect of paclitaxel-coated vs uncoated balloon angioplasty on TLF, with point estimates favoring treatment with paclitaxel-coated balloons over uncoated balloon angioplasty in both groups. However, these subgroup findings were underpowered.
