Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung
In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).
Full Text Available Background: Several studies have described the benefits of integrated care in chronic conditions. Keeping the patients out of hospital is considered to increase value to the patient and is also benefit to the society and the healthcare provider.As we have an increase in the treatment options, costs, age and demand, an optimized treatment model is required if we want to maintain or obtain a sustainable system. The objective of this study was to describe how costs of treatment and value to the patient, to the hospital and the society differs in a non integrated patient unit (IPU vs an IPU system.Methods: Contact data of schizophrenic patients (n=51 from the hospital's electronic medical records (EMRs was accessed (from October 2010 till March 2012 and analyzed. All financial data was obtained from the finance department. Time driven activity based costing (TDABC as used to calculate the costs.Results: The study examined 1,149 out-patient consultations and 4,386 days of occupancy. By adopting an IPU approach, the costs were significantly reduced compared to the non-IPU approach. Increased complexity benefitted significantly from IPU. These patients had a higher frequency of contact but lower degrees of admission, whilst the non-IPU had significantly higher admission rates and duration of stay.Conclusions: This study shows a striking difference in the resources used on patients treated with an IPU vs a non-IPU approach. In almost every aspect, the IPU approach is by far superior to the non-IPU approach.
Full Text Available Abstract Background Organizational context plays a central role in shaping the use of research by healthcare professionals. The largest group of professionals employed in healthcare organizations is nurses, putting them in a position to influence patient and system outcomes significantly. However, investigators have often limited their study on the determinants of research use to individual factors over organizational or contextual factors. Methods The purpose of this study was to examine the determinants of research use among nurses working in acute care hospitals, with an emphasis on identifying contextual determinants of research use. A comparative ethnographic case study design was used to examine seven patient care units (two adult and five pediatric units in four hospitals in two Canadian provinces (Ontario and Alberta. Data were collected over a six-month period by means of quantitative and qualitative approaches using an array of instruments and extensive fieldwork. The patient care unit was the unit of analysis. Drawing on the quantitative data and using correspondence analysis, relationships between various factors were mapped using the coefficient of variation. Results Units with the highest mean research utilization scores clustered together on factors such as nurse critical thinking dispositions, unit culture (as measured by work creativity, work efficiency, questioning behavior, co-worker support, and the importance nurses place on access to continuing education, environmental complexity (as measured by changing patient acuity and re-sequencing of work, and nurses' attitudes towards research. Units with moderate research utilization clustered on organizational support, belief suspension, and intent to use research. Higher nursing workloads and lack of people support clustered more closely to units with the lowest research utilization scores. Conclusion Modifiable characteristics of organizational context at the patient care unit
The purpose of this paper is to define the role of environmental design in improving family integration with patient care in Intensive Care Units (ICUs). It argues that it is necessary to understand family needs, experience and behavioral responses in ICUs to develop effective models for family integration. With its two components—the “healing culture” promoting effective relationships between caregivers and care seekers, and the “environmental design” supporting the healing culture—a “healin...
Heidari, Mohammad Reza; Norouzadeh, Reza
Family support in the intensive care units is a challenge for nurses who take care of dying patients. This article aimed to determine the Iranian nurses' experience of supporting families in end-of-life care. Using grounded theory methodology, 23 critical care nurses were interviewed. The theme of family support was extracted and divided into 5 categories: death with dignity; facilitate visitation; value orientation; preparing; and distress. With implementation of family support approaches, family-centered care plans will be realized in the standard framework. PMID:25099985
L. K. Moshetova; S. A. Kochergin; A. S. Kochergin
Aim. To describe eye injuries in intensive care unit (ICU) patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes) with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative...
Objectives: To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. Methods: The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Results: Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis of coronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57+-10.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%)had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit Conclusions: The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis. (author)
Alexandre Rodrigues da Silva
Full Text Available This study reported a case of rhinosinusitis for Respiratory Syncytial Virus in Intensive Care Unit patient. The settings were Intensive Care Unit at Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. One female HIV-infected patient with respiratory failure and circulatory shock due to splenic and renal abscesses, who developed rhinosinusitis caused by RSV and bacteria. Respiratory viruses can play a pathogenic role in airways infection allowing secondary bacterial overgrowth.
Selma Atay; Ukke Karabacak
intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care an...
Full Text Available intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care and rdquo; between the years of 2000- 2012. Inclusion criteria for the studies were being performed in adult intensive care unit patients on mechanical ventilation, published in peer-reviewed journals in English between the years of 2000-2012, included oral care practice and presence of a nurse among researchers. A total of 304 articles were identified. Six descriptive evaluation studies, three randomised controlled trials, four literature reviews, three meta-Analysis randomized clinical trials, one qualitative study and one semi-experimental study total 18 papers met all of the inclusion criteria. Oral care is emphasized as an infection control practice for the prevention of Ventilator-Associated Pneumonia (VAP. In conclusion, we mention that oral care is an important nursing practice to prevent VAP development in intensive care unit patients; however, there is no standard oral evaluation tool and no clarity on oral care practice frequency, appropriate solution and appropriate material. It can be recommended that the study projects on oral care in intensive care patients to have high proof level and be experimental, and longitudinal. [Int J Res Med Sci 2014; 2(3.000: 822-829
L. K. Moshetova
Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones.
L. K. Moshetova
Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones.
Uscinska, Ewa; Idzkowska, Ewelina; Sobkowicz, Bozena; Musial, Wlodzimierz J; Tycinska, Agnieszka M
The heterogeneous group of patients admitted to Intensive Cardiac Care Unit (ICCU) as well as nonspecific complaints associated with anemia might be the reason for underdiagnosing or minimization of this problem. Because of this heterogeneity, there are no clear guidelines to follow. It is known that anemia is impairing the outcome. Thus, it is crucial to keep alert in the diagnosis and treatment of anemia, especially in critically ill cardiac patients. The greatest groups of patients admitted to ICCU are those with acute coronary syndromes (ACS), acute decompensated heart failure (ADHF), severe arrhythmias as well as individuals after cardiac operations. However, patients suffering other critical cardiac illnesses quite often become anemic during hospitalization in ICCU. It is because anemia is typed in the clinical features of heavy diseases or may be the consequence of treatment. The current review focuses on the incidence, complex etiology and predictive role of anemia in a diverse group of ICCU patients. It discusses clinical aspects of anemia treatment in particular groups of critically ill cardiac patients because proper treatment increases chances for recovery and improves the outcome in this severe group of patients. PMID:26149915
Fernanda Luiza Hamze
Full Text Available Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit.Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software.Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8% caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients.Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.
Xisto Sena Passos
Full Text Available The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10³ yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100% and indwelling urinary catheter (92.6%. The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.
Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.
Devine, H.; MacTavish, P.; Quasim, T.; Kinsella, J; McPeake, J.; Daniel, M
Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Int...
Kalhori, Reza Pourmirza; Ehsani, Sohrab; Daneshgar, Farid; Ashtarian, Hossein; Rezaei, Mansour
Background: Patients with reduced consciousness level suffer from eye protection disorder and Keratopathy. This study was conducted to compare effect of three eye care techniques in prevention of keratopathy in the patients hospitalized in intensive care unit of Kermanshah. Methods: This clinical trial was conducted in 2013 with sample size of 96 persons in three random groups. Routine care included washing of eyes with normal saline and three eye care methods were conducted with poly ethylene cover, liposic ointment, and artificial tear drop randomly on one eye of each sample and a comparison was made with the opposite eye as the control. Eyes were controlled for 5 days in terms of keratopathy. Data collection instrument was keratopathy severity index. Data statistical analysis was performed with SPSS-16 software and chi-squared test, Fisher’s exact test, ANOVA and Kruskal–Wallis one-way analysis of variance. Findings: The use of poly ethylene cover (0.59±0.665) was significantly more effective in prevention of keratopathy than other methods (P=0.001). There was no statistically significant difference between two care interventions of liposic ointment and artificial tear drop (P=0.844) but the results indicated the more effective liposic ointment (1.13±0.751) than the artificial tear drop (1.59±0.875) in prevention of corneal abrasion (Phospitalized in intensive care unit.
Mohammad Feroz Azfar
Full Text Available Background: Eye care is an essential component in the management of critically ill patients. Standardized eye care can prevent corneal complications in ventilated patients. Objective: This study was designed to compare old and new practices of corneal care for reduction in corneal complications in ventilated patients. Methods: This study was done in three phases each of six month duration. Phase 1 was the ongoing practice of eye care in the unit. Before the start of phase 2, a new protocol was made for eye care. Corneal complications were observed in terms of haziness, dryness, and ulceration. All nursing staffs were educated and made compliant with the new protocol. In phase 2, a follow-up audit was done to check the effectiveness and compliance to protocol. In phase 3, a follow-up audit was started 3 months after phase 2. Results: In phase 1, total ventilated patients were 40 with 240 ventilator days. The corneal dryness rate was 40 per 1000 ventilator days while the haziness and ulceration rate was 16 per 1000 ventilator days each. In the second phase 2, total ventilated patients were 53 making 561 ventilator days. The rate of corneal haziness and dryness was 3.52 and 1.78 per 1000 ventilator days, respectively, with no case of corneal ulceration. In phase 3, the number of ventilated patients was 91 with 1114 ventilator days. The corneal dryness rate was 2.69 while the haziness and ulceration rate was 1.79 each. Conclusion: Protocolized eye care can reduce the risk of corneal complications in ventilated patients.
Okino, Takashi; Okagaki, Tetsuya; Nakamura, Hiromi; Okino, Akie
Kohka Public Hospital(KPH)was rebuilt at a new place in April 2013. The Palliative Care Unit(PCU)was newly constructed during renovation. We examined the will and outcome of cancer patients, especially on expiration. A 123 patients died in 2014: 27 died at the PCU, and the remaining 7 at home. Of 27 patients, 20 were willing to die at the PCU, and one patient visited the hospital after judgment by the Visiting Nurse Center. Other 6 patients were admitted finally after their families experienced fatigue. Six of seven patients who died at home, showed a strong will to stay at home. We think that patients' will drives the clinical course, especially in their end-stage. In this context, the majority of the patients decided their terminal place based on their will. On the contrary, there were several cases whose requests were not fulfilled. To overcome the problem, we should discuss cancer patients' will to make a choice regarding death at the end-stage of their lives and the place of expiration in advance. We including the staff of social care and regional medical resources, should co-operate and share information on these patients to solve the problems. PMID:26809413
Alexandre Franco Miranda
Full Text Available Objective: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs. Study Population and Methods: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages. A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. Results: Most participants were nursing professionals (80.3% working 12-h shifts in the ICU (70.4%; about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05. Most reported using spatulas, gauze, and toothbrushes (49.3% or only toothbrushes (28.2% with 0.12% chlorhexidine (49.3% to sanitize the oral cavity of ICU patients (P < 0.01. Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05. However, most professionals (56.4% reported feeling that the oral cavity was difficult to clean (P < 0.05. Conclusion: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.
S.E. Siegelaar; J.H. Devries; J.B. Hoekstra
Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ( ICU), de
Keith Killu; Victor Coba; Michael Mendez; Subhash Reddy; Tanja Adrzejewski; Yung Huang; Jessica Ede; Mathilda Horst
Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respec...
Amritjot Kaur*, Shimi S. L
This paper proposes a new system that takes the benefits of data flow technology. Its objective is to collect the data from monitoring system in the intensive care unit (ICU) and store that data for further analysis. Then it will be available for medical personnel to analyze data and take the suitable medication for patients. In fact, the monitoring system in intensive care unit provides a large amount of data quickly and continuously. Most units operate with a very limited storage capacity w...
Frisk, Ulla; Nordström, Gun
The main purpose of this study was to describe how patients treated in an intensive care unit (ICU) perceive their sleep and to compare patients' and nurses' perceptions of the patients' sleep. The study also determined the percentage of patients in the ICU who were able to fill in the Richard Campell Sleep Questionnaire (RCSQ). This instrument consists of six items and utilises a visual analogue scale (VAS). The results of five of the RCSQ questions are used to calculate a total sleep score, ranging between 0 and 100 (0=the worst possible sleep, 100=the best sleep).Approximately half of the patients were able to answer the RCSQ (n=31). The patients' rating of their sleep varied widely (total sleep score: range 0-97, mean 45.5). Patients who had received hypnotics or sedatives during the night (n=12) had a significantly lower total sleep score (mean=31.6) than the rest of the patients (mean 54.3; P=0.037). On comparing the patients' and the nurses' perceptions of the patients' sleep, no significant difference between the groups was seen. This indicates that nurses can use the RCSQ to assess the sleep of patients who are unable to report their sleep themselves. PMID:14637294
Laerkner, Eva; Egerod, Ingrid; Hansen, Helle Ploug
closeness. CONCLUSION: Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation was......OBJECTIVE: The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING: The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where a...... protocol of no sedation is implemented. Data were generated during participant observation in practice and by interviews with 16 nurses. Data were analysed using thematic interpretive description. FINDINGS: An overall theme emerged: "Demanding, yet rewarding". The demanding aspects of caring for more awake...
Carlsen, Sarah; Perner, A
Fluid is the mainstay of resuscitation of patients with septic shock, but the optimal composition and volume are unknown. Our aim was to evaluate the current initial fluid resuscitation practice in patients with septic shock in the intensive care unit (ICU) and patient characteristics and outcome...
Dadpour B; Soltani Gh; Peivandi Yazdi A; Zirak N; AR Sedaghat; Sabzevari AR; Eftekharzadeh Mashhadi S; Ariayee N; Amini Sh
Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU) for poisoned patients in Imam Reza (p) hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire....
Conn, Lesley Gotlib; Haas, Barbara; Cuthbertson, Brian H; Amaral, Andre C; Coburn, Natalie; Nathens, Avery B
This ethnography explores communication around critically ill surgical patients in three surgical intensive care units (ICUs) in Canada. A boundary framework is used to articulate how surgeons', intensivists', and nurses' communication practices shape and are shaped by their respective disciplinary perspectives and experiences. Through 50 hours of observations and 43 interviews, these health care providers are found to engage in seven communication behaviors that either mitigate or magnify three contested symbolic boundaries: expertise, patient ownership, and decisional authority. Where these boundaries are successfully mitigated, experiences of collaborative, high-quality patient care are produced; by contrast, boundary magnification produces conflict and perceptions of unsafe patient care. Findings reveal that high quality and safe patient care are produced through complex social and cultural interactions among surgeons, intensivists, and nurses that are also expressions of knowledge and power. This enhances our understanding of why current quality improvement efforts targeting communication may be ineffective. PMID:26481945
Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.
Stuck, Amy; Clark, Mary Jo; Connelly, Cynthia D
Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep? PMID:21983504
Sharma B, Gaurav; EVS, Maben; MS, Kotian; B., Ganaraja
Background: Psychological assessment for depression, anxiety and stress among ICU patients and the patients admitted to ward in a hospital in India. This aspect did not get much attention in India so far. Such studies were common in developed countries. Therefore we decided in this study, to analyse the psychological status responses from the hospitalised patients in Mangalore using a validated questionnaire.
Tai, Shu-Yu; Lee, Chung-Yin; Wu, Chien-Yi; Hsieh, Hui-ya; Huang, Joh-Jong; Huang, Chia-Tsuan; Chien, Chen-Yu
Background This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement. Methods This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the “Symptom Reporting Form”, and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1st, 3rd, 5th, and 7th Day in the palliative care unit...
Full Text Available Introduction: The objective of this study was to determine the thermal injury fluid resuscitation protocols at intensive care units (ICUs in the United Kingdom and Ireland. Materials and methods: A telephone questionnaire was designed to survey the fluid resuscitation protocols of ICUs at all hospitals with plastic/burn surgery departments in the British Isles in 2010. The feedback from the questionnaire was from the senior nurse in charge of the ICUs. Results: 32/64 (50% of these ICUs had provided care to burns patients. A 100% response from these 32 units was obtained. 71.4% commence fluid resuscitation at 15% total body surface area burn (TBSA, 21.4% at 20% TBSA and 7.1% at 10% TBSA in adults. The estimated resuscitation volume was most often calculated using the Parkland/Modified Parkland formula (87.5% or the Muir and Barclay formula (12.5%. Interestingly, of the ICUs using formulae, two had recently moved from using the Muir and Barclay formula to Parkland formula and one had recently moved from using the Parkland formula to Muir and Barclay formula. Despite this, 37.5% of ICUs using a formula did not rigidly follow it exactly. The most commonly used resuscitation fluid was Ringer’s lactate solution (46.9% and Human Albumin Solution was used in 12.5%. No ICU used red cell concentrate as a first line fluid. 18.8% used a central line. 40.6% ICUs considered changing the IV solution during resuscitation. 78.1% ICUs consider urine output to be the most important factor in modifying resuscitation volumes. 59.4% ICUs calculate a maintenance fluid rate after completion of resuscitation. The endpoint for resuscitation was at 24 h in 46.9% ICUs and at 36 h in 9.4%. 5/32 (16% felt their protocol gave too little and 6/32 (19% felt their protocol gave too much. 59.3% ICUs gave oral/enteral fluids by naso-gastric or naso-jejenal tubes. 21.9% felt that oral/enteral resuscitation worked. Exactly half of the units believed that the formula that they used
Jaquilene Barreto da Costa; Sonia Silva Marcon; Claudia Rejane Lima de Macedo; Amaury Cesar Jorge; Péricles Almeida Delfino Duarte
Objective To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the partici...
Halset, Jørgen Holli; Hanssen, Simon Wøhlert; Espinosa, Aurora; Klepstad, Pål
Background: Intensive care unit (ICU) patients usually have abnormal biochemical and hematological laboratory test results as a consequence of organ dysfunction and underlying disease. Thromboelastography (TEG®) is a point-of-care laboratory analysis that gives an overview of several aspects of the coagulation process. In order to be able to perform a clinical interpretation of abnormal TEG® results the expected values from non-bleeding ICU patients should be known. The aim of thi...
Münire Babayiğit; Zehra Baykal Tutal; Necla Dereli; Handan Güleç; Mustafa Alparslan Babayiğit; Eyüp Horasanlı
Objective: We aimed to demonstrate to what extent do the right information in patients’ inter-hospital transfers due to the intensive care indications Material and Method: In this study, 38 patients who applied to our general intensive care unit (ICU) from the other hospitals were included. The demographic data of patients, declarations before ICU admission and diagnosis after admission, the reason and accuracy of the transfer, the overall stay time and the treatments in ICU were recorded....
Siegelaar, S.E.; DeVries, J. H.; Hoekstra, J.B.
Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ( ICU), despite larger severity of illness in the diabetes group at admission. This study contributes to the growing evidence that diabetes in itself is not a risk factor for ICU mortality, although the mech...
Dalboni, Maria Aparecida; Beraldo, Daniel de Oliveira; Quinto, Beata Marie Redublo; Blaya, Rosângela; Narciso, Roberto; Oliveira, Moacir; Monte, Júlio César Martins; Durão, Marcelino de Souza; Cendoroglo, Miguel; Pavão, Oscar Fernando; Batista, Marcelo Costa
Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. ...
Ho Jun Yi; Je Hoon Jeong; Eun-Sun Jin; Il Young Shin; Hyung Sik Hwang; Seung-Myung Moon
Vitamin D plays an important role in maintaining normal bone metabolism. Recent studies have suggested that vitamin D influences many other physiological processes, including muscle function, cardiovascular homeostasis, nerve function, and immune response. Furthermore, accumulated evidence suggests that vitamin D also mediates the immune system response to infection. Critical neurosurgical patients have higher infection and mortality rates. To correlate vitamin D deficiency to the immunological status of neurosurgical intensive care unit patients, we detected serum vitamin D level in 15 patients with clinically suspected infection and 10 patients with confirmed infection. Serum level of 25-hydroxyvitamin D, the primary circulating form of vitamin D, was significantly decreased in patients with suspected or confirmed infection after a 2-week neurosurgical intensive care unit hospitalization, while serum level of 1,25-dihydroxyvitamin D, the active form of vitamin D, was significantly decreased in patients after a 4-week neurosurgical intensive care unit hospitalization. These findings suggest that vitamin D deficiency is linked to the immunological status of neurosurgical intensive care unit patients and vitamin D supplementation can improve patient's immunological status.
Hettema, Jennifer E.; Sorensen, James L.
This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more…
Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth
describe their experiences of professional patient care in a hospital unit? What kinds of experiences do nursing students have in professional patient care encounters? INCLUSION CRITERIA Types of participants This review will consider studies that include undergraduate and postgraduate nursing students....... The range of participants includes all nursing students independently of the level of their clinical period. There will be no limitations regarding the age, gender or ethnicity of participants. Types of phenomena of interest This review will consider studies that investigate nursing students' learning...... experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing...
Thiery Guillaume; Darmon Michael; Azoulay Elie
Over the last 15 years, the management of critically ill cancer patients requiring intensive care unit admission has substantially changed. High mortality rates (75-85%) were reported 10-20 years ago in cancer patients requiring life sustaining treatments. Because of these high mortality rates, the high costs, and the moral burden for patients and their families, ICU admission of cancer patients became controversial, or even clearly discouraged by some. As a result, the reluctance of i...
Lima, Camila S P; Barbosa, Sayonara F F
This is a methodological study and technological production that aims to describe the development of a computerized system of nursing care quality indicators for the Intensive Care Unit. The study population consisted of a systems analyst and fifteen critical care nurses. For the development of the system we adopted some of the best practices of the Unified Process methodology using the Unified Modeling Language and the programming language Java Enterprise Edition 7. The system consists of an access menu with the following functions: Home (presents general information), New Record (records the indicator), Record (record search), Census (add information and indicators of the patient), Report (generates report of the indicators) and Annex (accesses the Braden Scale). This information system allows for measurement of the quality of nursing care and to evaluate patient safety in intensive care unit by monitoring quality indicators in nursing. PMID:26262049
Lyon, G Marshall; Mehta, Aneesh K; Varkey, Jay B; Brantly, Kent; Plyler, Lance; McElroy, Anita K; Kraft, Colleen S; Towner, Jonathan S; Spiropoulou, Christina; Ströher, Ute; Uyeki, Timothy M; Ribner, Bruce S
West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history. Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD. The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities. We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction. As the patients' condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma. PMID:25390460
Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.
Armstrong, Susan J; Laetitia C. Rispel; Loveday Penn-Kekana
Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospital...
Armstrong, Susan J; Laetitia C. Rispel; Penn-Kekana, Loveday
Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals ...
Sharly Dwijayanti; Sylvi Irawati; Eko Setiawan
which may directly impact to the outcome of treatment to the Intensive Care Unit (ICU) patients. The objective of this study was to identify the profile of compatibility and incompatibility among IV admixtures given to the ICU patients. This observational research was conducted prospectively to the patients admitted in the ICU at a private hospital in Surabaya from October–December 2014. In this research, compatibility data of IV drug and its solution was compared with drug brochure and Handb...
ALIYALI, M.; HEDAYATI, M.T.; HABIBI, M.R.; KHODAVAISY, S.
Summary Introduction. Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunocompromised patients. During recent years, a rising incidence of IA in Intensive Care Unit (ICU) patients has been reported. The patterns of IA related infection may differ according to the type of underlying disease. Unfortunately little is known about the characteristics of IA in ICU patients. In the present study we assessed IA related clinical and bronchoscopy findings in ICU patien...
Foglia, Elizabeth; Meier, Mary Dawn; Elward, Alexis
Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is as...
Chernecky, Cynthia; Macklin, Denise; Blackburn, Paul
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. PMID:26039650
Objective: To determine the lunar effect on mortality among patients admitted to the intensive care unit. Methods: The retrospective study conducted at Rosalind Franklin University of Medicine and Science, North Chicago, and comprised data of 4387 patients in intensive care unit from December 2002 to November 2004. The subjects were divided into two groups: patients who died on full moon days (the 14th, 15th, and 16th days of the lunar month); and patients who died on the other days of the month. The mortality rates were calculated for patients in both groups. Parameters including patients' age, gender, acute physiology and chronic health evaluation scores, predicted mortality rates, type of intensive care unit, and actual mortality were compared, and non-parametric tests were performed to determine whether there were any differences between the groups. Results: Of the 4387 patients who were followed for 23 months, 297 patients died, including 31 on full moon days and 266 patients on the other days of the month. Both groups were similar in terms of mean age (73.6 +-14.59 vs. 71.07+-16.13 years; p=0.599), acute physiology and chronic health evaluation scores (82.06+-24.19 vs. 76.52+-27.42; p=0.258), and predicted mortality (0.405+-0.249 vs. 0.370+-0.268; p=0.305). There was no difference in the frequency of death between the full moon days and the other days (10.33+-0.58 vs. 9.8 +-3.46; p=0.845). Conclusions: The full moon does not affect the mortality of the patients in intensive care unit. (author)
Full Text Available Over the last 15 years, the management of critically ill cancer patients requiring intensive care unit admission has substantially changed. High mortality rates (75-85% were reported 10-20 years ago in cancer patients requiring life sustaining treatments. Because of these high mortality rates, the high costs, and the moral burden for patients and their families, ICU admission of cancer patients became controversial, or even clearly discouraged by some. As a result, the reluctance of intensivists regarding cancer patients has led to frequent refusal admission in the ICU. However, prognosis of critically ill cancer patients has been improved over the past 10 years leading to an urgent need to reappraise this reluctance. In this review, the authors sought to highlight that critical care management, including mechanical ventilation and other life sustaining therapies, may benefit to cancer patients. In addition, criteria for ICU admission are discussed, with a particular emphasis to potential benefits of early ICU-admission.
Farahani, Mansoureh A; Gaeeni, Mina; Mohammadi, Nooreddin; Seyedfatemi, Naima
Receiving information related to patients hospitalized in the intensive care unit is among the most important needs of the family members of such patients. When health care professionals should decide whether to be honest or to give hope, giving information becomes an ethical challenge We conducted a research to study the ethical approaches of Iranian nurses to giving information to the family members of patients in the intensive care units. This research was conducted in the intensive care units of three teaching hospitals in Iran. It employed a qualitative approach involving semi-structured and in-depth interviews with a purposive sample of 12 nurses to identify the ethical approaches to giving information to family members of the intensive care unit patients. A conventional content analysis of the data produced two categories and five subcategories. The two categories were as follows: a) informational support, and b) emotional support. Informational support had 2 subcategories consisting of being honest in giving information, and providing complete and understandable information. Emotional support in giving information had 3 sub-categories consisting of gradual revelation, empathy and assurance. Findings of the study indicated that ethical approaches to giving information can be in the form of either informational support or emotional support, based on patients' conditions and prognoses, their families' emotional state, the necessity of providing a calm atmosphere in the ICU and the hospital, and other patients and their families' peace. Findings of the present study can be used as a basis for further studies and for offering ethical guidelines in giving information to the families of patients hospitalized in the ICU. PMID:25512830
Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable
Güngörer, Vildan; Yisldırım, Nurdan Kökten
Aim: The study aimed to retrospectively examine the demographic and etiological characteristics, prognosis and length of stay in intensive care unit of intoxicated patients hospitalized in Level two Pediatric Intensive Care Unit in Maternity and Child Health Hospital of Samsun. Material and Methods: The study retrospectively examined the records of patients hospitalized between 14th March 2014 and 14th March 2015 in Level two Pediatric Intensive Care Unit in Maternity and Child Health Hospital of Samsun with respect to age, gender, cause of poisoning, time of emergency department admission, length of hospitalization and prognosis. Results: Of 82 patients admitted to the Intensive Care Unit, 29 (35.3%) were male and 53 (64.6%) were female. The mean age of the male and female patients was 7.89±6.3 years and 11.2±5.7 years, respectively and the mean age of the study group was 10.04±6.1. Twenthy one (39,6%) of the female patients were at the age group of 0–14 years and 32 (60.4%) were at the age group of 14–18 years. Twenthy (68.9%) of the male patients were at the age group of 0–14 years and nine (31.1%) were at the age group of 14–18 years. The cause of poisoning was drug intoxication (antidepressants, antibiotics, painkillers and other drugs) in 64 patients (78%) and the remaining 18 patients (22%) were admitted to hospital for other causes (rat poison, mushroom, carbonmonoxide, scorpion stings, bonzai and pesticides). Thirthy eight (46.3%) of all the patients used such substances for suicidal purpose. Thirthy three (62.2%) of these were female and 32 were at the age group of 14–18 years. Fourty (48.7%) of the patients who ingested medication ingested one drug, while 24 (29.2%) ingested multiple drugs. Antidepressants were found to be the most commonly used drugs (31.2%). The mean hospital admission time was 3.41±2 hours and the mean time of intensive care unit stay was 2.89±1.04 days. No mortality was recorded. Thirthy patients (36.5%) were referred
Pasinato, Valeska Fernandes; Berbigier, Marina Carvalho; Rubin, Bibiana de Almeida; Castro, Kamila; Moraes, Rafael Barberena; Perry, Ingrid Dalira Schweigert
Objective Evaluate the compliance of septic patients' nutritional management with enteral nutrition guidelines for critically ill patients. Methods Prospective cohort study with 92 septic patients, age ≥18 years, hospitalized in an intensive care unit, under enteral nutrition, evaluated according to enteral nutrition guidelines for critically ill patients, compliance with caloric and protein goals, and reasons for not starting enteral nutrition early or for discontinuing it. Prognostic scores...
Oliveira, Maria Sonia; Borges, Alvaro Henrique; Mattos, Fernanda Zanol; Semenoff, Tereza Aparecida Della Vedove; Segundo, Alex Semenoff; Tonetto, Mateus Rodrigues; Bandeca, Matheus Coêlho; Porto, Alessandra Nogueira
Background: The present study aimed to evaluate the different methods for removing oral biofilm in combination with 0.12% chlorhexidine, in patients admitted to the intensive care unit (ICU) of the General University Hospital. Materials and Methods: Initially, the patients were included in the study and underwent periodontal evaluation by means of the visible plaque index (VPI) and gingival bleeding index (GBI). The removal of visible biofilm, by a professional, was...
Varshika M. Bhana; Annali D.H. Botha
Patients perceive the intensive care unit (ICU) as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expo...
Farahani, Mansoureh A; Gaeeni, Mina; Mohammadi, Nooreddin; Seyedfatemi, Naima
Receiving information related to patients hospitalized in the intensive care unit is among the most important needs of the family members of such patients. When health care professionals should decide whether to be honest or to give hope, giving information becomes an ethical challenge We conducted a research to study the ethical approaches of Iranian nurses to giving information to the family members of patients in the intensive care units. This research was conducted in the intensive care units of three teaching hospitals in Iran. It employed a qualitative approach involving semi-structured and in-depth interviews with a purposive sample of 12 nurses to identify the ethical approaches to giving information to family members of the intensive care unit patients. A conventional content analysis of the data produced two categories and five subcategories. The two categories were as follows: a) informational support, and b) emotional support. Informational support had 2 subcategories consisting of being honest in giving information, and providing complete and understandable information. Emotional support in giving information had 3 sub-categories consisting of gradual revelation, empathy and assurance. Findings of the study indicated that ethical approaches to giving information can be in the form of either informational support or emotional support, based on patients’ conditions and prognoses, their families’ emotional state, the necessity of providing a calm atmosphere in the ICU and the hospital, and other patients and their families’ peace. Findings of the present study can be used as a basis for further studies and for offering ethical guidelines in giving information to the families of patients hospitalized in the ICU. PMID:25512830
Full Text Available OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units.METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121.RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument.CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units.
Tomazoni, Andréia; Rocha, Patrícia Kuerten; de Souza, Sabrina; Anders, Jane Cristina; de Malfussi, Hamilton Filipe Correia
OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units. METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121. RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument. CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units. PMID:25493670
Objective: To determine the frequency of fungal infection in nasal polyposis patients undergoing polypectomy in a tertiary care ENT unit. Methodology: This cross sectional study was conducted in the department of ENT, Pakistan Institute of Medical Sciences, Islamabad. A total of 60 patients with nasal polyposis were enrolled. Patients who did not give consent, with sinonasal malignancy, diabetes, and pregnant or lactating women were excluded from study. All the patients were operated and specimens of polypectomies were sent to the Department of Pathology for fungal culture, direct microscopy and histopathology. Data was entered and analysed using SPSS version 20. (author)
Moreira Daniel Martins
Full Text Available OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01 death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.
Viney, Linda L.; And Others
Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…
Pompilio, Carlos E; Pelosi, Paolo; Castro, Melina G
The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration. Finally, new data related to planning nutrition therapy of the critically obese have been highlighted and deserve consideration. In this review, we provide an outline of recent studies related to those important aspects of the care of the bariatric/metabolic patients in critical conditions. PMID:27464648
Joshi, Rohit; Szolovits, Peter
Real-time scalable predictive algorithms that can mine big health data as the care is happening can become the new "medical tests" in critical care. This work describes a new unsupervised learning approach, radial domain folding, to scale and summarize the enormous amount of data collected and to visualize the degradations or improvements in multiple organ systems in real time. Our proposed system is based on learning multi-layer lower dimensional abstractions from routinely generated patient data in modern Intensive Care Units (ICUs), and is dramatically different from most of the current work being done in ICU data mining that rely on building supervised predictive models using commonly measured clinical observations. We demonstrate that our system discovers abstract patient states that summarize a patient's physiology. Further, we show that a logistic regression model trained exclusively on our learned layer outperforms a customized SAPS II score on the mortality prediction task. PMID:23304406
Thiago de Paula Bon
Full Text Available Objective: To retrospectively analyze the relationship of time of care, combined with possible post-appendectomy complications, with the promptness of transfer of patients seen in Emergency Care Units (UPA to the emergency hospital.Methods: We analyzed patients with preoperative diagnosis of acute appendicitis undergoing appendectomy from January to July 2012. Patients were divided into two groups according to the site of the first care. Group A included patients who received initial care directly in the emergency department of the Lourenço Jorge County Hospital (HMLJ and group B consisted of patients seen in the UPA and forwarded to HMLJ to undergo surgical treatment.Results: the average time between initial treatment and surgery in group A was 29 hours (SD = 21.95 and 54 hours in group B (SD = 54.5. Considering the onset of symptoms, the patients in group A were operated on average 67 hours after (SD = 42.55, while group B, 90 hours (SD = 59.58. After the operation, patients in group A were hospitalized, on average, for 94 hours (SD = 73.53 and group B, 129 hours (SD = 193.42.Conclusion: there was no significant difference in the time elapsed between the onset of symptoms, initial treatment and early surgical treatment, or time elapsed between surgery and discharge.
Full Text Available BACKGROUND: Renal dysfunction is an established predictor of all-cause mortality in intensive care units. This study analyzed the outcomes of coronary care unit (CCU patients and evaluated several biomarkers of acute kidney injury (AKI, including neutrophil gelatinase-associated lipocalin (NGAL, interleukin-18 (IL-18 and cystatin C (CysC on the first day of CCU admission. METHODOLOGY/PRINCIPAL FINDINGS: Serum and urinary samples collected from 150 patients in the coronary care unit of a tertiary care university hospital between September 2009 and August 2010 were tested for NGAL, IL-18 and CysC. Prospective demographic, clinical and laboratory data were evaluated as predictors of survival in this patient group. The most common cause of CCU admission was acute myocardial infarction (80%. According to Acute Kidney Injury Network criteria, 28.7% (43/150 of CCU patients had AKI of varying severity. Cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.05 between patients with AKI versus those without AKI. For predicting AKI, serum CysC displayed an excellent areas under the receiver operating characteristic curve (AUROC (0.895 ± 0.031, p < 0.001. The overall 180-day survival rate was 88.7% (133/150. Multiple Cox logistic regression hazard analysis revealed that urinary NGAL, serum IL-18, Acute Physiology, Age and Chronic Health Evaluation II (APACHE II and sodium on CCU admission day one were independent risk factors for 6-month mortality. In terms of 6-month mortality, urinary NGAL had the best discriminatory power, the best Youden index, and the highest overall correctness of prediction. CONCLUSIONS: Our data showed that serum CysC has the best discriminative power for predicting AKI in CCU patients. However, urinary NGAL and serum IL-18 are associated with short-term mortality in these critically ill patients.
Žana Saratlija Novaković
Full Text Available Objective. To present patients who were examined, monitored and admitted at the urological emergency unit (UEU at the University Hospital, Split during the summer and winter of 2010 and to establish who of them were really in need of immediate urological care. Methods. A retrospective study of patients and diagnoses of patients examined at the UEU was undertaken during two winter and two summer months 2010. We compared the total number of patients, the number of patients with urological issues, patients with urological emergencies, patients with non-urological issues, patients who were briefly monitored at the UEU, and patients admitted to the urology department, within these two periods. Descriptive statistic and chi squared tests were used. Results. During the winter period 465 patients were examined at the UEU and during the summer 733 patients. During the summer period there were statistically more urological issues (χ2=12.3; p=0.005 and urological emergencies (χ2=4.14; p=0.042 while in the winter period there were more non-urological issues and more patients were monitored at the UEU (χ2=33.9; p<0.001. The most common diagnoses are: renal colic and urine retention, in both periods. Only 8% of patients in both the winter and summer periods were admitted to hospital after examination at the UEU, which represents the actual number of patients who needed immediate urological care. Conclusion. Of all the patients examined at the UEU, only a fraction constituted real, life-threatening urological emergencies. Primary care physicians and general emergency departments should be more educated in urological emergencies so that they can resolve more nonemergency patients themselves.
Kapadia F; Vadi S; Shukla U; Gursahani R
BACKGROUND: EEG is an investigative tool for assessing cerebral activity. Although certain EEG patterns may have a specific diagnostic or prognostic inference, they may not be precise for any sole etiology in majority of cases and may need clinical correlation. OBJECTIVE: Aim of this study was to assess the severity and prognosis of cerebral dysfunction in patients admitted to Intensive Care Unit (ICU) and to evaluate the incidence of non-convulsive status epilepticus (NCSE). DESIGN: A p...
Emine Yurdakul Ertürk; Şükrü Küçüködük; Kemal Baysal; Pelin Ayyıldız; Ayşegül Yılmaz; Gönül Oğur
Introduction: Congenital heart disease (CHD) is the most common congenital anomaly in newborns. In this study it was aimed to investigate the demographic features of the patients with CHD diagnosed in neonatal intensive care unit (NICU) to determine the frequency of the anomalies and to elucidate the etiologic risk factors. Materials and Methods: The files of 361 newborns who were diagnosed with CHD and hospitalized at Ondokuz Mayıs University NICU were retrospectively examined from 2006 t...
Fernández, Rosario; Moreno-Torres, Miguel; Contreras, Antonia M; Núñez, María I; Guirado, Damián; Peñas, Luis
The performance of radiography in the Intensive Care Unit (ICU) may be associated with a certain level of radiation exposure for staff and patients in the unit. Little evidence on exposure levels is available in the literature. However, healthcare professionals in the ICUs at our centre tend to leave the room during radiographic examinations, potentially compromising patient care. The objectives of this study were to quantify dose levels within the ICU and to evaluate the performance of ICU x-ray studies according to patient dose measurements. This study was conducted in the 18-bed ICU of a third-level hospital. The scattering radiation due to mobile x-ray examinations was measured by using four personal thermoluminiscent dosimeters (TLDs). The dose area product (DAP) was measured at each examination using a transmission chamber installed on the diaphragm of the x-ray equipment. Based on the TLD readings and taking account of the error margin, the annual dose to patients and staff was less than 0.6 mSv. The value given by the DAP meter for chest x-rays was 94 ± 17 mGy cm(2); this value is well below the lower limit recommended by different agencies and committees. Exposure levels were found to be extremely low and pose no apparent risk to staff or to those in beds adjacent to the patients undergoing x-ray examinations, which were correctly performed in the unit. PMID:26344655
Dithole, Kefalotse; Thupayagale-Tshweneagae, Gloria; Mgutshini, Tennyson
The Intensive Care Unit (ICU) can be traumatic, not only for patients, but also their closest relatives, especially spouses. Within Botswana, a developing country with very few ICUs and not so sophisticated machinery or a generalised lack of counselling for relatives, the ICU experience can be more traumatic. This study reports on the proportion of spouses who continued to experience mental distress, including the incidence of posttraumatic stress disorder, at six months after the discharge of their spouse from an intensive care unit. Mixed data collected approaches were used on a convenience sample of 28 spouses of patients who had been hospitalised at the Princess Marina Hospital ICU, Gaborone, Botswana, in the six months prior to the interview sessions. Participants were interviewed six months after the discharge of their spouse from the Intensive Care Unit using the PCL-S (PTSD Checklist). All the patients had been mechanically ventilated and had been hospitalised in the ICU for more than three days. Fifteen spouses reported intrusive memories of ICU and avoided reminders of the experience six months later. Ten spouses reported feeling anxious for a short while after their spouse's discharge but that they had come to terms with the experience. In order to mitigate the trauma experienced by spouses the study suggests that pre- and post-counselling for close relatives, especially spouses, should be implemented at the point of hospitalisation, during admission, and after discharge for a period of at least six months. PMID:23301567
BACKGROUND: Elderly patients in long-term care units are frailer than their community-dwelling peers and may be more at risk from toxic side-effects of anticonvulsant medication at standard doses. AIM: To examine the prescribing of anticonvulsants to patients in elderly care units. METHODS: Drug prescription sheets and case notes were reviewed. Serum anticonvulsant concentration, renal and liver profiles and albumin level were measured. RESULTS: Anticonvulsants were prescribed to twice as many male as female patients (32 vs 14%; p<0.03) and to 33% of those younger than 80 years of age versus 10% of those aged 80 years or older (p<0.0002). No patient had significant hypoalbuminaemia and routine measurement of serum anticonvulsant concentration did not indicate an alteration of dosage. CONCLUSIONS: Anticonvulsants appear to be well tolerated in these patients. The younger age of those receiving anticonvulsants is inadequately explained by the characteristics of the patient cohort and may reflect a shift towards a younger age in patients requiring anticonvulsants due to increased mortality in this group.
Full Text Available Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU for poisoned patients in Imam Reza (p hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. Results: According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. Conclusion: It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients
A simple economical apparatus was constructed to permit 99m technetium aerosol lung scanning in intubated patients requiring mechanical ventilation. A study was then undertaken which showed the technique to be feasible, reliable and to provide information leading to changes in diagnosis and management in patients in the Intensive Care Unit (ICU). The technique can identify pure ventilatory abnormalities particularly endobronchial obstruction. The technique does not require computer manipulation of images and allows the ready acquisition of ventilation scans in multiple projections which is a distinct advantage over radio xenon scanning
Fahime Rasoulinezhad; Shala Mohammadzadeh; Vahhab Piranfar; Reza Mirnejad
Background and Aim: Colonization of gram – negative bacteria and fungi in oropharynx of hospitalized patients in intensive care units, is an important process in the development of aspiration pneumonia in these patients (ICU). The purpose of current study was to define effect of selective oropharyngeal decontaminatio (SOD) on colonization of the oral-pharynx in hospitalized patients in intensive care units. Materials and Methods: In this clinical trial study, 60 ...
Full Text Available The difficult airway is a frequent problem among adult patients in intensive care unit. All critical patients should initially be evaluated as a potential difficult airway cases. Development of a serious desaturation should be considered since these patients have less physiological reserve compared to those with difficult airway due to elective surgery. Development of respiratory failure with H1N1 associated pneumonia is likely and support of intubation and mechanic ventilator shall be needed. The objective of this report is to present the management of a patient with H1N1 associated pneumonia who required intubation however could not be intubated due to difficult airway. J Clin Exp Invest 2014; 5 (4: 617-619
Full Text Available Aim: The aim of this study was to evaluate microorganism growth in blood cultures of hospitalized patients in our intensive care units and to determine appropriate antimicrobial agents for treatment. Methods: We retrospectively investigated the blood cultures obtained from the patients hospitalized in the Coronary and Surgical Intensive Care Units at the Institute of Cardiology, İstanbul University, between July 2013 and December 2014. All microorganisms were identified using the conventional methods. Results: A total of 1034 blood cultures were obtained from 324 patients. Microbial growth was detected in 174 (16.8% blood cultures of 68 patients. Among all microbial growth, 113 (58.55% were gram-positive bacteria, 69 (35.75% were gram-negative rods and 11 (5.7% were fungi. Staphylococcus aureus was the most frequent microorganism (48; 24.87%, followed by coagulasenegative Staphylococci (35; 18,13%, Enterococcus spp. (30; 15,54%, Stenotrophomonas maltophilia, Escherichia coli, and Pseudomonas spp. 60.4% of Staphylococcus aureus were methicillin-resistant and 65.7% of coagulase-negative Staphylococci were also methicillin-resistant. All Staphylococci and Enterococci were not resistant to vancomycin, teicoplanin and tigecycline. All the gram-negative rods were susceptible to colistin and tigecycline, followed by imipenem (71.6% and meropenem (70.7%. Conclusions: We assume that infection control measures must be increased due to high antibiotic resistance and besides, antibiotic policies should be improved.
Nunes-da-Cunha, Ines; Arguello, Blanca; Martinez, Fernando Martinez
Objective. To compare United States and European Higher Education Area (EHEA) undergraduate pharmacy curricula in terms of patient-centered care courses. Methods. Websites from all pharmacy colleges or schools in the United States and the 41 countries in the EHEA were retrieved from the FIP Official World List of Pharmacy Schools and investigated. A random sample of schools was selected and, based on analyses of course descriptions from syllabi, each course was classified into the following categories: social/behavioral/administrative pharmacy sciences, clinical sciences, experiential, or other/basic sciences. Results. Of 147 schools of pharmacy, 59 were included (23 in US and 36 in the EHEA). Differences existed in the percentages of credits/hours in all of the four subject area categories. Conclusion. Institutions in EHEA countries maintain a greater focus on basic sciences and a lower load of clinical sciences in pharmacy curricula compared to the United States. These differences may not be in accordance with international recommendations to educate future pharmacists focused on patient care. PMID:27402986
Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care...
Paulo Yuri Milen Firmino
Full Text Available Cardiovascular complications are relevant due to their frequency and severity on the hypertension scenario. Studies refer Pharmaceutical Care (PC as capable of decreasing cardiovascular risk rate (%CVR on hypertensive patients. This study aimed to investigate, through a randomized clinical assay, the influence of PC service on the %CVR of hypertensive patients assisted in a health primary care unit from Fortaleza-Ceará. Two study groups were formed: i. Intervention Group (IG, which received orientation about taking medicines, actions aiming to prevent/solve medicine interactions and adverse effects and non-pharmacological interventions for 9 months and, ii. Control Group (CG, which received traditional assistance of the unit and was monitored during the same period. It was observed a statistically significant reduction on %CVR (10.76 to 7.86; p=0.04 and systolic blood pressure levels (SBP (137.69 to 131.54; p<0.01 in the IG, while, in the CG, there was no significant alteration. 151 Drug Related Problem (DRP were identified and it was realized 124 pharmaceutical interventions, with 89.2% of them resulting on solution/prevention of the problem. Our findings indicated that the inclusion of the PC service in the hypertensive health assistance was more effective at the %CVR and the SBP reduction in comparison to the traditional assistance offered.
Full Text Available BACKGROUND: EEG is an investigative tool for assessing cerebral activity. Although certain EEG patterns may have a specific diagnostic or prognostic inference, they may not be precise for any sole etiology in majority of cases and may need clinical correlation. OBJECTIVE: Aim of this study was to assess the severity and prognosis of cerebral dysfunction in patients admitted to Intensive Care Unit (ICU and to evaluate the incidence of non-convulsive status epilepticus (NCSE. DESIGN: A prospective study, wherein we analyzed EEG characteristics in a series of 70 patients. SETTING: A tertiary care hospital in Mumbai, India. PATIENTS: EEG characteristics of 70 patients admitted in ICU over a period of 9 months were comprehensively analyzed. These patients were clinically examined and a questionnaire was completed without knowledge of the EEG findings. EEGs were requested for by neurologist or intensivist and our inclusion criteria were (i patients with altered sensorium of varying etiology, (ii unconscious patients at risk for non-convulsive status epilepticus (those with a history of epilepsy, and (iii unconscious patients with involuntary jerky eye movements. RESULTS: Of the various clinical presentations on ICU admission, there were 20 patients with seizures, 15 with metabolic disorders, 13 with infective causes, 9 with hypoxia, 9 with cerebro-vascular accident on presentation, 1 patient with alcohol/drug overdose, 2 with intra-cerebral space occupying lesion and 1 with ambiguous etiology on admission (there being an overlap among the presentation. Mean duration from presentation to performing EEG was 13 hours. 64 (91.42% patients had abnormal EEGs. 32(50% patients had EEG slowing and 4(6.25% patient had electro cerebral inactivity. Eleven (21.87% patients had epileptiform activity on the EEG of which seven did not have overt seizures (NCSE. Follow-up EEGs of these patients showed resolution of the epileptiform activity. CONCLUSIONS: EEG is useful
Pandian, Vinciya; Thompson, Carol B.; Feller-Kopman, David J.; Mirski, Marek A.
Objective To develop and validate a new instrument for measuring health-related quality of life in mechanically ventilated patients in the intensive care unit (ICU). Design Expert panel consensus and a prospective longitudinal survey. Setting Urban, academic, tertiary care medical center. Patients One hundred and fifteen awake, mechanically ventilated, ICU patients who either received a tracheostomy or remained endotracheally intubated. Interventions A new quality of life instrument was developed and validated by using pilot study data; informal interviews of patients, families, and nurses; expert panel consensus; and item analyses. The new instrument was used to measure quality of life at three time points (5 days, 10 days, and 15 days post-intubation). Measurements and Main Results A new 12-item quality of life questionnaire for mechanically ventilated patients was developed. Patients’ responses to the quality of life questionnaire revealed moderate to high correlations with EuroQol-5D scores (r = −0.4 to −0.9) and the EuroQol Visual Analog Scale (r = 0.6 to 0.9) across the three times, and a moderate correlation with the Sequential Organ Failure Assessment tool (r = 0.5) at 10 days post-intubation. Cronbach’s alpha ranged from 0.80 to 0.94 across the three times. The quality of life instrument was responsive to changes in treatment modalities (tracheostomy vs. no tracheostomy; and early vs. late tracheostomy demarcated by 10 days of intubation). Exploratory factor analysis revealed that this instrument was unidimensional in nature. Conclusions The new quality of life questionnaire is valid and can reliably measure QOL in mechanically ventilated ICU patients. It may provide clinicians with an accurate assessment of patients’ quality of life and facilitate optimal decision-making regarding patients’ ICU plan of care. PMID:25072754
Full Text Available Musculoskeletal pain syndromes are one of the most common causes of disability and referral to a medical specialist. Seven million consultations for lumbosacral pain are annually carried out in the United Kingdom.Examination of patients with back pain. Three levels of health care delivered to patients with back pain in the United Kingdom may be arbitrarily identified. Level 1 is outpatient: a general practitioner jointly with a manipulative therapist, a physiotherapist, a rehabilitation specialist, and mid-level health workers render care to patients with insignificant and mild pain syndrome; Level 2 is also outpatient, which involves the participation of a hospital or multidisciplinary team consultant, for example, in a musculoskeletal pain service or a specialized pain center; Level 3 is to deliver care at neurosurgical or orthopedic hospital, by applying invasive interventions. Acute back pain is a benign condition in the vast majority of cases; there is no need for additional instrumental and laboratory studies; but spinal X-ray study, computed tomography (СT scan, or magnetic resonance imaging (MRI, general blood and urine tests are required when marked neurological and somatic disorders are present.Management of patients with acute lumbosacral pain is to inform a patient about the benign nature of the disease; to exclude bed rest; to explain the need to maintain normal activity; to train how to correctly lift weights and to maintain normal posture; to refer for manual and exercise therapy in order to return to normal motor activity; to use proven effective medication. In most cases, acute back pain goes away spontaneously for a short period of time; an active treatment approach is considered to be optimal. Nonsteroidal anti-inflammatory drugs (NSAIDs and acetaminophen are used for analgesia if required. Patients who show no improvement after 4 weeks of treatment need rescreening for markers of potentially dangerous spinal diseases, as
Full Text Available Context: The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance. Aim of the Study: To study the current mobilization practices by the physiotherapists in neurological ICUs of India. Subjects and Methods: A cross-sectional survey was conducted with a content validated questionnaire about the mobilization practices. Online questionnaire was distributed to physiotherapists working in neurological ICUs of India. Descriptive statistics were used. Results: Out of 185 e-mails sent, 82 physiotherapists completed the survey (survey response rate = 44%. Eighty participants (97.6% mentioned that the patients received some form of mobilization during the day. The majority of the physiotherapists (58.5%, “always” provided bed mobility exercises to their patients when it was found appropriate for the patients. Many physiotherapists (41.5% used tilt table “sometimes” to introduce orthostatism for their patients. Conclusion: Mobilization in various forms is being practiced in the neurological ICUs of India. However, fewer mobilization sessions are conducted on weekends and night hours in Indian Neurological ICUs.
Chiasson, Ann Marie; Linda Baldwin, Ann; Mclaughlin, Carrol; Cook, Paula; Sethi, Gulshan
This study was performed to investigate the effect of live, spontaneous harp music on individual patients in an intensive care unit (ICU), either pre- or postoperatively. The purpose was to determine whether this intervention would serve as a relaxation or healing modality, as evidenced by the effect on patient's pain, heart rate, respiratory rate, blood pressure, oxygen saturation, and heart rate variability. Each consenting patient was randomly assigned to receive either a live 10-minute concert of spontaneous music played by an expert harpist or a 10-minute rest period. Spontaneous harp music significantly decreased patient perception of pain by 27% but did not significantly affect heart rate, respiratory rate, oxygen saturation, blood pressure, or heart rate variability. Trends emerged, although being not statistically significant, that systolic blood pressure increased while heart rate variability decreased. These findings may invoke patient engagement, as opposed to relaxation, as the underlying mechanism of the decrease in the patients' pain and of the healing benefit that arises from the relationship between healer, healing modality, and patient. PMID:24371459
Varshika M. Bhana
Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.
Hantikainen Virpi; Jeitziner Marie-Madlen; Conca Antoinette; Hamers Jan PH
Abstract Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs), such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and...
Jeitziner, Marie-Madlen; Hantikainen, Virpi; Conca, Antoinette; Hamers, Jan PH
Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs), such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the cons...
Jeitziner, Marie-Madlen; Hantikainen, Virpi; Conca, Antoinette; Hamers, Jan P. H.
Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs), such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the ...
Gallagher, Dympna; DeLegge, Mark
The study of body composition is a rapidly evolving science. In today’s environment, there is a great deal of interest in assessing body composition, especially in the obese subject, as a guide to clinical and nutrition interventions. There are some strikingly different compartments of body composition between the obese and the lean patient. We do have the ability to measure body composition accurately, although these techniques can be labor intensive and expensive. The recognition of patient...
Susan J. Armstrong
Full Text Available Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36. Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results: The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision
Leppert, Wojciech; Majkowicz, Mikolaj; Forycka, Maria; Mess, Eleonora; Zdun-Ryzewska, Agata
Aim of the study To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care center (DCC). Patients and methods QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL), the Edmonton Symptom Assessment System (ESAS), and the Karnofsky Perfor...
Full Text Available Introduction: Sepsis is one of the most important causes of mortality in the intensive care setting. An effective predictor of prognosis of sepsis is required to assess morbidity and mortality of this condition. In this study, sepsis in the intensive care unit (ICU of a tertiary care hospital was evaluated, with specific reference to clinical features and causative organisms. The sequential organ failure assessment (SOFA score was calculated to assess the severity of sepsis and multi-organ failure at presentation and after 48 h. The correlation of SOFA and mean SOFA scores with outcome was studied. Materials and Methods: This was a prospective, observational, cohort study carried out in a tertiary care teaching hospital. Forty consecutive cases of septicemia were studied. Detailed history, clinical features, and SOFA score was recorded to assess the disease severity at the time of presentation and after 48 h. Inclusion of patients in the study was performed using the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM definition of sepsis. Two sample t-test and 95% confidence interval (CI for difference of mean was applied. Results: When the SOFA score was <7, the mortality was 56%. It increased to 70% when the score was 8-15 (P = 0.0989, t value: 1.69, Mean difference: 2.12, 95% CI: 0.41-4.665. Patients with SOFA score <7 after 48 h had 52% mortality and it increased to 88% when the score was 8-15. The mean SOFA score at 48 h was 6.96 in patients who died and 2.5 in those who improved (P < 0.001, t value: 4.332, mean difference: 4.39, 95% CI: 2.34-6.44. Hence, the predictive value for mortality of SOFA score was better at 48 h than at presentation. Conclusions: Sequential assessment of organ dysfunction in ICU at presentation and at 48 h is a good indicator of prognosis. Both mean and highest SOFA scores are particularly useful predictors of outcome, independent of the initial score. A high SOFA score at 48 h of
Treatment in the intensive care unit of patients with end-stage liver disease has been limited. Liver transplantation has been a major improvement in this and has become standard in the management of these patients. However, many patients die awaiting liver transplantation, mainly due to the scarcity of organ donors. Conventional hemodialysis techniques have little or no effect on liver detoxification and do not improve the prognosis of these patients. In patients with acute hepatic failure, ...
Full Text Available Aims: To study the impact of hypothermia upon admission to the Intensive Care Unit (ICU on early and late mortality and to develop a prediction model for late mortality in severely injured trauma patients. Materials and Methods: A multicenter retrospective cohort study was performed in adult trauma patients admitted to the ICU of two Level-1 trauma centers between 2007 and 2012. Hypothermia was defined as a core body temperature of ≤35° Celsius. Logistic regression analyses were performed to quantify the effect of hypothermia on 24-hour and 28-day mortality and to develop a prediction model. Results: A total of 953 patients were included, of which 354 patients had hypothermia (37% upon ICU admission. Patients were divided into a normothermic or hypothermic group. Hypothermia was associated with a significantly increased mortality at 24 hours and 28 days (OR 2.72 (1.18-6.29 and OR 2.82 (1.83-4.35 resp.. The variables included in the final prediction model were hypothermia, age, APACHE II score (corrected for temperature, INR, platelet count, traumatic brain injury and Injury Severity Score. The final prediction model discriminated between survivors and non-survivors with high accuracy (AUC = 0.871, 95% CI 0.844-0.898. Conclusions: Hypothermia, defined as a temperature ≤35° Celsius, is common in critically ill trauma patients and is one of the most important physiological predictors for early and late mortality in trauma patients. Trauma patients admitted to the ICU may be at high risk for late mortality if the patient is hypothermic, coagulopathic, severely injured and has traumatic brain injury or an advanced age.
Balvers, Kirsten; Van der Horst, Marjolein; Graumans, Maarten; Boer, Christa; Binnekade, Jan M.; Goslings, J. Carel; Juffermans, Nicole P.
Aims: To study the impact of hypothermia upon admission to the Intensive Care Unit (ICU) on early and late mortality and to develop a prediction model for late mortality in severely injured trauma patients. Materials and Methods: A multicenter retrospective cohort study was performed in adult trauma patients admitted to the ICU of two Level-1 trauma centers between 2007 and 2012. Hypothermia was defined as a core body temperature of ≤35° Celsius. Logistic regression analyses were performed to quantify the effect of hypothermia on 24-hour and 28-day mortality and to develop a prediction model. Results: A total of 953 patients were included, of which 354 patients had hypothermia (37%) upon ICU admission. Patients were divided into a normothermic or hypothermic group. Hypothermia was associated with a significantly increased mortality at 24 hours and 28 days (OR 2.72 (1.18-6.29 and OR 2.82 (1.83-4.35) resp.). The variables included in the final prediction model were hypothermia, age, APACHE II score (corrected for temperature), INR, platelet count, traumatic brain injury and Injury Severity Score. The final prediction model discriminated between survivors and non-survivors with high accuracy (AUC = 0.871, 95% CI 0.844-0.898). Conclusions: Hypothermia, defined as a temperature ≤35° Celsius, is common in critically ill trauma patients and is one of the most important physiological predictors for early and late mortality in trauma patients. Trauma patients admitted to the ICU may be at high risk for late mortality if the patient is hypothermic, coagulopathic, severely injured and has traumatic brain injury or an advanced age. PMID:27512330
Chen, Chin-Ming; Chan, Khee-Siang; Yu, Wen-Liang; Cheng, Kuo-Chen; Chao, Hui-Chun; Yeh, Chiu-Yin; Lai, Chih-Cheng
Outcomes of adult patients with dengue infections requiring intensive care unit (ICU) admissions remain unclear. We assessed the clinical manifestations and prognostic factors of patients critically ill with severe dengue.This retrospective study was done in a tertiary referral hospital with 96 adult ICU beds. All of the patients with laboratory-confirmed severe dengue infections and admitted to the ICU were enrolled between July 31 and November 31, 2015, during the large outbreak period. The medical records of all the recruited patients were reviewed for the following information: age, gender, clinical manifestations, disease severity scores, underlying conditions, laboratory examinations, and outcomes. The primary endpoint was to find the predictors of ICU mortality.During the study period, 4787 patients with dengue infections required ICU admission. One hundred forty-three (2.99%) were critically ill (mean age: 69.7 years). Hypertension (n = 90, 62.9%) and diabetes mellitus (n = 70, 49.0%) were the 2 most common underlying diseases. Eighty critically ill patients (55.9%) had cobacterial infections, and 33 had cobacteremia. The hematologic system failed most often, followed by thoracic and cardiovascular systems. Fever was the most common presentation (n = 112; 78.3%), followed by anorexia (n = 47; 32.9%) and abdominal pain (n = 46; 32.2%). Overall, 33 patients died (mortality rate: 23.1%). Multivariate analysis showed that ICU mortality was significantly associated with lower Glasgow Coma Scale (GCS) scores, lower platelet counts before ICU discharge, and more organ failures.The number of severe dengue patients who require ICU admission remains high. The mortality rate was associated with lower GCS scores, lower platelet counts, and more organ failures. In addition, more than half of the critically ill dengue patients had comorbid bacterial infections. PMID:27495047
Chen, Chin-Ming; Chan, Khee-Siang; Yu, Wen-Liang; Cheng, Kuo-Chen; Chao, Hui-Chun; Yeh, Chiu-Yin; Lai, Chih-Cheng
Abstract Outcomes of adult patients with dengue infections requiring intensive care unit (ICU) admissions remain unclear. We assessed the clinical manifestations and prognostic factors of patients critically ill with severe dengue. This retrospective study was done in a tertiary referral hospital with 96 adult ICU beds. All of the patients with laboratory-confirmed severe dengue infections and admitted to the ICU were enrolled between July 31 and November 31, 2015, during the large outbreak period. The medical records of all the recruited patients were reviewed for the following information: age, gender, clinical manifestations, disease severity scores, underlying conditions, laboratory examinations, and outcomes. The primary endpoint was to find the predictors of ICU mortality. During the study period, 4787 patients with dengue infections required ICU admission. One hundred forty-three (2.99%) were critically ill (mean age: 69.7 years). Hypertension (n = 90, 62.9%) and diabetes mellitus (n = 70, 49.0%) were the 2 most common underlying diseases. Eighty critically ill patients (55.9%) had cobacterial infections, and 33 had cobacteremia. The hematologic system failed most often, followed by thoracic and cardiovascular systems. Fever was the most common presentation (n = 112; 78.3%), followed by anorexia (n = 47; 32.9%) and abdominal pain (n = 46; 32.2%). Overall, 33 patients died (mortality rate: 23.1%). Multivariate analysis showed that ICU mortality was significantly associated with lower Glasgow Coma Scale (GCS) scores, lower platelet counts before ICU discharge, and more organ failures. The number of severe dengue patients who require ICU admission remains high. The mortality rate was associated with lower GCS scores, lower platelet counts, and more organ failures. In addition, more than half of the critically ill dengue patients had comorbid bacterial infections. PMID:27495047
Pham, Julius Cuong; Banks, Michael C; Narotsky, David L; Dorman, Todd; Winters, Bradford D
The severity of patient illnesses and medication complexity in post-operative critically ill patients increase the risk for a prolonged QT interval. We determined the prevalence of prolonged QTc in surgical intensive care unit (SICU) patients. We performed a prospective cross-sectional study over a 15-month period at a major academic center. SICU pre-admission and admission EKGs, patient demographics, and laboratory values were analyzed. QTc was evaluated as both a continuous and dichotomous outcome (prolonged QTc > 440 ms). 281 patients were included in the study: 92 % (n = 257) post-operative and 8 % (n = 24) non-operative. On pre-admission EKGs, 32 % of the post-operative group and 42 % of the non-operative group had prolonged QTc (p = 0.25); on post-admission EKGs, 67 % of the post-operative group but only 33 % of the non-operative group had prolonged QTc (p experience increases the risk for long QTc. PMID:26169292
Ann Marie Chiasson
Full Text Available This study was performed to investigate the effect of live, spontaneous harp music on individual patients in an intensive care unit (ICU, either pre- or postoperatively. The purpose was to determine whether this intervention would serve as a relaxation or healing modality, as evidenced by the effect on patient’s pain, heart rate, respiratory rate, blood pressure, oxygen saturation, and heart rate variability. Each consenting patient was randomly assigned to receive either a live 10-minute concert of spontaneous music played by an expert harpist or a 10-minute rest period. Spontaneous harp music significantly decreased patient perception of pain by 27% but did not significantly affect heart rate, respiratory rate, oxygen saturation, blood pressure, or heart rate variability. Trends emerged, although being not statistically significant, that systolic blood pressure increased while heart rate variability decreased. These findings may invoke patient engagement, as opposed to relaxation, as the underlying mechanism of the decrease in the patients’ pain and of the healing benefit that arises from the relationship between healer, healing modality, and patient.
Full Text Available Objective: The aim of this study was to determine the mortality rate and factors affecting the mortality of trauma patients in general intensive care unit (ICU of a state hospital. Material and Method: Data of trauma patients hospitalized between January 2012 and March 2013 in ICU of Konya Numune Hospital were retrospectively analyzed. Demographic characteristics and clinical data of patients were recorded. Patients were divided into two groups as survivors and dead. Mortality rate and factors affectin mortality were examined. Results: A total of 108 trauma patients were included in the study. The mortality rate of overall group was 19.4%. Median age of the patients was 44.5 years and 75.9% of them were males. Median Glasgow Coma Scale of death group was lower (5 (3-8 vs. 15 (13-15, p<0.0001, median APACHE II score was higher (20 (15-26 vs. 10 (8-13, p<0.0001 and median duration of ICU stay was longer (27 (5-62,5 vs. 2 (1-5, p<0.0001 than those in the survival group. The most common etiology of trauma was traffic accidents (47.2% and 52.7% of patients had head trauma. The rate of patients with any fracture was significantly higher in the survival group (66.7% vs. 33.3%, p=0.007. The rate of erythrocyte suspension, fresh frozen plasma, trombocyte suspension and albumin were 38.9%, 27.8%, 0.9% and 8.3%, respectively in all group. The number of patients invasive mechanically ventilated was 27.8% and median length of stay of these patients were 5 (1.75-33.5 days. The rate of operated patients was 42.6%. The rate of tracheostomy, renal replacement therapy, bronchoscopy and percutaneous endoscopic gastrostomy enforcements were higher in the death group. The advanced age (p=0.016, OR: 1.054; 95% CI: 1.010-1100 and low GCS (p<0.0001, OR: 0.583; 95% CI: 0.456-0.745 were found to be independent risk factors the ICU mortality of trauma patients in logistic regression analysis. Conclusion: We believe that the determination of these risk factors affecting
Full Text Available Height measurement in the critical care unit is necessary for estimating ideal body weight and providing titrated patient care. In this study, we compare three methods of height assessment and evaluate their level of correlation and inter-observer reproducibility. Heights of 100 consecutive patients were assessed independently by two nurses by supine, four point, and arm span methods. Paired sample t-test, one-way analysis of variance, Tukey′s honestly significant difference post-hoc analysis and Bland-Altman plots were performed to assess agreement between measurements. Arm span method showed higher mean height compared to supine and four point methods. Mean heights derived by supine and four point measurements were similar to each other but were significantly different from that of arm span method (P < 0.001. Inter-observer correlation of the measured heights was very good among all three methods. The supine method seems to be easy, accurate, and reproducible in our study.
Full Text Available Background: This retrospective chart review assessed the characteristics and outcome of patients with hematological disorders who required admission to medical intensive care unit over a 4 year period (January 1998 to December 2001. Results: There were a total of 104 patients, 67 (64% male, 37 (36% female subjects, with a mean age of 36.3 ± 15.3 years (range 10 to 65 years. The mean duration from hospital admission to ICU transfer was 11 days. Sixty-nine (66% had malignant and 35 (34% had non-malignant conditions. Respiratory distress was the commonest reason for ICU admission 58 (56%. The other indications were hemodynamic instability 38 (36%, low sensorium 22 (21%, following cardio-pulmonary arrest 12 (11.5% and generalized tonic-clonic seizures 5 (5%. Forty-three (42% patients had absolute neutophil count (ANC less than 500, 48 (47.5% had platelet count < 20000. The mean duration of ICU stay was 4 days (range < 24 hours to 28 days. Sixty-nine (66% patients required mechanical ventilation, 61 (59% required hemodynamic support. Pneumonia or sepsis was diagnosed in 71 (68%. Twenty-five (24% survived ICU stay and 20 (19% survived to hospital discharge. ICU admission following cardio-pulmonary arrest, advanced malignancy, requirement of mechanical ventilation, vasopressor support, ANC count < 500 and platelet count < 20000 were the predictors of adverse outcome. Associated organ dysfunction further increases the mortality.
Full text: Improving patient care should be the primary focus of all healthcare providers, regardless of country, setting or department; radiology is no exception. Roles within radiology have evolved and professional boundaries blurred; assistant practitioners contribute to image acquisition and advanced and consultant radiographers undertake tasks historically performed by medical professionals. Team working and appropriate use of skill mix has been highlighted as a way of managing ever increasing imaging workloads.In the United Kingdom, trained radiographers have developed their roles to include tasks historically performed by medical practitioners, including definitive clinical reporting and interventional procedures. The aim of this study was to demonstrate how a radiology department within an acute district general hospital optimizes imaging services to improve access for patients and support for referrers through a strong emphasis on team-working. Data about service delivery was analyzed across three consecutive years and interrogated by modality, referral source and reporting practitioner to determine how workload had evolved. Feedback from referring clinicians was sought. Overall trend was for increased activity (13%) with significant reductions (p<0.001) in waiting and reporting times, with some modality variation. Radiographers interpreted >50% of x-ray and ultrasound examinations. Novel services and patient pathway redesigns were implemented with high clinician satisfaction. Radiologists and radiographers, working together, can deliver an effective service. Innovation, staff development and redesigned patient pathwayshave produced significant improvements
Li, Xiuyan; Fang, Guizhen; Yang, Danhua; Wang, Lanfang; Zheng, Chunmei; Ruan, Longjuan; Wang, Lingcong
BACKGROUND This study observed the efficacy of ultrasonic technique with out-of-plane orientation and in-plane guidance in radial artery puncture and cannulation in intensive care unit (ICU) shock patients to elucidate the effect of this technique on the security of cannulation. MATERIAL AND METHODS A total of 88 ICU shock patients, randomized into a palpation (control) group and an ultrasound (experimental) group, received continuous intravenous sedation and analgesia. The palpation group patients underwent radial artery cannulation using the traditional palpation pulsation approach, and the ultrasound group patients underwent radial artery cannulation under out-of-plane orientation and in-plane guidance using an ultrasonic apparatus. Data were recorded and compared between the 2 groups. RESULTS (1) The success rate of the first puncture in the ultrasound group and the palpation group was 80% and 42%, respectively (Pstoma in the ultrasound group was 2.5% and 5%, respectively, which was significantly lower than that in the palpation group, which was 20% and 32.5%, respectively (P<0.05). (4) Time to achieve the early goal-directed therapy in the ultrasound group and the palpation group was 306.73±39.98 min and 356.75±40.97 min, respectively (P<0.01). CONCLUSIONS Compared with the traditional method, radial artery cannulation with out-of-plane orientation and in-plane guidance is a quick and secure cannulation method and is appropriate for use in clinics. PMID:27397118
Dambaugh, Lori A; Ecklund, Margaret M
Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36:58-63). PMID:27481802
Full Text Available INTRODUCTION: Acid sphingomyelinase is involved in lipid signalling pathways and regulation of apoptosis by the generation of ceramide and plays an important role during the host response to infectious stimuli. It thus has the potential to be used as a novel diagnostic marker in the management of critically ill patients. The objective of our study was to evaluate acid sphingomyelinase serum activity (ASM as a diagnostic and prognostic marker in a mixed intensive care unit population before, during, and after systemic inflammation. METHODS: 40 patients admitted to the intensive care unit at risk for developing systemic inflammation (defined as systemic inflammatory response syndrome plus a significant procalcitonin [PCT] increase were included. ASM was analysed on ICU admission, before (PCT before, during (PCT peak and after (PCT low onset of SIRS. Patients undergoing elective surgery served as control (N = 8. Receiver-operating characteristics curves were computed. RESULTS: ASM significantly increased after surgery in the eight control patients. Patients from the intensive care unit had significantly higher ASM on admission than control patients after surgery. 19 out of 40 patients admitted to the intensive care unit developed systemic inflammation and 21 did not, with no differences in ASM between these two groups on admission. In patients with SIRS and PCT peak, ASM between admission and PCT before was not different, but further increased at PCT peak in non-survivors and was significantly higher at PCT low compared to survivors. Survivors exhibited decreased ASM at PCT peak and PCT low. Receiver operating curve analysis on discrimination of ICU mortality showed an area under the curve of 0.79 for ASM at PCT low. CONCLUSIONS: In summary, ASM was generally higher in patients admitted to the intensive care unit compared to patients undergoing uncomplicated surgery. ASM did not indicate onset of systemic inflammation. In contrast to PCT however
Borg, Linda; Julkunen, Anna; Madsen, Kristian Rørbaek;
adverse signs at hospital admission that turned out to need intensive care treatment. The effect of the antidepressants overdose risk assessment (ADORA) system was evaluated in patients with antidepressant as well as antipsychotic overdose. Our hypothesis was that patients with low ADORA do not need...... obvious need of intensive care. Of the 157 patients included, 12 patients (8%) developed events during the ICU stay. Only 3 patients received intubation, vasoactive drugs and/or dialysis. None developed ventricular dysrhythmias. There were no fatalities. All the patients with low-risk assessment by ADORA...
Electrical impedance tomography (EIT) is expected to become a valuable tool for monitoring mechanically ventilated patients due to its ability to continuously assess regional lung ventilation and aeration. Several sources of interference with EIT examinations exist in intensive care units (ICU). Our objectives are to demonstrate how some medical nursing and monitoring devices interfere with EIT measurements and modify the EIT scans and waveforms, which approaches can be applied to minimize these effects and how possible misinterpretation can be avoided. We present four cases of EIT examinations of adult ICU patients. Two of the patients were subjected to pulsation therapy using a pulsating air suspension mattress while being ventilated by high-frequency oscillatory or conventional pressure-controlled ventilation, respectively. The EIT signal modulation synchronous with the occurrence of the pulsating wave was 2.3 times larger than the periodic modulation synchronous with heart rate and high-frequency oscillations. During conventional ventilation, the pulsating mattress induced an EIT signal fluctuation with a magnitude corresponding to about 20% of the patient's tidal volume. In the third patient, interference with EIT examination was caused by continuous cardiac output monitoring. The last patient's examination was disturbed by impedance pneumography when excitation currents of similar frequency to EIT were used. In all subjects, the generation of functional EIT scans was compromised and interpretation of regional ventilation impossible. Discontinuation of pulsation therapy and of continuous cardiac output and impedance respiration monitoring immediately improved the EIT signal and scan quality. Offline processing of the disturbed data using frequency filtering enabled partial retrieval of relevant information. We conclude that thoracic EIT examinations in the ICU require cautious interpretation because of possible mechanical and electromagnetic
Jelinek, Richard C.; And Others
To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…
Braaten, Jane S; Bellhouse, Dorothy E
With the introduction of each new drug, technology, and regulation, the processes of care become more complicated, creating an elaborate set of procedures connecting various hospital units and departments. Using methods of Adaptive Design and the Toyota Production System, a nursing unit redesigned work systems to achieve sustainable improvements in productivity, staff and patient satisfaction, and quality outcomes. The first hurdle of redesign was identifying problems, to which staff had become so accustomed with various work arounds that they had trouble seeing the process bottlenecks. Once the staff identified problems, they assumed they could solve the problem because they assumed they knew the causes. Utilizing root cause analysis, asking, "why, why, why," was essential to unearthing the true cause of a problem. Similarly, identifying solutions that were simple and low cost was an essential step in problem solving. Adopting new procedures and sustaining the commitment to identify and signal problems was a last and critical step toward realizing improvement, requiring a manager to function as "teacher/coach" rather than "fixer/firefighter". PMID:17802999
Léa Fialkow; Maurício Farenzena; Iuri Christmann Wawrzeniak; Janete Salles Brauner; Sílvia Regina Rios Vieira; Alvaro Vigo; Mary Clarisse Bozzetti
OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mecha...
Panju, A; Farkouh, M E; Sackett, D L; Waterfall, W; Hunt, R; Fallen, E; Somers, S; Stevenson, G; S. Walter
OBJECTIVE: To determine the outcome and 3-year mortality rate among patients discharged from a coronary care unit (CCU) with a diagnosis of "chest pain not yet diagnosed." DESIGN: Prospective observational cohort study. SETTING: CCU in a university teaching hospital. PATIENTS: All 158 eligible patients discharged from the CCU between August 1986 and December 1988. Of them, 27 refused to participate and 31 did not meet the inclusion criteria because of significant co-morbidity or transportatio...
Fialkow, Léa; Farenzena, Maurício; Wawrzeniak, Iuri Christmann; Brauner, Janete Salles; Vieira, Sílvia Regina Rios; Vigo, Alvaro; Bozzetti, Mary Clarisse
OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mechani...
Borg, Linda; Julkunen, Anna; Rørbaek Madsen, Kristian; Strøm, Thomas; Toft, Palle
It is often advised that patients who have ingested an overdose of antidepressants (AD) or antipsychotics (AP) are monitored with continuous ECG for minimum of 12-24 hr. These patients are often observed in an ICU. Our aim was to identify the number of patients with AD and/or AP overdose without adverse signs at hospital admission that turned out to need intensive care treatment. The effect of the antidepressants overdose risk assessment (ADORA) system was evaluated in patients with antidepressant as well as antipsychotic overdose. Our hypothesis was that patients with low ADORA do not need intensive care treatment. This retrospective study was conducted in adult patients admitted to the ICU at Odense University Hospital after an overdose with AP and/or AD between 1 January 2009 and 1 September 2014. Patients with predefined adverse signs in the emergency department were excluded due to obvious need of intensive care. Of the 157 patients included, 12 patients (8%) developed events during the ICU stay. Only 3 patients received intubation, vasoactive drugs and/or dialysis. None developed ventricular dysrhythmias. There were no fatalities. All the patients with low-risk assessment by ADORA within the first 6 hr did not develop events within the first 24 hr after hospital admission. The vast majority of patients with AD and/or AP overdose and no adverse signs at admission did not require intensive care treatment. Low-risk ADORA identified patients with antidepressant as well as antipsychotic overdose who would not require initial intensive care treatment. This is the first time the ADORA system has been evaluated in patients with antidepressant as well as antipsychotic overdose. PMID:26663682
Perpiñá Galvañ, Juana; Richart Martínez, Miguel
Objective: To review studies of anxiety in critically ill patients admitted to an intensive care unit to describe the level of anxiety and synthesize the psychometric properties of the instruments used to measure anxiety. Methods: The CUIDEN, IME, ISOC, CINAHL, MEDLINE, and PSYCINFO databases for 1995 to 2005 were searched. The search focused on 3 concepts: anxiety, intensive care, and mechanical ventilation for the English-language databases and ansiedad, cuidados intensivos, and ventilación...
Tadyanemhandu, Cathrine; Manie, Shamila
Background Physiotherapy is integral to patient management in the Intensive Care Unit. The precise role that physiotherapists play in the critical care differs significantly worldwide. The aim of the study was to describe the profile of patients and the current patterns of physiotherapy services delivered for patients admitted in the five public hospital intensive care units in Zimbabwe. Methods A prospective record review was performed and records of all consecutive patients admitted into th...
Joshi, Rohit; Szolovits, Peter
Real-time scalable predictive algorithms that can mine big health data as the care is happening can become the new “medical tests” in critical care. This work describes a new unsupervised learning approach, radial domain folding, to scale and summarize the enormous amount of data collected and to visualize the degradations or improvements in multiple organ systems in real time. Our proposed system is based on learning multi-layer lower dimensional abstractions from routinely generated patient...
Argyropoulou, Maria I.; Kostandi, Eleonora; Kosta, Paraskevi; Zikou, Anastasia K; Kastani, Dimitra; Galiatsou, Efi; Kitsakos, Athanassios; Nakos, George
Introduction Heterotopic ossification (HO) is the formation of bone in soft tissues. The purpose of the present study was to evaluate the magnetic resonance imaging (MRI) findings on clinical suspicion of HO in the knee joint of patients hospitalised in the intensive care unit (ICU). Methods This was a case series of 11 patients requiring prolonged ventilation in the ICU who had the following diagnoses: head trauma (nine), necrotising pancreatitis (one), and fat embolism (one). On clinical su...
Mi-Yeon Cho; Eun Sil Min; Myung-Haeng Hur; Myeong Soo Lee
The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same e...
Park, Shin Hye; Dunton, Nancy; Blegen, Mary A
High patient turnover is a critical factor increasing nursing workload. Despite the growing number of studies on patient turnover, no consensus about how to measure turnover has been achieved. This study was designed to assess the correlation among patient turnover measures commonly used in recent studies and to examine the degree of agreement among the measures for classifying units with different levels of patient turnover. Using unit-level data collected for this study from 292 units in 88 hospitals participating in the National Database of Nursing Quality Indicators®, we compared four patient turnover measures: the inverse of length of stay (1/LOS), admissions, discharges, and transfers per daily census (ADTC), ADTC with short-stay adjustment, and the number of ADTs and short-stay patients divided by the total number of treated patients, or Unit Activity Index (UAI). We assessed the measures' agreement on turnover quartile classifications, using percent agreement and Cohen's kappa statistic (weighted and unweighted). Pearson correlation coefficients also were calculated. ADTC with or without adjustment for short-stay patients had high correlations and substantial agreement with the measure of 1/LOS (κ = .62 to .91; r = .90 to .95). The UAI measure required data less commonly collected by participating hospital units and showed only moderate correlations and fair agreement with the other measures (κ = .23 to .39; r = .41 to .45). The UAI may not be comparable and interchangeable with other patient turnover measures when data are obtained from multiple units and hospitals. © 2016 Wiley Periodicals, Inc. PMID:26998744
Full Text Available Ethical dilemmas that face heathcare team members referring patients to hospice programs include the ability of clinicians to predict accurately a patient bad prognosis. They affect day-to-day patient management in palliative care programs including healthcare team members concern over the use of morphine because possible respiratory depression in the patient, the question of providing enteral or parenteral nutritional support to patients who refuse to eat and the question of providing parenteral fluids to patients who are unable to take fluids during the terminal phrases of illness. A final ethical dilemma concerns the methodology for quality of life research in palliative care. Understanding and resolving these ethical dilemmas is an important factor determining the quality of the caring for the patient. The ethical dilemmas that are discussed in the article likely to occur in this period can be prevented through his/her participation in the decisions concerning his or her treatment. [Archives Medical Review Journal 2013; 22(1.000: 65-79
Li, Guowei; Cook, Deborah J.; Thabane, Lehana; Friedrich, Jan O.; Crozier, Tim M.; Muscedere, John; Granton, John; Mehta, Sangeeta; Steven C. Reynolds; Lopes, Renato D.; Francois, Lauzier; Freitag, Andreas P; Levine, Mitchell A. H.; ,
Background Despite the high mortality in patients with pneumonia admitted to an ICU, data on risk factors for death remain limited. Methods In this secondary analysis of PROTECT (Prophylaxis for Thromboembolism in Critical Care Trial), we focused on the patients admitted to ICU with a primary diagnosis of pneumonia. The primary outcome for this study was 90-day hospital mortality and the secondary outcome was 90-day ICU mortality. Cox regression model was conducted to examine the relationship...
Mahmoud Al Kalaldeh; Mahmoud Shahein
Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures...
We sent a questionnaire to 465 institutions provided with radiotherapy units in order to search for the radiotherapists' understanding of and concern about dento-oral care in patients with head and neck radiation therapy and subsequent occurrence of radiation side effects in the oral-maxillofacial region. An analysis of 292 responses showed that in 183 (62.7%) institutions radiotherapist had experience of dental consultation of these patients for dento-oral care to the dental facility and in 109 (37.3%) they hadn't. In dental consultation, the symptomatic care for toothache etc. were more often requested than the preventive care for radiation side effects. Of 6 items of the preventive care, periodical oral examination, oral hygiene instruction and treatment for radiation caries were less frequently requested. It is concluded that radiotherapists are not fully aware of the importance of dento-oral care including the preventive care in patients with radiation therapy in the head and neck region. (author)
Full Text Available Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL in cancer patients treated at home, at an in-patient palliative care unit (PCU, and at a day care center (DCC. Patients and methods: QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL, the Edmonton Symptom Assessment System (ESAS, and the Karnofsky Performance Status (KPS scale. Results: A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions: QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. Keywords: oncology, patient care
Zahra Abbas Ali Madadi
Full Text Available Background: Bedsores are injuries to skin and underlying tissues caused by prolonged pressure. Although, some methods like frequently changing position and using particular tools are used for preventing and caring of pressure ulcers, their prevention would still be as a vital urgency. Olive oil is an herbal product with potential preventive effects to prevent bedsores because of its numerous medical properties. The major aim of this study was to determine whether topical olive oil can prevent the risk of developing bedsores in I.C.U. patients. Methods: This clinical trial was accomplished in 2014 with 60 patients who were selected by simple random sampling method into intervention and control groups. During three weeks, the control group had received routine skin care, while the intervention group had received topical Olive oil in addition to the routine care. Statistical analysis, including Chi-square, T-test and Fisher's tests, were performed with SPSS version 20 software. Results: The intervention group had contained 19 male and 11 female, with an average age of 60.46 +/- 18.06 and the control group had contained 20 male, 10 female, with an average age of 50.96 +/- 21.38. Five patients (16% who received routine care plus topical olive oil had developed bedsore after an average of 18.73 +/- 5.36 days and twelve patients (40% who received routine care only had developed bedsore after an average of 15.46 +/- 7.40 days. The risks of developing bedsores between two groups were statistically significant (P=0.03. Conclusions: Our study has revealed potential effects of topical olive oil to prevent bedsores in I.C.U. patients. [Int J Res Med Sci 2015; 3(9.000: 2342-2347
Aim: It was aimed to investigate the microorganisms and their antibiotic susceptibilities isolated from various clinical specimens sent from the intensive care unit of our hospital between January 2010 and June 2011.Material and Method: Standard microbiological methods were assessed for the isolation of bacteria from clinical specimens. Antimicrobial susceptibilites were investigated according to the Clinical and Laboratory Standards Institute (CLSI) standards by disc diffusion me...
Full Text Available Background: H1N1 pandemic in 2009-2010 created a state of panic not only in India, but in the whole world. The clinical picture seen with H1N1 is different from the seasonal influenza involving healthy young adults. Critical care management of such patients imposes a challenge for anesthesiologist. Materials and Methods: A retrospective analysis of hospitalized positive H1N1 patients was performed from July 2009-June 2010. Those requiring the ventilatory support were included in the study. Result: 54 patients were admitted in the swine-flu ward during the study period out of which 19 required ventilatory support. The average day of presentation to the health care facility was 6 th day causing delay in initiation of antiviral therapy and increased severity of the disease. 65% of the ventilated patients were having associated comorbidities. Mortality was 74% among ventilated patients. Conclusion: Positive H1N1 with severe disease profile have a poor outcome. Early identification of high-risk factors and thus early intervention in the form of antiretroviral therapy and respiratory care will help in reducing the overall mortality.
Thiele, R; Meier, F; Penk, I; Striehn, E
Over a period of 2 years patients with exogenic intoxications take 16% in the total number of patients of the department for internal intensive care. The cases in question were 43.3% males and 56.7% females. The average age of the patients with 31 years was low. The mortality was 2.4%. In the first place of the exogenic intoxications were intoxications with the groups of medicaments sedatives, hypnotics, tranquilizers, analgetics and antipyretics followed by intoxications with neuroleptics, beta-receptor blockers, antidepressives, antiepileptics and glycosides. The rate of complications was greatest in the mixed intoxications. PMID:3590879
Meraner, V; Sperner-Unterweger, B
During intensive care treatment patients suffer from various forms of stress. Certain psychological and psychotherapeutic interventions (e. g. cognitive behavior therapy, hypnotherapy and psychoeducation) can provide relief. Even patients with a severely reduced ability to communicate can benefit from an early psychological intervention as supportive treatment. The aim of these interventions is to reduce psychological impairments and burdens, provide strategies for coping with physical handicaps or necessary treatment and avoid long-term negative psychological impacts. Organizational and institutional constraints as well as emotional stress are a specific challenge for intensive care personnel. In order to guarantee an efficient collaboration within an interdisciplinary team it is vital to follow clearly defined methods of communication exchange, such as daily ward rounds, regular multidisciplinary meetings and team or case-focused supervision. Properly functioning teamwork increases job satisfaction and is the key to an optimal therapy for the patients. PMID:26927678
During a period of seven months data were collected regarding radiological activity (CT, radiographic and fluoroscopic procedures, and scintigraphies) at the Intensive Care Unit (ICU) of Cremona Hospital. Radiological activity is related to the clinical data of patients. The patient exposure burden due to each type of examination was evaluated. Personnel exposure is mainly due to radiological activity at the patient's bedside. Estimation of patient dose, in bedside examinations and CT procedures, is based on experimental measurements on a phantom and on patients; patient dose in nuclear medicine procedures is calculated on the basis of ICRP 53. Personnel exposure evaluations are based on experimental dosimetry, performed in simulated working conditions. Results are compared with staff routine personal dosimetry. Patient and personnel exposure reduction is related to changes in techniques, involving both radiological and protective equipment. (Author)
Full Text Available Aim: A demographic study was conducted to understand the social status of the urban and rural patients attending a palliative care unit in South India. Methods: Fifty rural and 50 urban patients attending the palliative care outpatient clinic of the Christian Medical College and Hospital, South India were prospectively surveyed using a structured interview and home visits. Parameters studied included age, gender, marital status, education, occupation, religion, caste, housing, economic status, diagnosis, distance to the nearest health resource personnel and hospitals. Results: Occupation, religion, caste, housing, electricity, toilet and accessibility to health care were found to be significantly different between urban and rural patients. Seventy percent of the patients were below 60 years of age. The majority were unskilled laborers or housewives. One-third had never been to school and only 3% had been educated beyond high school. Half the patients slept on the floor, 50% of the dwellings had only one or two rooms and did not have toilets or running water. Ninety-five percent had electricity. The economic status of the patients correlated significantly with age, occupation and facilities in the house such as number of rooms, availability of beds, toilets and water supply. Women and older patients were significantly less likely to have completed school education. Women were less likely to be the main decision-makers and more likely to be the main caregivers. Conclusion: Economic status was a strong predictor of the various facilities available to the patient. A significant proportion of this population lived in deprived circumstances. A knowledge and understanding of the social conditions of the palliative care patients helps provide better-tailored care.
Very few studies from Pakistan have examined the profile of patients seen by psychiatrists in general hospital. The aim of this research is to describe the clinical and demographic characteristics of patients referred to the psychiatric unit of a general hospital over a one year period. Methods: This cross-sectional study was conducted at the Ayub Teaching Hospital, Abbottabad, from January 1st to December 31st 2012. All patients being referred to psychiatry were included in the study over one year period. The information was recorded on a structured questionnaire and analysed the data using SPSS-19.0. Results: Out of the 105 patients referred to the psychiatric unit, 74 (72.3%) were females. A total of 69 (68.5%) patients were married. More than half were uneducated and only number 4 (3%) patients had university qualification. Housewives made up 64.4% of the patient population followed by students (11%). Majority 55 (53%) had less than Rs. 5000/ monthly income. About 30% patients were shifted to psychiatry ward while, nearly one tenth were discharged. In 35% cases the psychiatrist was asked to help in the management, while in 50% cases only opinion was sought. Aggressive and threatening behaviour was source of concern in majority of patients for the primary team while 34% exhibited suicidal behaviour. Depression was most frequent diagnosis in 45 43% patients, followed by conversion disorder 19 (17%) and delirium 16 (14%). Conclusion: The rate of psychiatric referrals is dismal with only one third of the patients being transferred to the psychiatric ward. The major psychiatric diagnosis was depression. Patients with aggressive and threatening behaviour were more frequently referred. (author)
Canbulat, Atilla; Goren, Suna; Moğol, Elif Başağan; Kaya, Fatma Nur
Objectives: We compared effects of mechanical and manual ventilation during transport to the intensive care unit(ICU) in cardiac surgeries. Materials and methods: After ethical approval, 66 patients (ASAgrade II and III, 20-80years) were assigned randomly. Ventilation during transport to ICU was performed manual (Group EV; n=36) or mechanical ventilation (Group MV; n=30). Measurements were recorded: operation room (A), during transport (T) and in ICU (YB). Systolic, diastolic pressures (S...
Ferreira, Lucas Lima; Valenti, Vitor Engrácia; Vanderlei, Luiz Carlos Marques
Objective To analyze the outcomes of increased or decreased intracranial pressure and/or the decrease in cerebral perfusion pressure resulting from respiratory physiotherapy on critically ill patients admitted to the intensive care unit. Methods Through a systematic review of the literature, clinical trials published between 2002 and 2012 were selected. The search involved the LILACS, SciELO, MedLine and PEDro databases using the keywords "physical therapy", "physiotherapy", "respiratory ther...
Tao Wang; Yun-Liang Cui; Zhao-Fen Lin; De-Chang Chen
Background: Both procalcitonin (PCT) and plasma endotoxin levels cannot be solely used for a definite diagnosis of bacteremia or sepsis, and there has been few study comparing the values of the two biomarkers for the diagnosis of bacteremia. The aim of this study was to identify bacteria causing bacteremia and evaluate the role of the two biomarkers in the diagnosis of bacteremia in Intensive Care Unit (ICU). Methods: The medical records of 420 patients in ICU were retrospectively reviewed...
WANG, Tao; Cui, Yun-Liang; Lin, Zhao-fen; Chen, De-Chang
Background: Both procalcitonin (PCT) and plasma endotoxin levels cannot be solely used for a definite diagnosis of bacteremia or sepsis, and there has been few study comparing the values of the two biomarkers for the diagnosis of bacteremia. The aim of this study was to identify bacteria causing bacteremia and evaluate the role of the two biomarkers in the diagnosis of bacteremia in Intensive Care Unit (ICU). Methods: The medical records of 420 patients in ICU were retrospectively reviewed. P...
Alotaibi, AK; Alotaibi, SK; Alshayiqi, M; Ramalingam, S
Introduction: Ventilator-associated pneumonia is a major morbid outcome among intensive care unit (ICU) patients. Providing oral care for intubated patients is an important task by the ICU nursing staff in reducing the mortality and morbidity. The objectives of this study were to evaluate the attitudes and knowledge of ICU nurses regarding oral care delivery to critically ill patients in Saudi Arabian ICUs. The findings were further correlated to the presence of healthcare quality accreditation of the institution. Materials and Methods: The nurses’ knowledge, attitudes, and healthcare quality accreditation status of the hospital were recorded. Two hundred fifteen nurses conveniently selected from 10 random hospitals were included in this study from Riyadh city, Saudi Arabia. This is a cross-sectional study in the form of a questionnaire. Results: When comparing the knowledge of the participants to their level of education, there was no statistically significant difference between the two groups of nurses. The majority of the nurses agreed that the oral cavity is difficult to clean and that oral care delivery is a high priority for mechanically ventilated patients. Furthermore, there was no statistically significant difference in the attitudes between nurses working in accredited and nonaccredited hospitals. Conclusion: The presence of healthcare quality accreditation did not reflect any significance in attitudes or knowledge of the ICU nurses in regard to mechanically ventilated patients. Factors affecting oral care delivery should be evaluated on the personal and institutional level to achieve better understanding of them. PMID:27051375
Full Text Available Background Posttraumatic Stress Disorder (PTSD is a severe anxiety disorder occurred due to past adverse experiences. Several researches have demonstrated that PTSD is quite common among patients discharged from critical care unit. Objectives This study aimed to investigate the prevalence of PTSD and its related factors among patients discharged from critical care units in Kashan, Iran, during 2014. Patients and Methods A descriptive prospective study was performed on 332 patients admitted to critical care units of Kashan Shahid Beheshti Hospital using a convenience sampling method. Data were collected in wards during hospitalization and one month after their discharge from hospital using questionnaires on demographic, medical information and PTSD Checklist (PCL. The PCL scores of 45 or more were considered as PTSD. Data were analyzed using chi-square, t-test, Mann-Whitney U and logistic regression. Results From a total of 332 patients, 160 cases (48.2% had PTSD and the mean total PCL score in participants was 44.24 ± 19.89. There was a significant difference between the total score of PTSD and its domains in patients with and without PTSD. the univariate analysis showed a significant association between PTSD and increasing age, increased length of hospital stay, more children, having additional comorbidities, unemployed, use of mechanical ventilation (P < 0.001, drug abuse (P = 0.003 and single patients (P = 0.028. However, there was no significant association between PTSD and gender, type of the critical care unit, level of education and admission due to trauma. However, in multivariate analysis using logistic regression, factors associated with PTSD were older age of the participants, use of mechanical ventilation having additional comorbidities, unemployed (P<0.001 and being single (P=0.04 Conclusions Prevalence of PTSD is high among patients discharged from ICUs and some medical individual factors such as elderly, unemployed, being single
This is the third article in a four-part continuing education series relating to patient care and management. After completing the article, the reader should be able to: 1) understand the application, potential, and problems of nuclear cardiology in the coronary care unit; 2) recognize the utilization of nuclear cardiology in acute coronary care management; and 3) appreciate the important role of nuclear cardiology in cardiac patient care
Zümrüt Ela Aslan
Full Text Available Objective: Delirium is a state not to be neglected which can cause severe consequences that is related to critical illness in intensive care unit with acute cerebral dysfunction. Magnesium (Mg plays an important role in many physiological events affecting the brain. In this study, we retrospectively investigated the incidence of delirium development and its relationship with the serum Mg levels. Material and Method: Patients who admitted to intensive care unit (ICU were divided in to two groups according to their serum Mg levels (0.7 normomagnesemia. Delirium was assessed using Richmond Agitation Sedation Scale and Confusion Assessment Method for ICU. We identified the duration of mechanical ventilation, applied sedation, age, gender, sepsis, shock, malignancy, ICU requirement after operation, admission SOFA score, admission APACHE II score, admission of Mg and mean Mg levels as secondary outcome measures whether they affected delirium incidence. Results: A total of 178 patients were assessed, 72 of them were found delirium positive. The incidence of delirium was found 45% in patients with hypomagnesaemia; this was found 25% in patients with normomagnesaemia. Duration of mechanical ventilation, ICU stay, and mortality rate were found higher in patients with delirium than those in individuals without delirium. Conclusion: We retrospectively investigated delirium incidence in critically ill patients and the percentage was found remarkably high. Our findings were parallel with the other studies that, delirium has a negative impact on morbidity and mortality rates.
Daniel Agustin Godoy
Full Text Available Myasthenia gravis (MG is an autoimmune disorder affecting neuromuscular transmission leading to generalized or localized muscle weakness due most frequently to the presence of autoantibodies against acetylcholine receptors in the postsynaptic motor end-plate. Myasthenic crisis (MC is a complication of MG characterized by worsening muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. It also includes postsurgical patients, in whom exacerbation of muscle weakness from MG causes a delay in extubation. MC is a very important, serious, and reversible neurological emergency that affects 20–30% of the myasthenic patients, usually within the first year of illness and maybe the debut form of the disease. Most patients have a predisposing factor that triggers the crisis, generally an infection of the respiratory tract. Immunoglobulins, plasma exchange, and steroids are the cornerstones of immunotherapy. Today with the modern neurocritical care, mortality rate of MC is less than 5%.
Full Text Available OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeirão Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.
Cooke, Marie; Chaboyer, Wendy; Schluter, Philip; Foster, Michelle; Harris, Denise; Teakle, Roz
Research consistently demonstrates that intensive care unit (ICU) patients experience pain, discomfort and anxiety despite analgesic and sedative use. The most painful procedure reported by critically ill patients is being turned. Music diminishes anxiety and discomfort in some populations; however, its effect on critically ill patients remains unknown. This research aimed to identify the effect of music on discomfort experienced by ICU patients during turning using a single blind randomized cross-over design. Seventeen post-operative ICU patients were recruited and treatment order randomized. Discomfort and anxiety were measured 15 min before and immediately after two turning procedures. Findings indicated that listening to music 15 min before and during turning did not significantly reduce discomfort or anxiety. Pain management might effectively be addressing discomfort and anxiety experienced during turning. Given previous studies have identified turning as painful, current results are promising and it might be useful to determine if this is widespread. PMID:20487057
Thurn, J R; Crossley, K B; Gerdts, A; Baken, L
Because there is little information about the frequency of carriage of various species of coagulase-negative staphylococci (CNS) in hospital staff, we prospectively investigated nasal CNS in patients and personnel in a Surgical Intensive Care Unit (SICU). The majority of CNS from personnel were Staphylococcus epidermiditis. The CNS species from patients on admission were more diverse and included multiply antibiotic-resistant S. haemolyticus. Patients' CNS became more like CNS colonizing personnel after admission with respect to both antimicrobial susceptibility and speciation. Plasmid and antibiotic sensitivity profiles of S. epidermidis resistant to multiple antibiotics from five patients were identified as those from one employee, but there was no evidence that this was of clinical significance. A variety of factors influence nasal colonization by CNS in SICUs. The nasal CNS of patients change after admission and may become more resistant and less diverse. The factors influencing changes in the antibiotic susceptibility and the aetiology of CNS infection require further study. PMID:1350601
Terminal care in older patients in hospital: development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital
Cools, Annelies; Vaneechoutte, Delphine; Van Den Noortgate, Nele; VERSLUYS, KAREN; De Laat, Martine; Petrovic, Mirko; Piers, Ruth
Background: Care at the end-of-life of geriatric inpatients is of increasing importance. Nevertheless, limited research has been conducted on this subject so far. Objectives: To compose a set of quality indicators (QIs) which measure the quality of terminal care for geriatric inpatients and to compare the quality of end-of-life care between the Acute Geriatric Unit (AGU) and the Palliative Care Unit (PCU). Design: Retrospective case study. Setting: Belgian university hospital. Par...
Karadas, Canan; Ozdemir, Leyla
The purpose of this study was to determine the effect of range of motion exercises on preventing delirium and shortening the duration of delirium among patients in the intensive care unit who are aged 65 and over. The study was conducted in the intensive care unit on patients with non-invasive mechanical ventilation. The sample size included 47 patients from the intervention group and 47 from the control group. The incidence of delirium was 8.5% in the intervention group and 21.3% in the control group. The duration of delirium was 15 h for patients in the intervention group and 38 h for those in the control group. Although delirium incidence and duration decreased by 2.5-fold in the intervention group compared to the control group; there was no significant relationship between the intervention and control groups. In conclusion, as the decreases in delirium occurrence and duration were not statistically significant, the effect of range of motion exercises was limited. PMID:26763172
Yurdalan, S. Ufuk
Physiotherapy is a part of the multidisciplinary treatment in different intensive care units. Respiratory, cardiovascular and neuromusculoskeletal- focused physiotherapy programmes and prevention of the respiratory, neuromuscular complications which may be possible, developing the exercise capacity related to inspiratory muscle function in critically patients internalized and postoperative cases in intensive care unit are clinical targets. It is known that physiotherapy initiated early is rel...
Gutierrez, Marco A.; Cestari, Idagene A.; Hamamoto, Gina; Bacht, Simão; Rebelo, Marina S.; Silva, João E. M. M.; Lage, Silvia G.
The current study describes the experience in the implementation of a mobile HIS/PACS workstation to assist critical cardiac patients in an Intensive Care Unit (ICU). Recently, mobile devices connected to a WiFi network were incorporated to the Hospital information System, providing the same functionalities of common desktop counterpart. However, the use of commercially devices like PDAs and Pocket PCs presented a series of problems that are more emphasized in the ICUs 1) low autonomy of the batteries, which need constant recharges; 2) low robustness of the devices; 3) insufficient display area to show medical images and vital signals; 4) data entry remains a major problem and imposes an extra time consumption to the staff; 5) high cost when fully equipped with WiFi connection, optical reader to access bar codes and memory. To address theses problems we developed a mobile workstation (MedKart) that provides access the HIS and PACS systems, with all resources and an ergonomic and practical design to be used by physicians and nurses inside the ICU. The system fulfills the requirements to assist, in the point-of-care, critical cardiac patients in Intensive Care Units.
Dafoe, S; Chapman, M J; Edwards, S; Stiller, K
We conducted a quality improvement project aimed at increasing the frequency of mobilisation in our ICU. We designed a four-part quality improvement project comprising: an audit documenting the baseline frequency of mobilisation; a staff survey evaluating perceptions of the barriers to mobilisation; identification of barriers that were amenable to change and implementation of strategies to address these; and a follow-up audit to determine their effectiveness. The setting was a tertiary care, urban, public hospital ICU in South Australia. All patients admitted to the ICU during the two audit periods were included in the audits, while all permanent/semi-permanent ICU staff were eligible for inclusion in the staff survey. We found that patient- and institution-related factors had the greatest impact on the mobilisation of patients in our ICU. Barriers identified as being amenable to change included insufficient staff education about the benefits of mobilisation, poor interdisciplinary communication and lack of leadership regarding mobilisation. Various strategies were implemented to address these barriers over a three-month period. Multivariable analyses showed that three out of four mobility outcomes did not significantly change between the baseline and follow-up audits, with a significant difference in favour of the baseline audit found for the fourth mobility outcome (maximum level of mobility). We concluded that implementing relatively simple measures to improve staff education, interdisciplinary communication and leadership regarding early progressive mobilisation was ineffective at improving mobility outcomes for patients in a large tertiary-level Australian ICU. Other strategies, such as changing sedation practices and/or increasing staffing, may be required to improve mobility outcomes of these patients. PMID:26603796
Leung, Patricia; Chiu, Chun Hung; Ho, Ka Man; Gomersall, Charles David; Underwood, Malcolm John
Introduction Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery. Methods and analysis 100 patients undergoing elective coronary artery bypass graft, with or without valve replacement surgery, will be recruited into a 2-group, parallel, superiority, double-blinded randomised controlled trial. Participants will be randomised to either preoperative patient education comprising of a video and ICU tour with standard care (intervention) or standard education (control). The primary outcome measures are the satisfaction levels of patients and family members with ICU care and decision-making in the ICU. The secondary outcome measures are patient anxiety and depression levels before and after surgery. Ethics and dissemination Ethical approval has been obtained from the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (reference number CREC 2015.308). The findings will be presented at conferences and published in peer-reviewed journals. Study participants will receive a 1-page plain language summary of results. Trial registration number ChiCTR-IOR-15006971. PMID:27334883
Full Text Available Resistance to carbapenems is commonly seen in nonfermenting gram negative bacilli (NFGNB. We document herein the prevalence of carbapenem resistance in NFGNB isolated from patients with respiratory tract infections in the intensive care units (ICUs. A total of 460 NFGNB were isolated from 606 endotracheal aspirate specimens during January through December 2003, of which 56 (12.2% were found to be resistant to imipenem and meropenem. Of these, 24 (42.8% were Pseudomonas aeruginosa , 8 (14.2% were Acinetobacter spp. and 24 (42.8% were other NFGNB. Stringent protocols such as antibiotic policies and resistance surveillance programs are mandatory to curb these bacteria in ICU settings.
Gupta, Mahua Das; Kaur, Harsimran; Ray, Pallab; Gautam, Vikas; Puri, G D
Early diagnosis and treatment of sepsis by appropriate antibiotics is of utmost importance. Therefore, we evaluated 16S rRNA panbacterial polymerase chain reaction (PCR) for rapid diagnosis of sepsis in 49 adult patients in Intensive Care Units (ICUs) and compared it with an automated blood culture. 8 ml of 10 ml blood collected was inoculated into BACTEC® aerobic bottle and the remaining 2 ml was used for DNA extraction and PCR. 109 of 115 (93%) episodes of suspected sepsis showed concordant results between automated culture and PCR. Six episodes were positive by PCR only. Panbacterial PCR reduces turnaround time with rapid differentiation between systemic inflammatory response syndrome and sepsis. PMID:27080778
Objective: To determine the frequency of fungal infections in intensive care unit (ICU) of Military Hospital, Rawalpindi, a tertiary care health facility. Study Design: Cross sectional study. Place and Duration of Study: Intensive Care Department of Military Hospital Rawalpindi from 01 Jan 2012 to 30 Jun 2012. Methodology: A total of 89 patients were screened with stay of more than 5 days in intensive care unit. Thirty cases were enrolled in the study for investigation of fungal infections that had fever even after 05 days of being on broad spectrum antibiotics. Culture was done on blood, urine and catheter tip samples as per clinical condition of a patient. Results: Candida infection was found in 23.4% of study cases. The mean age of study patients was 41.2 +- 20.0 years while 63.4% were female patients as compared to 36.7% males. Conclusion: Fungal infections especially candidemias are quite frequent in the intensive care units. (author)
Full Text Available The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP of percutaneous coronary intervention (PCI patients in an intensive care unit (ICU. Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t=5.99, P<.001 and improving sleep quality (t=−3.65, P=.001 compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F=4.63, P=.036. The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F=6.93, P=.011. In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.
Cho, Mi-Yeon; Min, Eun Sil; Hur, Myung-Haeng; Lee, Myeong Soo
The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t = 5.99, P < .001) and improving sleep quality (t = −3.65, P = .001) compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F = 4.63, P = .036). The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F = 6.93, P = .011). In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients. PMID:23476690
Russell, Rebecca Ann; Burke, Kimberly; Gattis, Katherine
A lack of standardized nursing procedures regarding the management of patients receiving preoperative regional anesthesia in the perianesthesia setting raises a number of issues for perianesthesia nurses. In January 2010, Duke University Hospital's perianesthesia care unit implemented a regional anesthesia "block nurse" team in the preoperative holding area as a patient safety initiative. In January 2011, a retrospective data review was conducted. Results indicated that the implementation of the block nurse team not only increased patient safety but also increased perioperative efficiency and productivity, and decreased delays to operating room start times. This article describes the role of the regional anesthesia block nurse, the development of a block nurse team, and the early benefits of implementing a dedicated regional anesthesia block nurse team in the perianesthesia setting. PMID:23351242
May, Carl; Finch, Tracy; Mair, Frances; Mort, Maggie
'Modernization' is a key health policy objective in the UK. It extends across a range of public service delivery and organizational contexts, and also means there are radical changes in perspective on professional behaviour and practice. New information and communications technologies have been seen as one of the key mechanisms by which these changes can be engendered. In particular, massive investment in information technologies promises the rapid distribution and deployment of patient-centred information across internal organizational boundaries. While the National Health Service (NHS) sits on the edge of a pound sterling 6 billion investment in electronic patient records, other technologies find their status as innovative vehicles for professional behaviour change and service delivery in question. In this paper, we consider the ways that telemedicine and telehealthcare systems have been constructed first as a field of technological innovation, and more recently, as management solutions to problems around the distribution of health care. We use NHS responses to chronic illness as a medium for understanding these shifts. In particular, we draw attention to the shifting definitions of 'innovation' and to the ways that these shifts define a move away from notions of technological advance towards management control. PMID:15893864
Objective:Environmental stresses, especially extreme cold and hot weathers, have tendency to have more admissions for acute coronary syndromes. Due to scarcity of local data, we studied the variation in patient admission rates with acute coronary syndrome according to different seasons. Study Design: Descriptive study. Place and Duration of Study: Coronary Care Unit, Civil Hospital and Pakistan Steel Hospital, Karachi, from January 2011 to December 2011. Methodology: The study group comprised consecutive patients with acute coronary syndrome (unstable angina, Non ST-Elevation Myocardial Infarction (NSTEMI), ST-Elevation Myocardial Infarction (STEMI) admitted to the coronary care unit. Patients with stable angina and valvular heart disease were excluded. Data was analyzed for admission according to different seasons, (winter, spring, summer and autumn). Results: The mean age of the 428 cases was 48.5 ± 10.4 years (range 27 to 73 years). Among the study group, 261 (61%) and 167 (39%) cases were male and female respectively. ST-elevation myocardial infarction, non ST-elevation myocardial infarction and unstable angina were present in 206 (48%), 128 (30%) and 94 (22%) respectively. Among the 428 patients, 184 (43%) cases had hypertension, 133 (31%) cases were smokers, 103 (24%) cases had dyslipidemia and diabetes mellitus and 08 (2%) cases had history of premature coronary artery disease. The number of patients admissions with acute coronary syndrome tended to change with sudden change in season. It increased in Winter 158 (36.9%) and Summer 130 (30.3%) in comparison to Spring 80 (18.69%) and Autumn 60 (14.02%) season. Conclusion: It was found variation in admission rates of acute coronary syndrome patients according to different seasons. The number of admissions not only increased in the cold season (winter) but also in hot season (summer) with sudden changes in temperature. (author)
Full Text Available Aim: It was aimed to investigate the microorganisms and their antibiotic susceptibilities isolated from various clinical specimens sent from the intensive care unit of our hospital between January 2010 and June 2011.Material and Method: Standard microbiological methods were assessed for the isolation of bacteria from clinical specimens. Antimicrobial susceptibilites were investigated according to the Clinical and Laboratory Standards Institute (CLSI standards by disc diffusion method. Result: In 236 samples microorganisms were isolated through 538 various clinical specimens. The most common isolated microorganisms are Acinetobacter baumanii 49 (%21, Pseudomonas aeruginosa 49 (%21, Escherichia coli 47 (%20, Candida spp. 22 (%9 and Enterococcus spp. 21 (%9 respectively. One of the most common isolated bacteria Acinetobacter baumanii strains are extremely resistant and their suscepitibilty against amikacin and imipenem were both found to be %8. While in Pseudomonas aeruginosa strains were found to be %80 susceptibile to amikacin, susceptibility to ciprofloxacin was %35. The highest resistance in E.coli was 87% against ampicillin and the least resistance was against imipeneme as 5%. While no resistance against vancomycin in Enterococci, penicillin resistance was found to be 86%. Penicillin resistance in S. aureus was found 86% and oxacillin resistance was found 43%. Discussion: Knowledge of microorganism variety and the profile of antibiotic resistance in hospitals, especially in the ICU which is risky, against infectious disease is important in rational antibotic usage and infection control precautions.
Full Text Available Introduction. Retroperitoneal hematoma may occur as a result of trauma, but also from rupture of arterial aneurysms (aortic or iliac, surgical complications, tumors or anticoagulation therapy. Case report. We presented a patient on permanent anticoagulation therapy. On the day of admission to our institution, the patient had the value of his INR 5.57 which required immediate suspension of the therapy. The main symptom in this patient was pain in the right inguinal canal with propagation along the right leg, which was indicated in clinical picture of spontaneous retroperitoneal haematoma. After three days the fall of hemoglobin occurred, so the additonal diagnostics was done. A computed tomography of the abdomen was performed showing well limited, large retroperitoneal hematoma (213 x 79 x 91 mm. Transfusion of concentrated red blood cells was performed twice with satisfactory correction of hemoglobin level, and four units of fresh frozen plasma. The patient was hemodynamically stabilized and discharged after a two-month long intensive care unit treatment, with the advice to use low-molecular weight heparin 2 x 0.4 mg subcutaneusly, due to persistent arrhythmia. Conclusion. In patients on anti-coagulation therapy regular monitoring of the anticoagulant status is extremely important, because of the possibility of fatal complications development, such as retroperitoneal hematoma.
Mohan, Deepika; Angus, Derek C
Despite concerted efforts to improve the quality of care provided in the intensive care unit, inconsistency continues to characterize physician decision making. The resulting variations in care compromise outcomes and impose unnecessary decisional regret on clinicians and patients alike. Critical care is not the only arena where decisions fail to conform to the dictates of logic. Behavioral psychology uses scientific methods to analyze the influence of social, cognitive, and emotional factors on decisions. The overarching hypothesis underlying this "thought outside the box" is that the application of behavioral psychology to physician decision making in the intensive care unit will demonstrate the existence of cognitive biases associated with classic intensive care unit decisions; provide insight into novel strategies to train intensive care unit clinicians to better use data; and improve the quality of decision making in the intensive care unit as characterized by more consistent, patient-centered decisions with reduced decisional regret and work-related stress experienced by physicians. PMID:21164408
Full Text Available Carbapenem resistant A. baumannii is an emerging cause of nosocomial infections. The aims of this study were identification of the most prevalent of carbapenem resistant genes, molecular typing and antimicrobial evaluation of A.baumannii in intensive care units.Two hundred and six A. baumannii were isolated from tracheal tube discharge of hospitalized patients at different intensive care units in Ahvaz, Iran. Antimicrobial susceptibility test was done on all isolates. Multiplex and singleplex PCR were performed for detection of bla OXA-23-like, bla OXA-24-like, bla OXA-51-like, bla OXA-58-like, bla VIM, bla IMP, bla SPM and bla NDM genes. Genetic relationship of all isolates was determined by REP-PCR method.Out of 206 examined isolates, 198 (96.1% isolates were resistant to imipenem and meropenem. However 3.9% isolates were sensitive to these antibiotics. The bla OXA-23-like and bla OXA-24-like genes were detected in 85% and 8.7% of strains, respectively. No bla OXA-58- like, bla IMP, bla VIM, bla SPM and bla NDM were detected. REP-PCR results showed that isolates were belonged to five genotypes: Genotype A was the most prevalent (P- value < 0.001: it was observed in 75 of 206 strains (36.4%. Genotype B, and C were found in 28.6% and 27.7%, respectively. The rate of other genotypes was as follows: D (2.4%, E (1%.Based on the obtained results, the rate of carbapenem resistance was high among of A. baumannii which was isolated from intensive care units patients and oxacillinase genes were the most prevalent carbapenem resistant genes. These results revealed that three clones, A, B and C of A.baumannii are common in our hospitals.
Roth, A; Barbash, G I; Hod, H; Miller, H I; Rath, S; Modan, M; Har-Zahav, Y; Keren, G; Bassan, S; Kaplinsky, E
The growing recognition of the importance of early thrombolysis in evolving myocardial infarction was the basis for the present study, which evaluated the effectiveness, feasibility and safety of prehospital thrombolytic therapy. In a relatively small study, 118 patients were allocated to receive either prehospital treatment with recombinant tissue-type plasminogen activator (rt-PA) in the mobile intensive care unit (group A, 74 patients) or hospital treatment (group B, 44 patients). A total of 120 mg of rt-PA was infused over a period of 6 h. All patients were fully heparinized and underwent radionuclide left ventriculography and coronary angiography during hospitalization. Although group A was treated significantly earlier than group B after onset of symptoms (94 +/- 36 versus 137 +/- 45 min, respectively; p less than 0.001), no significant differences were observed between the groups in 1) extent of myocardial necrosis, 2) global left ventricular ejection fraction at discharge, 3) patency of infarct-related artery, 4) length of hospital stay, and 5) mortality at 60 days. However, a trend to a lower incidence of congestive heart failure at hospital discharge was observed in the prehospital-treated compared with the hospital-treated group (7% versus 16%, respectively; p = NS). No major complications occurred during transportation. It is concluded that myocardial infarction can be accurately diagnosed and thrombolytic therapy initiated relatively safely during the prehospital phase by the mobile intensive care team, thus instituting a beneficial clinical trend in favor of prehospital thrombolysis. PMID:2107239
Ullman, B; Hulting, J; Lundberg, J M
Plasma neuropeptide Y-like immunoreactivity (NPY-LI) is elevated in patients with acute myocardial ischaemia and congestive heart failure (CHF) owing to increased activity of the sympathetic nervous system. The prognostic value of plasma NPY-LI with regard to mortality was studied in 324 random patients admitted to a coronary care unit. The one-year mortality was 37% in 113 patients with acute myocardial infarction (AMI) and 18% in those without AMI. Several factors were tested by multiple logistical regression analysis to predict the one-year mortality. Plasma NPY-LI > 60 pmol.l-1, advanced age and previous CHF were independent prognostic factors for an increased risk of mortality in patients without AMI. The mortality rate after one year in non-AMI patients with plasma NPY-LI 60 pmol.l-1. Increased heart rate was the only independent prognostic factor for increased mortality in AMI patients. Plasma NPY-LI on admission was an independent predictor of mortality in CCU patients without AMI and thus resembles plasma noradrenaline. PMID:8070470
Rainer Lenhardt; Ozan Akca
Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without d...
Mahmoud Al Kalaldeh
Full Text Available Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals and private sectors (two hospitals were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined.Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment. Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels. A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.
Saroj Kumar Pattnaik
Full Text Available Introduction: Percutaneous tracheostomy (PCT is being increasingly done by intensivists for critical care unit patients requiring either prolonged ventilation and/or for airway protection.  Bronchoscopic guidance considered a gold standard, , is not always possible due to logistic reasons and ventilation issues. We share our experience of Griggs PCT technique without bronchoscopic guidance with simple modifications to ensure safe execution of the procedure. Objective: The purpose of this study was to evaluate the safety issues and complications of PCT without bronchoscopic guidance in a multi-disciplinary tertiary Intensive Care Unit (ICU. Materials and Methods: A retrospective review of consecutive PCTs performed in our ICU between August 2010 and December 2013 by Griggs guide wire dilating forceps technique without bronchoscopic guidance is being presented. It is done by withdrawing endotracheal tube with inflated cuff while monitoring expired tidal volume on ventilator and ensuring the free mobility of guide wire during each step of the procedure, thereby ensuring a safe placement of the tracheostomy tube (TT in trachea. Results: Analysis of 300 PCTs showed 26 patients (8.6% had complications including 2 (0.6% patients deteriorated neurologically and 2 (0.6% deaths observed within 24 h following procedure. The median operating time was 3.5 min (range, 2.5-8 min. There were no TT placement problems in any case. Conclusion: Percutaneous tracheostomy can be safely performed without bronchoscopic guidance by adhering to simple steps as described.
Full Text Available Teshome Abebe, Mullu Girmay, Girma G/Michael, Million Tesfaye Department of Anesthesia, Jimma University, Jimma, Ethiopia Background: In least developing countries, there are few data on children's critical care. This makes the provision of aid and improvement of outcome difficult. Objectives: To describe admission and outcome patterns of children managed in a general intensive care unit at Jimma University Specialized Hospital (JUSH, Ethiopia, over a 5-year period. Methods: A retrospective cross-sectional study design was used. All children from birth to 14 years of age who were admitted to the general ICU of the hospital from 2009–2013 were included. Patient charts and ICU documentation log were reviewed. Results: A total of 170 children were admitted to the ICU of JUSH over the study period. The greater share was taken by males (54.7%, with a male-to-female ratio of 1.2:1. The overall mortality rate was 40%. The majority of the children were in the age range of 10–14 years (38.8%. Of the total number of patients admitted, 34.7% were trauma cases, 45.8% of whom died. The highest percentage, 69.5%, of trauma patients were admitted for head injuries. Among the trauma cases, burn and polytrauma were the second and third leading causes (15.3% of admission. Postoperative patients and medical patients accounted for the rest of the admitted cases (28.2% and 27.6% of the cases respectively. Conclusion: The leading cause of admission and death was trauma. Postoperative and medical causes of admission were also significant. The mortality rate in the ICU was very high, and this could be due to various factors. Further research benchmarking and interventions are highly recommended. Keywords: trauma, critical care, pediatric, ICU, ventilation, oxygenation
Moreno, R; Metnitz, P; Metnitz, B; Bauer, P.; Afonso de Carvalho, S; Hoechtl, A; SAPS 3 Investigators
OBJECTIVE: The objective of the study was to develop a model for estimating patient 28-day in-hospital mortality using 2 different statistical approaches. DESIGN: The study was designed to develop an outcome prediction model for 28-day in-hospital mortality using (a) logistic regression with random effects and (b) a multilevel Cox proportional hazards model. SETTING: The study involved 305 intensive care units (ICUs) from the basic Simplified Acute Physiology Score (SAPS) 3 cohort. ...
Andrew S. Allegretti; Hundemer, Gregory; Chorghade, Rajeev; Cosgrove, Katherine; Bajwa, Ednan; Bhan, Ishir
Background Recent studies suggest discrepancies between patients and providers around perceptions of hemodialysis prognosis. Such data are lacking for continuous renal replacement therapy (CRRT). We aim to assess patient and provider understanding of outcomes around CRRT. Methods From February 1 to August 31, 2013, a triad of (1) a patient on CRRT (or health care proxy [HCP]), (2) physician and (3) primary nurse from the intensive care unit (ICU) team were surveyed. Univariate chi-square and ...
Full Text Available The empiric antibiotic therapy can result in antibiotic overuse, development of bacterial resistance and increasing costs in critically ill patients. The aim of the present study was to evaluate the effect of procalcitonin (PCT guide treatment on antibiotic use and clinical outcomes of patients admitted to intensive care unit (ICU with systemic inflammatory response syndrome (SIRS. A total of 60 patients were enrolled in this study and randomly divided into two groups, cases that underwent antibiotic treatment based on serum level of PCT as PCT group (n=30 and patients who undergoing antibiotic empiric therapy as control group (n=30. Our primary endpoint was the use of antibiotic treatment. Additional endpoints were changed in clinical status and early mortality. Antibiotics use was lower in PCT group compared to control group (P=0.03. Current data showed that difference in SOFA score from the first day to the second day after admitting patients in ICU did not significantly differ (P=0.88. Patients in PCT group had a significantly shorter median ICU stay, four days versus six days (P=0.01. However, hospital stay was not statistically significant different between two groups, 20 days versus 22 days (P=0.23. Early mortality was similar between two groups. PCT guidance administers antibiotics reduce antibiotics exposure and length of ICU stay, and we found no differences in clinical outcomes and early mortality rates between the two studied groups.
Rafinazari, Niloofar; Abbasi, Saeed; Farsaei, Shadi; Mansourian, Marjan; Adibi, Peyman
Objective: Concern about adverse effects of the inconsistent use of stress-related mucosal damage prophylaxis in intensive care unit (ICU) is increasing. Hence, this study was designed to prospectively evaluate the rate of inappropriate stress ulcer prophylaxis (SUP) administration upon ICU admission, at ICU discharge and determine the adherence to American Society of Health-System Pharmacists (ASHP) guideline during ICU stay. Methods: In this study, 200 patients were randomly selected from all ICU admissions during 9 months. Risk factors of stress ulcer were recorded daily during ICU stay and appropriateness of SUP administration was assessed according to the ASHP criteria. Findings: Of all 160 (80%) patients who received SUP, 44.4% did not have indication; and among 95 patients with an indication for SUP administration, 6.3% did not receive it upon ICU admission. Consequently, 77 (38.5%) of 200 patients received inappropriate prophylaxis on ICU admission. In addition, 53.5% of patients had appropriate adherence to ASHP guideline during all days of ICU stay (44% and 2.5% of patients received SUP more than 120% and administration included both overutilization and underutilization in this ICU, but high prevalence of SUP overutilization caused unnecessary hospital costs, personal monetary burden, and may increase adverse drug reactions. Therefore, educating physicians and cooperation of clinical pharmacists regarding implementing standard protocols could improve patterns of SUP administration.
Thorgaard, Per; Ertmann, Ellen; Hansen, Vibeke; Noerregaard, Anni; Hansen, Vibeke; Spanggaard, Lene
A multicentre study in five postanaesthesia care units (PACUs) was performed to investigate patient and staff opinion of a specially designed music environment (DME), related to geographical location. Patients (325) and staff (91) described their opinion by means of a questionnaire-anonymously in the case of staff. Patients were not asked beforehand for permission to play music. Amongst patients 267 (83%) found the sound environment with DME pleasant or very pleasant, 26 (6%) found it unpleasant, whereas 32 (11%) answered "no opinion". The opinion of the patients did not differ significantly with geographical location. A strong correlation (P<0.05) between a positive attitude towards DME and degree of relaxation and satisfaction with stay was found. The staff had an equally positive attitude towards the DME; but theirs varied significantly with location. The opinion of the staff was more similar concerning the beneficial effect on working conditions and distress, but varied still significantly. The opinion of the staff had no demonstrable impact on that of the patients. PMID:16039959
Full Text Available The objective of the present study was to assess the incidence, risk factors and outcome of patients who develop acute renal failure (ARF in intensive care units. In this prospective observational study, 221 patients with a 48-h minimum stay, 18-year-old minimum age and absence of overt acute or chronic renal failure were included. Exclusion criteria were organ donors and renal transplantation patients. ARF was defined as a creatinine level above 1.5 mg/dL. Statistics were performed using Pearsons' chi2 test, Student t-test, and Wilcoxon test. Multivariate analysis was run using all variables with P < 0.1 in the univariate analysis. ARF developed in 19.0% of the patients, with 76.19% resulting in death. Main risk factors (univariate analysis were: higher intra-operative hydration and bleeding, higher death risk by APACHE II score, logist organ dysfunction system on the first day, mechanical ventilation, shock due to systemic inflammatory response syndrome (SIRS/sepsis, noradrenaline use, and plasma creatinine and urea levels on admission. Heart rate on admission (OR = 1.023 (1.002-1.044, male gender (OR = 4.275 (1.340-13642, shock due to SIRS/sepsis (OR = 8.590 (2.710-27.229, higher intra-operative hydration (OR = 1.002 (1.000-1004, and plasma urea on admission (OR = 1.012 (0.980-1044 remained significant (multivariate analysis. The mortality risk factors (univariate analysis were shock due to SIRS/sepsis, mechanical ventilation, blood stream infection, potassium and bicarbonate levels. Only potassium levels remained significant (P = 0.037. In conclusion, ARF has a high incidence, morbidity and mortality when it occurs in intensive care unit. There is a very close association with hemodynamic status and multiple organ dysfunction.
Full Text Available Abstract Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs, such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1 to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2 to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use, living situation, and survival after discharge and at 6 and 12 months of follow-up. Methods/Design A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group. Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group. Discussion Little
ZHANG Li-na; WANG Xiao-ting; AI Yu-hang; GUO Qu-lian; HUANG Li; LIU Zhi-yong; Yao Bo
Background Encephalopathy is a common complication of sepsis,and its onset can occur at any stage of sepsis and implies worse prognosis.However,the incidence,epidemiology,and pathogenesis of sepsis-associated encephalopathy remain controversial.The purpose of this study was to investigate the epidemiological features and risk factors for sepsis-associated encephalopathy.Methods Our retrospective study included all patients with sepsis admitted to our intensive care unit from 2008 to 2011.After excluding 91 patients,232 patients were assigned to either a sepsis-associated encephalopathy group or sepsis without encephalopathy group.Between-group differences in baseline patient data including vital signs,disease severity,pathogens,sites of infection,biochemical indicators,and time on a mechanical ventilator,intensive care unit (ICU) stay,and 28-day mortality rate were analyzed.Results The incidence of sepsis-associated encephalopathy was 17.7％.The sepsis-associated encephalopathy group had significantly higher 28-day mortality (56.1％ vs.35.1％; P=0.013),spent a significantly longer time on a ventilator ((8.2±2.2) days vs.(2.9±0.4) days; P=0.021),and had a significantly longer ICU stay ((12.4±2.4) days vs.(7.1±0.6) days;P=0.042).Acute physiology and chronic health evaluation Ⅱ score,Glasgow coma scale,heart rate,blood lactate,serum sodium,platelets,serum albumin,and pH values were related to the presence of encephalopathy.Patients with biliary tract infections and intestinal infections caused by Staphylococcus aureus,Enterococcus faecium,Acinetobacter spp,Pseudomonas aeruginosa,and Stenotrophomonas maltophilia,were more prone to develop sepsis-associated encephalopathy.Conclusions Encephalopathy increases mortality rate in septic patients.Clinical intervention to reduce risk factors and thereby morbidity and mortality depends on a correct understanding of the differences between patients with sepsis and patients with both sepsis and encephalopathy.
Full Text Available Abstract Background The Patient Assessment of Chronic Illness Care (PACIC is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM. It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK. We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions. Method We collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures. Results There was evidence that rates of missing data were high on PACIC (9.6% - 15.9%, and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94, responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale than ceiling effects (generally Conclusion The importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.
Full Text Available Background : Invasive pulmonary aspergillosis (IPA is an important infection in critically ill patients including patients of intensive care units (ICU. Different diagnostic tools are available and since its mortality is high, it is vital to start the antifungal therapy as soon as possible. Knowing the epidemiology of this disease in each ICU and area will help to better and more rapid management of such patients. The aim of this study is to determine the frequency of IPA based on the level of galactomannan in bronchoalveolar lavage fluid in ICU of Al-Zahra hospital, Isfahan, Iran. Materials and Methods : This was a cross sectional study, which was conducted in Al-Zahra hospital, Isfahan, Iran, between 2010 to 2011. The study population was all the patients admitted to ICU and were suspected to have invasive Aspergillus spp pneumonia. The level of galactomannan in bronchoalveolar lavage was measured and demographic data were gathered by the questionnaire. Results : The frequency of IPA in this study was calculated as 2.43% while galactomannan level in bronchoalveolar lavage fluid of this patient (2.50 was significantly higher than others (0.03 ± 0.02. Conclusion : Larger studies are required to determine the exact frequency of IPA and the best antifungal therapy for it.
Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle; Lauridsen, Jørgen T; Birkelund, Regner
The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients' SOC would be negatively related to their experience of pain and nausea, consumption of opioids, and length of stay in the PACU--the higher the SOC, the lower the experience of pain and nausea, less consumption of opioids, and shorter PACU stay. Data were collected from the anesthesia and electronic medical records, and combined with a questionnaire. A total of 115 adults undergoing general anesthesia for orthopedic surgery were included in the analysis. Results showed a statistically significant negative relationship between SOC and postoperative pain and consumption of opioids in the PACU. Patients with a stronger SOC experienced significantly less pain (P PACU. Therefore, patients' SOC could be one of many factors that nurse anesthetists consider in their efforts to predict, prevent, and decrease patients' experience of pain in the PACU. PMID:26742336
Full Text Available BACKGROUND : Since the 2009 pandemic of H1N1 or Swine Flu influenza , there have been respiratory emergencies every year throughout India , but in the early part of this year that is between January and April 2015 an explosion of cases was seen throughout the country , and so also in our state , Andhra Pradesh. The study of clinical presentation , radiological features and course of the disease helps in early suspicion , isolation , detection and institution of treatment in swine flu positive patients so that further spread of the disease can be co ntrolled and the patients saved . MATERIAL AND METHODS : This is a cross - sectional study conducted at the Department of Pulmonary Medicine , S.V.R.R. Govt. General Hospital , Tirupathi , between January 2015 and April 2015. Study sample was the total number of swine flu suspects who were admitted in the Respiratory Intensive Care Unit and swine flu wards of the Department of Pulmonary Medicine. SUMMARY : Out of 32 suspects admitted , 13 tested positive for swine flu. 8 of the 13 were females (61% and 5 were males (39%. Cold , cough and breathlessness were present in all the patients (100%. Sore throat was present in only 4 patients (30%. 11 out of the 13 patients were in respiratory failure (85%. 9 out of the 13 had comorbidities like diabetes , bronchial asthma and chronic kidney disease (70%. Chest X - ray and CT chest showed ARDS like pic ture and pneumonia in 11 out of the 13 patients (85%.
Full Text Available Abstract Background Poor outcomes of invasive candidiasis (IC are associated with the difficulty in establishing the microbiological diagnosis at an early stage. New scores and laboratory tests have been developed in order to make an early therapeutic intervention in an attempt to reduce the high mortality associated with invasive fungal infections. Candida albicans IFA IgG has been recently commercialized for germ tube antibody detection (CAGTA. This test provides a rapid and simple diagnosis of IC (84.4% sensitivity and 94.7% specificity. The aim of this study is to identify the patients who could be benefited by the use of CAGTA test in critical care setting. Methods A prospective, cohort, observational multicentre study was carried out in six medical/surgical Intensive care units (ICU of tertiary-care Spanish hospitals. Candida albicans Germ Tube Antibody test was performed twice a week if predetermined risk factors were present, and serologically demonstrated candidiasis was considered if the testing serum dilution was ≥ 1:160 in at least one sample and no other microbiological evidence of invasive candidiasis was found. Results Fifty-three critically ill non-neutropenic patients (37.7% post surgery were included. Twenty-two patients (41.5% had CAGTA-positive results, none of them with positive blood culture for Candida. Neither corrected colonization index nor antifungal treatment had influence on CAGTA results. This finding could corroborate that the CAGTA may be an important biomarker to distinguish between colonization and infection in these patients. The presence of acute renal failure at the beginning of the study was more frequent in CAGTA-negative patients. Previous surgery was statistically more frequent in CAGTA-positive patients. Conclusions This study identified previous surgery as the principal clinical factor associated with CAGTA-positive results and emphasises the utility of this promising technique, which was not
Momennasab, Marzieh; Ghahramani, Tahereh; Yektatalab, Shahrzad; Zand, Farid
Background: Monitoring the health status of patients discharged from intensive care units is a crucial method of service evaluation. Objectives: This study aimed to assess the physical and mental health status of patients immediately after discharge from the ICU and 24 hours later. Patients and Methods: This descriptive comparative study was conducted on 104 patients discharged from the ICUs of a referral trauma center in Shiraz, Southwest Iran. Physical parameters, including respiratory rate, need for supplemental oxygen, heart rate, blood pressure, and need for cardiac monitoring, were assessed. Hospital anxiety and depression scale (HADS) was used for mental health evaluation. The mental and physical status of patients were assessed before ICU discharge and 24 hours later; data were recorded in information forms and were analyzed using SPSS statistical software version 17. Results: At the time of discharge, the respiratory rate of 28% of the participants was more than 24 minutes, and 95.2% received supplemental oxygen. However, after 24 hours these values decreased to 10% and 21.6%, respectively. The mean heart rate and systolic blood pressure were within the normal range at both time points. Additionally, 63% of the patients had anxiety scores above 11 at both time points, reflecting high anxiety. The number of patients who reported depression increased from 58.7% at ICU discharge to 69.6% after 24 hours. Conclusions: Despite the considerable improvement in most of the patients’ physical condition in the first 24 hours after discharge from ICU, a significant number of them remain at risk for the development of adverse effects from this transition. The high prevalence of mental health disorders in these patients reveals the necessity to conduct follow-up consultations.
Tejaswini Arunachala Murthy
Full Text Available Background: Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN. The impact of these practices on outcome in Indian scenario is less studied. Aims: This study compares the impact of early EN (within 48 h after surgery with late EN (48 h postsurgery on outcomes in abdominal surgical ICU patients. Settings and Design: Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed. Methods: Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis. Results: Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI; P = 0.003 and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001 were other predictors of prolonged LOS. Conclusions: Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.
Full Text Available Habibollah Saadat¹, Hossein Shiri², Zahra Salarpour², Tahereh Ashktorab² , Hamid Alavi Majd², Zahra Saadat¹, Hosein Vakili¹ 1Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran; 2Nursing School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Background: Most patients who present to medical centers due to chest pain do not suffer from acute coronary syndromes and do not need to be hospitalized in coronary care units (CCUs. This study was done to determine exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in CCUs of educational hospitals affiliated with a major medical university. Methods: Over a 4-month period, 550 patients with chest pain who were hospitalized in the CCUs belonging to six hospitals affiliated to the authors' medical university were recruited by census method. Using Thrombolysis in Myocardial Infarction risk score, 95 patients (17.27% were categorized as low-risk patients. This group was evaluated with respect to demographics, bed occupancy rate, mean hospitalization period, expenses during admission, and cardiovascular outcomes in the 30-day period postdischarge. Results: Mean (± standard deviation hospitalization duration was 3.04 (±0.71 days. No significant difference was seen between the six surveyed hospitals regarding hospitalization duration (P = 0.602. The highest bed occupancy rate was seen in Taleghani and Shohada Tajrish hospitals and the lowest was in Modarres Hospital. The mean paid treatment expenses by low-risk patients was IRR 2,050,000 (US$205. Mean total hospitalization expenses was US$205. No significant difference was seen between the six surveyed hospitals (P = 0.699. Of the patients studied, 89.5% did not show any cardiovascular complications in 1 month and no deaths occurred. Conclusion: Given the high bed-occupancy rate by low-risk patients, associated high hospitalization
Qvarfordh, Pernilla; Olsen, Karsten Skovgaard; Bendix, Tom;
PURPOSE: The aim of this pilot study was to investigate whether it was feasible and safe to mobilize patients shortly after lumbar disc surgery with the objective of reducing postoperative complications and allowing shorter hospitalization. DESIGN: Randomized controlled study. METHOD: The patients...... and safe to mobilize patients shortly after lumbar disc surgery. There were no indications of an increased number of postoperative complications....
Chiang, Hou-Hsien; Hung, Chien-Ching; Lee, Chang-Min; Chen, Hsuan-Yu; Chen, Mao-Yuan; Sheng, Wang-Huei; Hsieh, Szu-Min; Sun, Hsin-Yun; Ho, Chao-Chi; Yu, Chong-Jen
Introduction Although access to highly active antiretroviral therapy (HAART) has prolonged survival and improved life quality, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support in intensive care units (ICU). This study aimed to describe the etiology and analyze the prognostic factors of HIV-infected Taiwanese patients in the HAART era. Methods Medical records of all HIV-infected adults who were admitted to ICU at ...
Priscilla Roberta Silva Rocha
Full Text Available Central venous catheterization is a common practice in the management of critically ill patients and is associated with various complications, such as Bloodstream Infections (BSI, which are major determinants of increased morbidity, mortality and healthcare expenses. Few studies have addressed factors that predict mortality in patients with this complication. The aim of this study was to investigate factors associated with mortality in patients with Central Venous Catheter (CVC-related BSI in an intensive care unit of a tertiary care hospital in the Federal District, Brazil. This was a retrospective and observational study, in which all CVC-related BSI that occurred between January 2008 and December 2010 were reviewed. We obtained demographic, clinical, biochemical and microbiological data from medical records and investigated its association with mortality during ICU stay. There were 4,504 ICU admissions during the study period and 68 were complicated by CVC-related BSI (4.09 per 1000 catheter-days, most due to gram-negative organisms (45.6%. Overall mortality was 59.7%. Death risk was significantly associated with mechanical ventilation (OR 27.8, 95% CI 3.28-250, p-1 in survivors vs. 73.9 mg dL-1 in non-survivors, p = 0.001. Mortality was not associated with other clinical or biochemical features, neither with microbiological variables, although lethality was high among patients with gram-positive infections (77% Vs 58.33% for fungi and 54.83% for gram-negative. CVC-related BSI was associated with high absolute mortality, which was predicted by mechanical ventilation and a higher number of invasive devices other than the CVC. Knowledge of local factors predictive of mortality is critical for planning strategies to reduce death risk associated with this complication.
Mokart, Djamel; Lambert, Jérôme; Schnell, David; Fouché, Louis; Rabbat, Antoine; Kouatchet, Achille; Lemiale, Virginie; Vincent, François; Lengliné, Etienne; Bruneel, Fabrice; Pene, Frederic; Chevret, Sylvie; Azoulay, Elie
Acute respiratory failure (ARF) is the leading reason for intensive care unit (ICU) admission in patients with cancer. The aim of this study was to identify early predictors of death in patients with cancer admitted to the ICU for ARF who were not intubated at admission. We conducted analysis of a prospective randomized controlled trial including 219 patients with cancer with ARF in which day-28 mortality was a secondary endpoint. Mortality at day 28 was 31.1%. By multivariate analysis, independent predictors of day-28 mortality were: age (odds ratio [OR] 1.30/10 years, 95% confidence interval [CI] [1.01-1.68], p = 0.04), more than one line of chemotherapy (OR 2.14, 95% CI [1.08-4.21], p = 0.03), time between respiratory symptoms onset and ICU admission > 2 days (OR 2.50, 95% CI [1.25-5.02], p = 0.01), oxygen flow at admission (OR 1.07/L, 95% CI [1.00-1.14], p = 0.04) and extra-respiratory symptoms (OR 2.84, 95%CI [1.30-6.21], p = 0.01). After adjustment for the logistic organ dysfunction (LOD) score at admission, only time between respiratory symptoms onset and ICU admission > 2 days and LOD score were independently associated with day-28 mortality. Determinants of death include both factors non-amenable to change, and delay in ARF management. These results suggest that early intensive care management of patients with cancer with ARF may translate to better survival. PMID:23185988
Muteya, Michel Manika; Kabey, Alain Kabey a; Lubanga, Théophile Muyumba; Tshamba, Henri Mundongo; Nkoy, Albert Mwembo Tambwe a
Tetanus is still a public health problem in developing countries including the Democratic Republic of Congo. The objective of this study was to determine the prognosis of patients with tetanus admitted in the Intensive Care Unit (ICU) of Provincial Hospital Jason Sendwe, Lubumbashi, DR Congo. This is a descriptive study which collected information from registers and medical records of patients admitted for tetanus in the ICU of Jason Sendwe Hospital, between January 2005 and December 2009. We calculated the parameters of position, dispersion as well as frequencies. We used the test of independent association of prognosis (death versus survival). Tetanus constituted 2.1% of admissions in the ICU during the 5-year period. The average age of patients was 39.38 ± 17; majority of patients were males (95.5%). The majority of patients lived the townships of Kampemba (27.3%), Kenya (22.7%), and Annexe (18.2%). All patients presented the generalized form of the infection. The door of entry was detectable in 71.5% of cases, localized mainly to the lower limbs (61.9%). The average length of stay was 11.29 ± 11.39 days. Mortality was observed in 52.4% of cases. This mortality was statistically significant in patients aged mrore than 40 years (p=0.029) but not not related to the length of stay (p=0.080) nor the location of point of entry(p=0.28). In our environment the prognosis of tetanus remains severe. This disease is still frequent in the city of Lubumbashi; sensibilisation of population on preventive strategies as well as setting up appropriate structures for better management of cases is required. PMID:23717709
Full Text Available Introduction: Caloric intake of critically ill patients are usually calculated using predictive equations. Recent advances in gas exchange measurements have the potential to estimate energy expenditure at the bedside and at different time periods. Materials and Methods: Energy needs of critically ill patients were estimated over a period of 3 months using simplistic formula of 25 kcal/kg/day estimated energy expenditure (EEE, Harris-Benedict equation (HBE (Basal energy expenditure [BEE] and M-COVX™ metabolic monitor resting energy expenditure (REE on day 4 of Intensive Care Unit (ICU admission. Calculations based on HBE were taken as standard, and percentage errors (PE were calculated for each patient for values derived from simplistic formula and metabolic monitor. Adequacy of nutritional intake in ICU was also assessed. Results: Metabolic monitor could be used in only 20/70 patients. The mean age of patients was 40 years, 65% were males, and average body mass index was 23.69 kg/m 2 . Intermittent intolerance to feeds was reported in 50%. Values of REE and EEE were greater than BEE in 70% of patients. A significant difference was reported in values of PE of ≤20% and ≥30%; P = 0.0003 and 0.0001, respectively estimated using REE and EEE. Conclusions: It is not feasible to use metabolic monitors in all patients. Variability in readings is large and further studies are needed to establish the validity of its measurements. Calculations using simplistic formulas are much closer to values obtained using HBE.
Chigira, Yusuke; Takai, Tomoko; Igusa, Hironobu; Dobashi, Kunio
[Purpose] We performed early physiotherapy for elderly patients with pneumonia admitted to an intensive care unit (ICU), and examined the effects of this early physiotherapy on the severity of pneumonia. [Subjects and Methods] Patients for whom physiotherapy was started the day after admission to the ICU (acute phase) were assigned to the early intervention group and compared with patients in the standard intervention group. All patients were divided into three groups (Groups I, II, and III) ...
Kamel Abdelaziz Mohamed
Conclusion Our current study showed that nondiabetic patients with hyperglycemia had a 1.6 times higher relative risk of in-hospital 28-day mortality than diabetic patients. Stress hyperglycemia predicts an increased risk of in-hospital mortality after ischemic stroke; thus, we should not underestimate the potential harm, as patients with the highest admission glucose levels would have most likely been treated earlier and more aggressively.
Rassouli, Maryam; Zamanzadeh, Vahid; Ghahramanian, Akram; Abbaszadeh, Abbas; Alavi-Majd, Hamid; Nikanfar, Alireza
Background: Although nurses acknowledge that spiritual care is part of their role, in reality, it is performed to a lesser extent. The purpose of the present study was to explore nurses’ and patients’ experiences about the conditions of spiritual care and spiritual interventions in the oncology units of Tabriz. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in the oncology units of hospitals in Tabriz. Data were collected through purp...
Mehrholz, Jan; Mückel, Simone; Oehmichen, Frank; Pohl, Marcus
Objectives To describe the time course of recovery of walking function and other activities of daily living in patients with intensive care unit (ICU)-acquired muscle weakness. Design This is a cohort study. Participants We included critically ill patients with ICU-acquired muscle weakness. Setting Post-acute ICU and rehabilitation units in Germany. Measures We measured walking function, muscle strength, activities in daily living, motor and cognitive function. Results We recruited 150 patien...
Full Text Available Abstract Background The optimal level of positive end-expiratory pressure (PEEP is still widely debated in treating acute respiratory distress syndrome (ARDS patients. Current methods of selecting PEEP only provide a range of values and do not provide unique patient-specific solutions. Model-based methods offer a novel way of using non-invasive pressure-volume (PV measurements to estimate patient recruitability. This paper examines the clinical viability of such models in pilot clinical trials to assist therapy, optimise patient-specific PEEP, assess the disease state and response over time. Methods Ten patients with acute lung injury or ARDS underwent incremental PEEP recruitment manoeuvres. PV data was measured at increments of 5 cmH2O and fitted to the recruitment model. Inspiratory and expiratory breath holds were performed to measure airway resistance and auto-PEEP. Three model-based metrics are used to optimise PEEP based on opening pressures, closing pressures and net recruitment. ARDS status was assessed by model parameters capturing recruitment and compliance. Results Median model fitting error across all patients for inflation and deflation was 2.8% and 1.02% respectively with all patients experiencing auto-PEEP. In all three metrics' cases, model-based optimal PEEP was higher than clinically selected PEEP. Two patients underwent multiple recruitment manoeuvres over time and model metrics reflected and tracked the state or their ARDS. Conclusions For ARDS patients, the model-based method presented in this paper provides a unique, non-invasive method to select optimal patient-specific PEEP. In addition, the model has the capability to assess disease state over time using these same models and methods.
Prevot, N.; Granjon, D.; Dubois, F. [Dept. of Nuclear Medicine, Service de Medecine Nucleaire, Hopital Nord, CHRU Saint-Etienne (France); Mariat, G.; Mahul, P.; Jospe, R.; Auboyer, C. [Department of Intensive Care, Hospital Nord, CHRU Saint-Etienne (France); Cuilleron, M. [Department of Radiology, Hospital Nord, CHRU Saint-Etienne (France); Tiffet, O. [Department of Surgery, Hospital Nord, CHRU Saint-Etienne (France); De Filipis, J.-P. [Department of Nephrology, Hospital Nord, CHRU Saint-Etienne (France)
Thirty-two intensive care unit patients (78% on long-term total parenteral nutrition) suspected of having acute acalculous cholecystitis (AAC) were studied prospectively. All of these patients underwent abdominal ultrasonography and cholescintigraphy with technetium-99m mebrofenin. Morphine sulphate (0.04 mg/kg) was administered only if the gallbladder was not visualised after 1 h (16 patients). The final diagnosis was reached after clinical improvement, or upon the discovery of another aetiology for the symptoms presented, or on the basis of histopathology following cholecystectomy (when this was performed). We analysed the contribution of individual cholescintigraphic findings (I: non-visualisation of the gallbladder during the first 60 min of the examination; II: persistent non-visualisation of the gallbladder 30 min following morphine administration; III: non-visualisation of the small bowel for at least 90 min) and their various combinations. We obtained a sensitivity of 79% and a specificity rate 100% using the interpretative criteria ''I and II or III''. Excluding obstructive syndrome (''I and II''), the sensitivity and specificity figures were 70% and 100% respectively (28 patients). We had no false-positive results in our patient population. Cholescintigraphy was found to complement ultrasonography, which had either good sensitivity (93%) and poor specificity (17%), when at least two of the three major signs were present (sludge, thickened wall, gallbladder distension), or poor sensitivity (36%) and good specificity (89%) when all three signs were present. We conclude that cholescintigraphy is a useful tool for early diagnosis of AAC in critically ill patients, in whom ultrasonography alone does not provide enough information to permit a sufficiently early decision regarding the use of surgery. (orig.)
Elizabeth De Fransceco Daher
Full Text Available Introduction: Acute kidney injury (AKI is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. Methods: This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory findings were evaluated. Results: A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodeficiency virus (HIV infection, HIV/acquired immunodeficiency syndrome (AIDS (30%, tuberculosis (12%, leptospirosis (11% and dengue (4%. Dialysis was performed in 70 cases (27.6%. The patients were classified as risk (4.4%, injury (63.6% or failure (32%. The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%. The Acute Physiology and Chronic Health Evaluation (APACHE II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01 and dengue (68±11, p-value=0.01. Death occurred in 159 cases (62.8%. Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02. A multivariate analysis identified the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. Conclusions: AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases.
Full Text Available Abstract Background Epidemic outbreaks of multi-drug resistant (MDR Acinetobacter baumannii (AB in intensive care units (ICUs are increasing. The incidence of MDR AB bacteremia, which develops as a result of colonization, is increasing through widespread dissemination of the pathogen, and further colonization. We sought to determine risk factors for MDR AB bacteremia in patients colonized with MDR AB in the ICU. Methods We conducted a retrospective, observational study of 200 patients colonized with MDR AB in the ICU at Severance Hospital, South Korea during the outbreak period between January 2008 and December 2009. Results Of the 200 patients colonized with MDR AB, 108 developed MDR AB bacteremia, and 92 did not. APACHE II scores were higher in bacteremic than non-bacteremic patients at the time of ICU admission and colonization (24.0 vs. 21.6; P = 0.035, 22.9 vs. 16.8; P P = 0.923, but the duration of time at risk was shorter in bacteremic patients (12.1 vs. 6.0 days; P = 0.016. A recent invasive procedure was a significant risk factor for development of bacteremia (odds ratio = 3.85; 95% CI 1.45-10.24; P = 0.007. Multivariate analysis indicated infection and respiratory failure at the time of ICU admission, maintenance of mechanical ventilation, maintenance of endotracheal tube instead of switching to a tracheostomy, recent central venous catheter insertion, bacteremia caused by other microorganism after colonization by MDR AB, and prior antimicrobial therapy, were significant risk factors for MDR AB bacteremia. Conclusions Patients in the ICU, colonized with MDR AB, should be considered for minimizing invasive procedures and early removal of the invasive devices to prevent development of MDR AB bacteremia.
Full Text Available Background: Outcome and predictors of survival after cardiopulmonary resuscitation (CPR in Intensive Care Units (ICUs have been extensively studied in western world, but data from developing countries is sparse. Objectives: To study the outcome and predictors of survival after CPR in a Medical ICU (MICU of a tertiary level teaching hospital in North India. Materials and Methods: A 1-year prospective cohort study. Results: Of 105 in-MICU CPRs, forty patients (38.1% achieved return of spontaneous circulation (ROSC. Only one patient (0.9% survived up to hospital discharge. The predictors of ROSC were ventricular tachycardia/ventricular fibrillation as first monitored rhythm, intubation during CPR and CPR duration ≤ 10 min. CPR duration > 10 min was a significant factor for resuscitation failure. Conclusions: The rate of survival to hospital discharge after in-MICU CPRs is extremely poor. Our data may aid treating physicians, resuscitation teams, and families in understanding the likely outcome of patients after in-MICU CPRs.
To Guide the Design of the Mobile Device Using a Participatory Design Process With PICU Nurses, Respiratory Therapists and Physicians.; To Evaluate the Efficacy of the Mobile Messenger in Helping Nurses, Respiratory Therapists and Physicians Triage Simulated Patients.
Digby, Justin; Kalbfleisch, John; Glenn, Andy; Larsen, Angie; Browder, William; Williams, David
Fungal infections in the critically ill patient are difficult to diagnose and are associated with a high mortality rate. A major obstacle to managing fungal infection is the lack of a reliable clinical assay that will rapidly identify patients with fungal sepsis. Glucans are polymers of glucose that are found in the cell wall of fungi and certain bacteria. Glucans are also released from the fungal cell wall into the extracellular milieu. Several studies have reported that detection of fungal ...
The overall aim of the present thesis was to study aspects of patient safety in critically ill patients with special focus on airway management, respiratory complications and nursing procedures. Study I describes a method called pharyngeal oxygen administration during intubation in an experimental acute lung injury model. The study showed that pharyngeal oxygenation prevented or considerably increased the time to life-threatening hypoxemia at shunt fractions by at least up to 25% and that thi...
Birinder S Paul
Full Text Available Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives.
Baddley John W
Full Text Available Abstract Background Few data are available regarding the epidemiology of invasive aspergillosis (IA in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. Methods Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008. Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6 who received initial antifungal therapy (AF in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. Results From 6,424 aspergillosis patients in the database, 412 (6.4% ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%, acute respiratory failure (76% and acute renal failure (41%. In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once. Mean length of stay (LOS was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p Conclusions Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.
Tao Wang; Yun-Liang Cui; Zhao-Fen Lin; De-Chang Chen
Background: Both procalcitonin (PCT) and plasma endotoxin levels cannot be solely used for a definite diagnosis ofbacteremia or sepsis, and there has been few study comparing the values of the two biomarkers for the diagnosis of bacteremia.The aim of this study was to identify bacteria causing bacteremia and evaluate the role of the two biomarkers in the diagnosis ofbacteremia in Intensive Care Unit (ICU).Methods: The medical records of 420 patients in ICU were retrospectively reviewed.Patients (n =241) who met the inclusion criteria were subjected to blood culture (BC) for the analysis of the endotoxin or PCT levels.The exclusion criteria included the presence of infection with human immunodeficiency virus and/or AIDS, neutropenia without sepsis, pregnancy, treatment with immunosuppressive therapies, or blood diseases such as hematological tumors.Patients' BC episodes were divided into BC negative, Gram-negative (GN) bacteria, Gram-positive bacteria, and fungi groups.The PCT and plasma endotoxin levels were compared in the different groups.Results: A total of 241 patients with 505 episodes of BC were analyzed.The GN bacteria group showed higher levels of PCT and endotoxin than the BC negative, Gram-positive bacteria, and fungi groups.GN bacteremia was more prevalent than Gram-positive bacteremia.The GN bacteremia caused by non-Enterobacteriaceae infection presented higher endotoxin level than that by Enterobacteriaceae, but no significant difference in PCT levels was observed between the two groups.The plasma endotoxin significantly differed among different groups and was bacterial species dependent.Conclusions: Plasma endotoxin was more related to GN than to Gram-positive bacteremia, and that endotoxin level was species dependent, but PCT level remained relatively more stable within the GN bacteria caused bacteremia.Both GN and positive bacteria caused bacteremia in the ICU patients in different regions of China.And PCT is a more valuable biomarker than endotoxin
Full Text Available Background: Ventilator Associated Pneumonia (VAP, developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates.Methods: Neonates admitted to neonatal intensive care unit (NICU, over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation, NICU length of stay, hospital cost, and death.Results: Thirty eight patients were enrolled (58% were boys and 42% were girls. 42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni (43%. On multiple regression analysis, duration of mechanical ventilation was associated with VAP (P=0.00. Patients with VAP had greater need for mechanical ventilation (18.7 vs 6 median days, longer NICU length of stay (39 vs 21.5 median days and higher total median hospital costs (79.5 vs 52 million rials than those without VAP. The mortality rate was not different between two groups.Conclusion: In mechanically ventilated neonates, those with VAP had a prolonged need for mechanical ventilation, a longer NICU stay, and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn’t increase mortality in patients.
Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires that physicians, radiologic technologists and other health care providers develop good communication skills and address patient needs effectively. Patient-centered care also requires that the health care provider become a patient advocate and strive to provide care that not only is effective but also safe. For radiologic technologists, patient-centered care encompasses principles such as the as low as reasonably achievable (ALARA) concept and contrast media safety. Patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store. According to one theory, most patients judge the quality of their healthcare much like they rate an airplane flight. They assume that the airplane is technically viable and is being piloted by competent people. Criteria for judging a particular airline are personal and include aspects like comfort, friendly service and on-time schedules. Similarly, patients judge the standard of their healthcare on nontechnical aspects, such as a healthcare practitioner's communication and "soft skills." Most are unable to evaluate a practitioner's level of technical skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care.(1). PMID:19901351
Objectives: To investigate how changes in service delivery within the radiology department of an acute district general hospital optimized imaging services for patients and referrers through a strong emphasis on team-working. Methods: Data related to service delivery was collected for three consecutive years and interrogated by imaging modality and reporting practitioner (radiologist, reporting radiographer, sonographer) to explore how workload had changed over the cycle. Results: Departmental activity demonstrated consistent increases, both overall (13.3%) and for most modalities (MRI 43.7%, CT 22.8%) for the study period (March 2010–March 2013). Overall trend suggested significantly shorter waiting times (CT 0.7 weeks, MRI 1.3 weeks, non-obstetric ultrasound one week; all modalities p = 0.001). Some modality variation in reporting times was apparent, with CT (p = 0.06) and MRI (p = 0.01) decreasing but there was an increase in X-ray reporting times (p = 0.001). Reporting radiographers and sonographers reported the majority of X-ray and non-obstetric ultrasound interpretations (59% and 52%, respectively). A radiographer-led neonatal reporting service was implemented and the urology patient pathway redesigned. Effective team-working produced savings of three full-time consultant radiologist posts. Conclusion: Radiologists and radiographers, working together, can deliver an effective service. Innovation, staff development and redesign of patient pathways, have produced significant improvements
Vaara, Suvi T; Pettilä, Ville; Reinikainen, Matti; Kaukonen, Kirsi-Maija
Introduction Acute kidney injury (AKI) increases mortality and morbidity of critically ill patients. Mortality of patients treated with renal replacement therapy (RRT) is high. We aimed to evaluate the nationwide incidence of RRT-treated AKI in Finland, hospital and six-month mortality, and health-related quality of life (HRQoL) of these patients. Methods We performed a retrospective cohort study including all general intensive care unit (ICU) admissions in Finland in 2007 through 2008. We id...
Wang, Tao; Cui, Yun-Liang; Lin, Zhao-Fen; Chen, De-Chang
Background: Both procalcitonin (PCT) and plasma endotoxin levels cannot be solely used for a definite diagnosis of bacteremia or sepsis, and there has been few study comparing the values of the two biomarkers for the diagnosis of bacteremia. The aim of this study was to identify bacteria causing bacteremia and evaluate the role of the two biomarkers in the diagnosis of bacteremia in Intensive Care Unit (ICU). Methods: The medical records of 420 patients in ICU were retrospectively reviewed. Patients (n = 241) who met the inclusion criteria were subjected to blood culture (BC) for the analysis of the endotoxin or PCT levels. The exclusion criteria included the presence of infection with human immunodeficiency virus and/or AIDS, neutropenia without sepsis, pregnancy, treatment with immunosuppressive therapies, or blood diseases such as hematological tumors. Patients’ BC episodes were divided into BC negative, Gram-negative (GN) bacteria, Gram-positive bacteria, and fungi groups. The PCT and plasma endotoxin levels were compared in the different groups. Results: A total of 241 patients with 505 episodes of BC were analyzed. The GN bacteria group showed higher levels of PCT and endotoxin than the BC negative, Gram-positive bacteria, and fungi groups. GN bacteremia was more prevalent than Gram-positive bacteremia. The GN bacteremia caused by non-Enterobacteriaceae infection presented higher endotoxin level than that by Enterobacteriaceae, but no significant difference in PCT levels was observed between the two groups. The plasma endotoxin significantly differed among different groups and was bacterial species dependent. Conclusions: Plasma endotoxin was more related to GN than to Gram-positive bacteremia, and that endotoxin level was species dependent, but PCT level remained relatively more stable within the GN bacteria caused bacteremia. Both GN and positive bacteria caused bacteremia in the ICU patients in different regions of China. And PCT is a more valuable
Simon Condliffe; Charles Link; Micheal F. Pollack; Shreekant Parasuraman
We identify a representative sample of U.S. diabetes patients with comorbid hypertension and evaluate health care expenditures in this population across BMI strata. The underlying hypothesis is that the presence of comorbid obesity and hypertension poses an additional burden on patients with diabetes, thus impacting their overall resource utilization. That is, hypertension and obesity in combination have a greater adverse impact on health care expenditures than individually. More than one-thi...
Full Text Available Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without diabetes and has a strong association with increased mortality in the intensive care unit patients. Insulin is the drug of choice to treat hyperglycemia in the intensive care unit. In patients with moderate hyperglycemia a basal–bolus insulin concept can be used. Close glucose monitoring is of paramount importance throughout the intensive care unit stay of the patient. In the guidelines for glycemic control based on meta-analyses it was shown that a tight glycemic control does not have a significant mortality advantage over conventional treatment. Given the controversy about optimal blood glucose goals in the intensive care unit setting, it seems reasonable to target a blood glucose level around 140 mg/dL to avoid episodes of hypoglycemia and minimize glycemic variability. The closed loop system with continuous glucose monitoring and algorithm based insulin application by an infusion pump is a promising new concept with the potential to further reduce mortality and morbidity due to hyperglycemia, hypoglycemia and glycemic variability. The goal of this review was to give a brief overview about pathophysiology of hyperglycemia and to summarize current guidelines for glycemic control in critically ill patients.
Mariana de Almeida Moraes Gibaut
Full Text Available This study aimed to identify the level of comfort of families of patients in a critical health condition related to the welcoming practices performed by the hospital staff. Interviews were conducted with 250 relatives in hospitals of the state Bahia, using a Likert scale. Data were analyzed as percentages and quartiles. For nine of the 12 statements of the scale, most relatives scored their comfort level between very and totally comfortable, median of 4,revealing kindness, tranquility and friendly communication with family members. More than half of the sample scored its level as not at all to more or less comfortable, median of 3, for statements about demonstration of interest towards the relative by the staff and flexible visiting of the patient. The necessity of greater interest of the team in the condition and needs of the family was observed. Promoting comfort from the dimension of welcoming demands interdisciplinary actions grounded in humanistic philosophy, in which the nurse has an important role to play.
Full Text Available INTRODUCTION: Care of the critically ill parturient is a unique challenge in obstetrics particularly because of its unpredictability. Hemorrhage , toxemia , anemia and septicemia are common causes of mortality and morbidity in these patients. Obstetric critical care in developing countries continues to be ra dically different from developed countries. AIMS AND OBJECTIVES: To analyze all cases of critically ill obstetric patients admitted to an obstetric intensive care unit in relation to causes for admissions, interventions required, course during their ICU st ay and fetal maternal outcome. MATERIALS AND METHODS : A one year retrospective analysis of all obstetric admissions to the ICU at our referral hospital was conducted, observations made and results were analyzed . RESULTS AND ANALYSIS : There were 24 ICU admi ssions with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33%, n=20, P <0.05 with more patients presenting with obstetric complications (91.66%, n=22, P <0.01 as compared to medical complications (8.32%, n=2. Obstetric hemorrhage (n=15, 62.5% and hemodynamic instability (n=20, 83.33% were considered to be significant risk factors for ICU admission ( P =0.000. Inotropic support was required in 22 patients (91.66% while 17 p atients (70.83% required ventilatory support. The mean duration of ventilation (30.17±21.65 h and ICU stay (39.42±33.70 h were of significantly longer duration in survivors ( P =0.01, P =0.00 respectively versus non - survivors. The observed mortality n=10, 41.67% was significantly higher since ours is a referral tertiary center and delay in reaching the tertiary center from the place of occurrence of the mishap is a usual occurrence. CONCLUSION: Obstetric hemorrhage leading to hemodynamic instability remains the leading cause of ICU admissions and maternal mortality.
Peng, Jin-Min; Du, Bin; Wang, Qian; Weng, Li; Hu, Xiao-Yun; Wu, Chan-Yuan; Shi, Yan
Introduction Patients with idiopathic inflammatory myopathies (IIMs) are sometimes complicated with life-threatening conditions requiring intensive care unit (ICU) admission. In the past, owing to the low incidence of IIM, little was known about such patients. Our aim was to investigate the clinical features and outcomes of these patients and identify their risk factors for mortality. Methods A retrospective study was performed of IIM patients admitted over an 8-year period to the medical ICU of a tertiary referral center in China. We collected data regarding demographic features, IIM-related clinical characteristics, reasons for admission, organ dysfunction, and outcomes. Independent predictors of ICU mortality were identified through multivariate logistic regression analysis. Results Of the 102 patients in our cohort, polymyositis (PM), dermatomyositis (DM), and clinically amyopathic dermatomyositis (CADM) accounted for 23.5%, 64.7%, and 11.7% respectively. The median duration from the onset of IIM to ICU admission was 4.3 months (interquartile range [IQR], 2.6–9.4 months). Reasons for ICU admission were infection alone (39.2%), acute exacerbation of IIM alone (27.5%), the coexistence of both (27.5%), or other reasons (5.8%). Pneumonia accounted for 97% of the infections; 63.2% of infections with documented pathogens were caused by opportunistic agents. Rapid progressive interstitial lung disease (RP-ILD) was responsible for 87.5% of acute exacerbation of IIM. The median Acute Physiology and Chronic Health Evaluation II (APACHE II) score on ICU day 1 was 17 (IQR 14–20). On ICU admission, acute respiratory failure (ARF) was the most common type (80.4%) of organ failure. The mortality rate in the ICU was 79.4%. Factors associated with increased ICU mortality included a diagnosis of DM (including CADM), a high APACHE II score, the presence of ARF, a decreased PaO2/FiO2 ratio, and a low lymphocyte count at the time of ICU admission. Conclusions The outcome of IIM
Sherertz, R J; Heard, S O; Raad, I I; Gentry, L; Bowton, D; Scuderi, P; Hu, J.; Carruth, W; Satishchandra, B; J. Pepe; Mosenthal, A; Burke, T.; Dupuis, J.
In a randomized, double-blind trial, gamma radiation-sterilized, chlorhexidine-coated triple-lumen catheters were compared with uncoated control catheters for their ability to prevent catheter infection in 254 intensive care unit patients. The chlorhexidine coating was not efficacious, and a rabbit model demonstrated that reduction of chlorhexidine activity by gamma radiation sterilization was the likely explanation for the failure.
J.E. Klopotowska; R. Kuiper; H.J. van Kan; A.C. de Pont; M.G. Dijkgraaf; L. Lie-A-Huen; M.B. Vroom; S.M. Smorenburg
Introduction: Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an
... https://medlineplus.gov/news/fullstory_158830.html Many COPD Patients Have Trouble Finding Care They can face ... first comprehensive look at chronic obstructive pulmonary disease (COPD) care in the United States. COPD is the ...
Full Text Available Aims The present study is a fundamental effort to evaluate the bacteriological and antibiotic patterns in the Intensive Care Unit (ICU setting in a tertiary care hospital. This study was carried out to guide the clinician in choosing the appropriate antibiotics and to prevent emergence of multidrug resistance bacteria. Materials and Methods Between March 2009 to Feb 2012, the samples from various ICUs that were submitted to the microbiology laboratory for culture and sensitivity were included in this study. All the organisms were identified morphologically and biochemically by standard laboratory procedure and antibiotic susceptibility pattern was determined by disc diffusion methods. Result Of 3,780 specimens, 2,312 (61.1% isolates were recovered. Single organisms were isolated from 1,746 (75.5% samples while the remaining 566 (24.4% had two or more organisms isolated. Pseudomonas aeruginosa was the most common isolate 819 (35.4%, followed by Klebsiella pneumoniae 637 (27.5%. Antibiotics sensitivity of Pseudomonas aeruginosa showed that almost all isolates were resistant to cephalexin (97.8% and ciprofloxacin (80.3%. However (95.8% of the isolates were sensitive to tobramycin, (92.0% to meropenem & (74.80 % to amikacin. Conclusion It is concluded that Pseudomonas aeruginosa is the predominate pathogen isolated from ICUs of this Hospital. Most of the frequently isolated pathogens are resistant to cephalosporins and quinolone antibiotics as compared to aminoglycosides and carbapenem. Regular surveillance of antibiotic susceptibility pattern is very important for setting a guideline to the clinician in choosing an appropriate therapy of infected patients of ICUs. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-3, 1-8 DOI: http://dx.doi.org/10.3126/jcmsn.v8i3.8678
Reader, Tom W; Flin, R; Mearns, Kathryn; Cuthbertson, Brian H
Background. Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. Methods. Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. Results. A sample o...
Mohammadkarim BAHADORI; RAVANGARD, Ramin; Raadabadi, Mehdi; Mosavi, Seyed Masod; Gholami Fesharaki, Mohammad; Mehrabian, Fardin
Background: The nursing workload has a close and strong association with the quality of services provided for the patients. Therefore, paying careful attention to the factors affecting nursing workload, especially those working in the intensive care units (ICUs), is very important. Objectives: This study aimed to determine the factors affecting nursing workload in the ICUs of the hospitals affiliated to Tehran University of Medical Sciences. Materials and Methods: This was a cross-sectional a...
Drory, Y; Shapira, I; Goldbourt, U; Fisman, E Z; Villa, Y; Tenenbaum, A; Pines, A
The objective of the study was to assess factors associated with ward assignment in the emergency room for patients assignment (coronary care unit versus internal ward). Eight major centrally located Israeli hospitals provided data during one year. The study population included 1252 patients, of whom 83% were men, 37% were hypertensives, 22% were diabetics, and 14% had previous anginal syndrome. Most patients (83%) were admitted to the coronary care unit. Internal medicine ward assignment was significantly associated with advanced age, history of hypertension or diabetes, a longer time from appearance of symptoms to arrival at the hospital, and myocardial infarction type (non-Q-wave or non-anterior). The likelihood of medical ward referral increased stepwise with the increasing number of a patient's predictive factors: those with > or = 4 factors had a > 30% chance of being assigned to a medical ward compared to a decision making in the emergency room are needed to resolve this paradoxical situation. PMID:10998758
This is a database software application for information a neonatologist routinely considers in the newborn intensive care unit (NICU). Users enter data at the point of care on a handheld device that also encrypts the data. Data management follows synchronization via an ODBC DSN to a secure Microsoft® Access application. User feedback guides software modification over time. The poster illustrates the data model, the software user interface, and data management products.
Ziegler Thomas R
Full Text Available Abstract Background Vitamin D insufficiency is common in hospitalized patients. Recent evidence suggests that vitamin D may enhance the innate immune response by induction of cathelicidin (LL-37, an endogenous antimicrobial peptide produced by macrophages and neutrophils. Thus, the relationship between vitamin D status and LL-37 production may be of importance for host immunity, but little data is available on this subject, especially in the setting of human sepsis syndrome and other critical illness. Methods Plasma concentrations of 25-hydroxyvitamin D (25(OHD, vitamin D binding protein (DBP and LL-37 in critically ill adult subjects admitted to intensive care units (ICUs with sepsis and without sepsis were compared to healthy controls. Results Critically ill subjects had significantly lower plasma 25(OHD concentrations compared to healthy controls. Mean plasma LL-37 levels were significantly lower in critically ill subjects compared to healthy controls. Vitamin D binding protein levels in plasma were significantly lower in critically ill subjects with sepsis compared to critically ill subjects without sepsis. There was a significant positive association between circulating 25(OHD and LL-37 levels. Conclusion This study demonstrates an association between critical illness and lower 25(OHD and DBP levels in critically ill patients as compared to healthy controls. It also establishes a positive association between vitamin D status and plasma LL-37, which suggests that systemic LL-37 levels may be regulated by vitamin D status. Optimal vitamin D status may be important for innate immunity especially in the setting of sepsis. Further invention studies to examine this association are warranted.
Impact of hyperhydration on the mortality risk in critically ill patients admitted in intensive care units: comparison between bioelectrical impedance vector analysis and cumulative fluid balance recording
Samoni, Sara; Vigo, Valentina; Reséndiz, Luis Ignacio Bonilla; Villa, Gianluca; De Rosa, Silvia; Nalesso, Federico; Ferrari, Fiorenza; Meola, Mario; Brendolan, Alessandra; Malacarne, Paolo; Forfori, Francesco; Bonato, Raffaele; Donadio, Carlo; Ronco, Claudio
Background Studies have demonstrated a positive correlation between fluid overload (FO) and adverse outcomes in critically ill patients. The present study aims at defining the impact of hyperhydration on the Intensive Care Unit (ICU) mortality risk, comparing Bioelectrical Impedance Vector Analysis (BIVA) assessment with cumulative fluid balance (CFB) recording. Methods We performed a prospective, dual-centre, clinician-blinded, observational study of consecutive patients admitted to ICU with...
B Abhilash; Chakra Dhar Tripathi; Anoop Raj Gogia; Girish Gulab Meshram; Manu Kumar; Suraj, B.
Background and Aim: Widespread use of imipenem in intensive care units (ICUs) in India has led to the development of numerous carbapenemase-producing strains of pathogens. The altered pathophysiological state in critically ill patients could lead to subtherapeutic antibiotic levels. Hence, the aim of this study was to investigate the variability in the pharmacokinetic and pharmacodynamic profile of imipenem in critically ill patients admitted to an ICU in India. Materials and Methods: Plasma ...
Wasim Ahmed; Javed I Memon; Rifat Rehmani; Abdulmajeed Al Juhaiman
Acute kidney injury (AKI) in the intensive care unit (ICU) is commonly caused by severe sepsis and septic shock. There is limited data regarding the incidence and outcomes of patients developing AKI treated with early goal-directed therapy (EGDT). Our aim was to observe the incidence and outcomes of patients with AKI in severe sepsis and septic shock, treated with EGDT as compared with historic controls. Study subjects included all adults admitted to the ICU with a diagnosis of severe sepsis ...
Mehrdad Masoudifar; Omid Aghadavoudi; Lida Nasrollahi
Background: There is insufficient evidence to conclude that the timing of tracheostomy alters the duration of mechanical ventilation, hence this study was designed to investigate the correlation between timing of tracheostomy and duration of mechanical ventilation for patients admitted to intensive care unit (ICU) with potentially normal lungs. Materials and Methods: In a retrospective study for a period of 2 years, all adult patients admitted to the medical ICU of Al-Zahra Hospital in Is...
Biais, Matthieu; Ehrmann, Stephan; Mari, Arnaud; Conte, Benjamin; Mahjoub, Yazine; Desebbe, Olivier; Pottecher, Julien; Lakhal, Karim; Benzekri-Lefevre, Dalila; Molinari, Nicolas; Boulain, Thierry; Lefrant, Jean-Yves; Muller, Laurent; ,
Introduction Pulse pressure variation (PPV) has been shown to predict fluid responsiveness in ventilated intensive care unit (ICU) patients. The present study was aimed at assessing the diagnostic accuracy of PPV for prediction of fluid responsiveness by using the grey zone approach in a large population. Methods The study pooled data of 556 patients from nine French ICUs. Hemodynamic (PPV, central venous pressure (CVP) and cardiac output) and ventilator variables were recorded. Responders we...
Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors
Renom-Guiteras, Anna; Planas, José; Farriols, Cristina; Mojal, Sergi; Miralles, Ramón; Silvent, Maria A; Ruiz-Ripoll, Ada I
Background The aims of this study were: 1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account. Methods Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was asse...
... Order from the National Technical Information Service NCHS Dementia Special Care Units in Residential Care Communities: United ... Facilities Seventeen percent of residential care communities had dementia special care units. Figure 1. Number and percent ...
Full Text Available Abstract Background Studies consistently highlight in-patient postnatal care as the area of maternity care women are least satisfied with. As part of a quality improvement study to promote a continuum of care from the birthing room to discharge home from hospital, we explored women's expectations and experiences of current in-patient care. Methods For this part of the study, qualitative data from semi-structured interviews were transcribed and analysed using content analyses to identify issues and concepts. Women were recruited from two postnatal wards in one large maternity unit in the South of England, with around 6,000 births a year. Results Twenty women, who had a vaginal or caesarean birth, were interviewed on the postnatal ward. Identified themes included; the impact of the ward environment; the impact of the attitude of staff; quality and level of support for breastfeeding; unmet information needs; and women's low expectations of hospital based postnatal care. Findings informed revision to the content and planning of in-patient postnatal care, results of which will be reported elsewhere. Conclusions Women's responses highlighted several areas where changes could be implemented. Staff should be aware that how they inter-act with women could make a difference to care as a positive or negative experience. The lack of support and inconsistent advice on breastfeeding highlights that units need to consider how individual staff communicate information to women. Units need to address how and when information on practical aspects of infant care is provided if women and their partners are to feel confident on the woman's transfer home from hospital.
Lee, Yi-Jang; Chao, Cheng-Han; Chang, Ying-Feng; Chou, Chien
The actin depolymerizing factor (ADF)/cofilin protein family has been reported to be associated with ischemia induced renal disorders. Here we examine if cofilin-1 is associated with acute kidney injury (AKI). We exploited a 96-well based fiber-optic biosensor that uses conjugated gold nanoparticles and a sandwich immunoassay to detect the urine cofilin-1 level of AKI patients. The mean urine cofilin-1 level of the AKI patients was two-fold higher than that of healthy adults. The receiver operating characteristic (ROC) curve showed that cofilin-1 is a potential biomarker for discriminating AKI patients from healthy adults for intensive care patients.
Bagheri-Nesami, Masoumeh; Gorji, Mohammad Ali Heidari; Rezaie, Somayeh; Pouresmail, Zahra; Cherati, Jamshid Yazdani
The purpose of this three-group double-blind clinical trial study was to investigate the effect of acupressure (指壓 zhǐ yā) with valerian (纈草 xié cǎo) oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome (ACS) in a coronary intensive care unit (CCU). This study was conducted on 90 patients with ACS in Mazandaran Heart Center (Sari, Iran) during 2013. The patients were randomly assigned to one of three groups. Patients in the acupressure with valerian oil 2.5% ...
A rapid response team was instigated in Cork to improve prehospital care and reduce unnecessary Emergency Department (ED) visits. This consisted of a Specialist Registrar (SpR) in Emergency Medicine and a Paramedic who attended all "999" calls in a designated rapid response vehicle on the allotted study days. Two hundred and sixty-three patients were seen on designated days between Jan 2004 and March 2006. Presentations seen included; road traffic accident (23%) collapse (12%), fall (10%) and seizure (8%). The majority of calls were to houses (36%). The most common medical intervention was intravenous cannulation (25%). Intravenous medications were administered in 21% of these patients--morphine sulphate was the most common drug given. It was possible to safely discharge 31% of patients on scene. In our experience skilled Emergency Medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance.
Ilusca Cardoso de Paula; Luciano Cesar Pontes de Azevedo; Luiz Fernando dos Reis Falcão; Bruno Franco Mazza; Melca Maria Oliveira Barros; Flavio Geraldo Rezende Freitas; Flávia Ribeiro Machado
Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusio...
Full Text Available Introduction: Family satisfaction of Intensive Care Unit (FS-ICU care is believed to be associated with ICU survival and ICU outcomes. A review of literature was done to determine factors influencing FS-ICU care in ICU deaths. Results: Factors that positively influenced FS-ICU care were (a communication: Honesty, accuracy, active listening, emphatic statements, consistency, and clarity; (b family support: Respect, compassion, courtesy, considering family needs and wishes, and emotional and spiritual support; (c family meetings: Meaningful explanation and frequency of meetings; (d decision-making: Shared decision-making; (e end of life care support: Support during foregoing life-sustaining interventions and staggered withdrawal of life support; (f ICU environment: Flexibility of visiting hours and safe hospital environment; and (g other factors: Control of pain and physical symptoms, palliative care consultation, and family-centered care. Factors that negatively influenced FS-ICU care were (a communication: Incomplete information and unable to interpret information provided; (b family support: Lack of emotional and spiritual support; (c family meetings: Conflicts and short family meetings; (d end of life care support: Resuscitation at end of life, mechanical ventilation on day of death, ICU death of an elderly, prolonged use of life-sustaining treatment, and unfamiliar technology; and (e ICU environment: Restrictive visitation policies and families denied access to see the dying loved ones. Conclusion: Families of the patients admitted to ICU value respect, compassion, empathy, communication, involvement in decision-making, pain and symptom relief, avoiding futile medical interventions, and dignified end of life care.
Barry, Ben N; Mallick, Abhiram; Bodenham, Andrew R; Vucevic, Michael
Background: Bolus thermodilution is the standard bedside method of cardiac output measurement in the intensive care unit (ICU). The Baxter Vigilance monitor uses a modified thermodilution pulmonary artery catheter with a thermal filament to give a continuous read-out of cardiac output. This has been shown to correlate very well with both the 'gold standard' dye dilution method and the bolus thermodilution method. Bioimpedance cardiography using the Bomed NCCOM 3 offers a noninvasive means of ...
Full Text Available The most essential matter about following a patient in intensive care unit is a fine and correct monitorization. While benefitting from monitorization is the main objective of every intensive care physician, it should be discussed how successful we are when we do not take monitorization as a subject of interest sufficiently. This physicians who are both performing medical care and education has a very important role regarding the matter: To question and confirm the correctness of the parameters that are being followed and to use this data for choosing the treatment type. The vital parameters that are found necessary to be followed usually do not present us the sufficient utility. For purpose, implementing monitorization in a way of whole perspective including Examining, Questioning, Reading (Observing, Repeating, Recalling will maintain to receive consequences for the benefit of the patient. (Journal of the Turkish Society Intensive Care 2011; 9: 110-5
Madden, Kevin; Wolfe, Joanne; Collura, Christopher
The chronicity of illness that afflicts children in Pediatric Palliative Care and the medical technology that has improved their lifespan and quality of life make prognostication extremely difficult. The uncertainty of prognostication and the available medical technologies make both the neonatal intensive care unit and the pediatric intensive care unit locations where many children will receive Pediatric Palliative Care. Health care providers in the neonatal intensive care unit and pediatric intensive care unit should integrate fundamental Pediatric Palliative Care principles into their everyday practice. PMID:26333755
Bro Brask, Kirsten; Birkelund, Regner
The aim of this study was to research how the staff experience care expressed during the brief encounter with the patients in a diagnostic imaging department. This was a qualitative study with a phenomenological and hermeneutical frame of reference. The data were collected using field observations...... and semistructured interviews and analyzed according to the guidelines for meaning condensation by Giorgi. The imaging staff found that care is expressed in an administrative, an instrumental, and a compassionate sense. The imaging staff perceived care in a way that clearly differs from the traditional perception...... of care understood as the close relations between people. In their self-understanding, the staff found that care not only comprised the relational aspect but also that it was already delivered during the preparatory phases before the actual meeting with the patient and up until the image...
Relatives may experience a difficult and demanding situation when the patient is critically ill. During the period in the intensive care unit (ICU), the relatives may be subject to strong emotions of an existential nature, and the situation may involve several stressors as a result of changed roles, responsibilities and routines. These emotional stress experiences may result in weakened mental and physical functioning on the part of the relatives. During the patient’s rehabilitation at home t...
Pérez-Bárcena, Jon; Crespí, Catalina; Regueiro, Verónica; Marsé, Pedro; Raurich, Joan M; Ibáñez, Jordi; García de Lorenzo-Mateos, Abelardo; Bengoechea, José A.
Introduction The use of glutamine as a dietary supplement is associated with a reduced risk of infection. We hypothesized that the underlying mechanism could be an increase in the expression and/or functionality of Toll-like receptors (TLR), key receptors sensing infections. The objective of this study was to evaluate whether glutamine supplementation alters the expression and functionality of TLR2 and TLR4 in circulating monocytes of trauma patients admitted to the intensive care unit (ICU)....
Moeini, Mahin; Khadibi, Maryam; Bekhradi, Reza; Mahmoudian, Seyed Ahmad; Nazari, Fatemeh
BACKGROUND: Sleep disorder is one of the common problems patients face in ICU and CCU and it is usually treated by sleeping pills. Nowadays, the complementary medicine is highly considered because of its effectiveness and safety. Aromatherapy is one of the holistic nursing cares which sees human beings as a biological, mental and social unit while the psychological dimension has the central role. Each of these dimensions is dependent on each other and is affected by each other. Therefore, it ...