WorldWideScience

Sample records for adult critical care

  1. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  2. Waterborne Elizabethkingia meningoseptica in Adult Critical Care1

    Science.gov (United States)

    Owens, Daniel S.; Jepson, Annette; Turton, Jane F.; Ashworth, Simon; Donaldson, Hugo; Holmes, Alison H.

    2016-01-01

    Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome >2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source–associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen. PMID:26690562

  3. Mead Johnson Critical Care Symposium for the Practising Surgeon. 1. Transport of critically ill adult patients.

    Science.gov (United States)

    Girotti, M J; Pagliarello, G

    1988-09-01

    Interhospital transportation of critically ill patients over long distances is common in the tiered health care systems of North America. The authors describe their 1-year experience with a physician-assisted transport system, operating out of the surgical intensive care unit at the Toronto General Hospital. The application of a well-known severity of illness measure (therapeutic intervention scoring system) allowed them to correlate severity of illness, as assessed over the telephone before patient transfer, with eventual outcome after admission to the surgical intensive care unit. Their analysis of 107 critically ill patients transported by this system led them to conclude that the system is reliable and is associated with acceptable morbidity and mortality. PMID:3138018

  4. What is supportive when an adult next-of-kin is in critical care?

    Science.gov (United States)

    Johansson, Ingrid; Fridlund, Bengt; Hildingh, Cathrine

    2005-01-01

    There is little documented knowledge about what is supportive from the perspective of relatives with a critically ill next-of-kin in the intensive care unit (ICU). The aim of the present study was to generate a theoretical understanding of what relatives experience as supportive when faced with the situation of having an adult next-of-kin admitted to critical care. The study was designed using a grounded theory methodology. Interviews were conducted with 29 adult relatives of adult ICU patients in southwest Sweden. Relatives described the need to be empowered and that support was needed to enable them to use both internal and external resources to cope with having a next-of-kin in critical care. To achieve empowerment, the relatives described the need to trust in oneself, to encounter charity and to encounter professionalism. The findings can contribute understanding and sensitivity to the situation of the relatives as well as indicating what form social support should take. It is essential that healthcare professionals understand how important it is for relatives to have control over their vulnerable situation and that they also reflect upon how they would like to be treated themselves in a similar situation. Recommendations for future practice are presented. PMID:16255336

  5. About Critical Care Nursing

    Science.gov (United States)

    ... requiring intense and vigilant nursing care. Number of Critical Care Nurses in the United States According to "The Registered ... nurses who work in a hospital setting. Where Critical Care Nurses Work According to "The Registered Nurse Population" study, ...

  6. Critical care during epidemics

    OpenAIRE

    Rubinson, Lewis; O'Toole, Tara

    2005-01-01

    We recommend several actions that could improve hospitals' abilities to deliver critical care during epidemics involving large numbers of victims. In the absence of careful pre-event planning, demand for critical care services may quickly exceed available intensive care unit (ICU) staff, beds and equipment, leaving the bulk of the infected populace without benefit of potentially lifesaving critical care. The toll of death may be inversely proportional to the ability to augment critical care c...

  7. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients.

    Science.gov (United States)

    Cox, Jill; Rasmussen, Louisa

    2014-12-01

    Prevention and healing of pressure ulcers in critically ill patients can be especially challenging because of the patients' burden of illness and degree of physiological compromise. Providing adequate nutrition may help halt the development or worsening of pressure ulcers. Optimization of nutrition can be considered an essential ingredient in prevention and healing of pressure ulcers. Understanding malnutrition in critical care patients, the effect of nutrition on wound healing, and the application of evidence-based nutritional guidelines are important aspects for patients at high risk for pressure ulcers. Appropriate screenings for nutritional status and risk for pressure ulcers, early collaboration with a registered dietician, and administration of appropriate feeding formulations and micronutrient and macronutrient supplementation to promote wound healing are practical solutions to improve the nutritional status of critical care patients. Use of nutritional management and enteral feeding protocols may provide vital elements to augment nutrition and ultimately result in improved clinical outcomes.

  8. Critical Care Team

    Science.gov (United States)

    ... of these areas: Surgery Internal medicine Pediatrics Anesthesiology Critical care nurse: A highly skilled nurse who provides all aspects ... and can often uphold the patient's wishes. The critical care nurse becomes an important part of decision-making with ...

  9. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  10. Perceived barriers to the regionalization of adult critical care in the United States: a qualitative preliminary study

    Directory of Open Access Journals (Sweden)

    Rubenfeld Gordon D

    2008-11-01

    Full Text Available Abstract Background Regionalization of adult critical care services may improve outcomes for critically ill patients. We sought to develop a framework for understanding clinician attitudes toward regionalization and potential barriers to developing a tiered, regionalized system of care in the United States. Methods We performed a qualitative study using semi-structured interviews of critical care stakeholders in the United States, including physicians, nurses and hospital administrators. Stakeholders were identified from a stratified-random sample of United States general medical and surgical hospitals. Key barriers and potential solutions were identified by performing content analysis of the interview transcriptions. Results We interviewed 30 stakeholders from 24 different hospitals, representing a broad range of hospital locations and sizes. Key barriers to regionalization included personal and economic strain on families, loss of autonomy on the part of referring physicians and hospitals, loss of revenue on the part of referring physicians and hospitals, the potential to worsen outcomes at small hospitals by limiting services, and the potential to overwhelm large hospitals. Improving communication between destination and source hospitals, provider education, instituting voluntary objective criteria to become a designated referral center, and mechanisms to feed back patients and revenue to source hospitals were identified as potential solutions to some of these barriers. Conclusion Regionalization efforts will be met with significant conceptual and structural barriers. These data provide a foundation for future research and can be used to inform policy decisions regarding the design and implementation of a regionalized system of critical care.

  11. Coping strategies when an adult next-of-kin/close friend is in critical care: a grounded theory analysis.

    Science.gov (United States)

    Johansson, Ingrid; Hildingh, Cathrine; Fridlund, Bengt

    2002-04-01

    The aim of the study was to generate a theoretical model of how relatives/close friends cope when faced with having an adult next-of-kin/close friend admitted to critical care. Using interviews, data were collected from 18 relatives/close friends of adult patients in thoracic surgical, neurosurgical, coronary, and general ICUs in south-west Sweden. The design incorporated grounded theory methodology. The results indicate the relatives/close friends tried to make the experience of their situation easier, but that the approaches used differed in accordance with the individual's internal and external resources. Four coping strategies exhibiting different characteristics were identified: the relatives/close friends alleviated, recycled, mastered, or excluded their feelings. Factors determining the choice of coping strategy were social background, previous experience of ICU-care and how the situation was apprehended. The theoretical model described in this article can contribute to expanding nurses' understanding of the coping strategies of relatives/close friends in critical care. PMID:12353657

  12. Making space for belonging: critical reflections on the implementation of personalised adult social care under the veil of meaningful inclusion.

    Science.gov (United States)

    Power, Andrew

    2013-07-01

    This paper critically reflects on the way in which recent adult social care reform has been evolving beneath the alleged policy goal of prioritising the cultivation of meaningful inclusion and 'belonging' in the community. With this goal, there has been a focus away from 'services' for persons with intellectual disabilities, to supporting natural connections within the community. This paper draws on a grounded theory study of the perspectives of those responsible for overseeing community living arrangements for persons with disabilities, drawing on interviews and focus groups with service providers and relevant government officials. It examines the socio-spatial implications of the gradual shift towards 'belonging' as a disability policy goal, as it has evolved in two discrete settings - British Columbia, Canada and Ireland. The findings identify the complexities involved in facilitating active community connection for persons with intellectual disabilities and reveal important cautionary lessons for other jurisdictions where community living policy has arguably been moving away from communal services towards self-managed supports in 'real' communities through personal budgets in an effort to remove barriers to participation. The paper thus critically reflects on the rapid pursuit for transformation in personalised adult social care in government policy, arguing that the process of fostering meaningful community inclusion will and should take time.

  13. Critical care in India.

    Science.gov (United States)

    Udwadia, F E; Guntupalli, K K; Vidyasagar, D

    1997-04-01

    India is a vast democracy of nearly one billion people. Before the British rule ended in 1947, the life span of an Indian was a mere 21 years. Within a short span of 50 years, it increased to an impressive 63 years, largely due to public health measures initiated by the government. This created a pool of more than 300 million middle class Indians who could afford the benefits of modern and specialized care when needed. Critical care medicine, as practiced in the West, is still confined to large Metropolitan areas. A large pool of expatriate Indian physicians from all over the world are helping bridge the resource gap between the West and India by transfer of technology and providing appropriate training to physicians and paramedical personnel. This article describes the history and current status of development of critical care medicine in India. PMID:9107510

  14. Predictive power of the Braden scale for pressure sore risk in adult critical care patients: a comprehensive review.

    Science.gov (United States)

    Cox, Jill

    2012-01-01

    Critical care is designed for managing the sickest patients within our healthcare system. Multiple factors associated with an increased likelihood of pressure ulcer development have been investigated in the critical care population. Nevertheless, there is a lack of consensus regarding which of these factors poses the greatest risk for pressure ulceration. While the Braden scale for pressure sore risk is the most commonly used tool for measuring pressure ulcer risk in the United States, research focusing on the cumulative Braden Scale score and subscale scores is lacking in the critical care population. This author conducted a literature review on pressure ulcer risk assessment in the critical care population, to include the predictive value of both the total score and the subscale scores. In this review, the subscales sensory perception, mobility, moisture, and friction/shear were found to be associated with an increased likelihood of pressure ulcer development; in contrast, the Activity and Nutrition subscales were not found to predict pressure ulcer development in this population. In order to more precisely quantify risk in the critically ill population, modification of the Braden scale or development of a critical care specific risk assessment tool may be indicated.

  15. Society of Critical Care Medicine

    Science.gov (United States)

    ... Care App Social Media Critical Care Statistics eCommunity Media Relations SmartBrief SCCM App Education Center Annual Congress Program ... Care App Social Media Critical Care Statistics eCommunity Media Relations SmartBrief SCCM App Education Center Annual Congress Program ...

  16. Sepsis in critical care.

    Science.gov (United States)

    King, Joan E

    2007-03-01

    Sepsis is a syndrome produced by the accelerated activity of the inflammatory immune response, the clotting cascade, and endothelial damage. It is a systematic process that can progress easily into septic shock and MODS. The chemical mediators or cytokines produce a complex self-perpetuating process that impacts all body systems. It is critical for the nurse first to identify patients at risk for developing sepsis and to assess patients who have SIRS and sepsis continually for signs and symptoms of organ involvement and organ dysfunction. Once sepsis has been diagnosed, evidence-based practice indicates initiation of fluid resuscitation. Vasopressor therapy, positive inotropic support, and appropriate antibiotic therapy should be started within the first hour. Within a 6-hour timeframe the goal is stabilization of the CVP, MAP, and UOP to prevent further organ damage. The challenge for nurses caring for septic patients is to support the treatment goals, to prevent added complications including stress ulcers, DVTs, aspiration pneumonia, and the progression to MODS, and to address the patient's and the family's psychosocial needs. As complex as the pathophysiology of sepsis is, the nursing care is equally complex but also rewarding. Patients who previously might have died now recover as vigilant nursing care combines forces with new drug therapies and evidence-based practice guidelines.

  17. Teamwork in obstetric critical care

    OpenAIRE

    Guise, Jeanne-Marie; Segel, Sally

    2008-01-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well t...

  18. Critical Care Statistics

    Science.gov (United States)

    ... mortality rate of up to 61%, and severe respiratory failure has a mortality rate ranging from 20% to 50%. Sepsis, the second ... renal failure, and up to 20% have acute respiratory failure requiring mechanical ventilatory support. Overall, mortality rates in patients admitted to adult ICUs average 10% ...

  19. Critical Care of Pet Birds.

    Science.gov (United States)

    Jenkins, Jeffrey Rowe

    2016-05-01

    Successful care of the critical pet bird patient is dependent on preparation and planning and begins with the veterinarian and hospital staff. An understanding of avian physiology and pathophysiology is key. Physical preparation of the hospital or clinic includes proper equipment and understanding of the procedures necessary to provide therapeutic and supportive care to the avian patient. An overview of patient intake and assessment, intensive care environment, and fluid therapy is included. PMID:27131161

  20. Teamwork in obstetric critical care.

    Science.gov (United States)

    Guise, Jeanne-Marie; Segel, Sally

    2008-10-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.

  1. Critical care nurses’ views on medication administration: an organizational perspective

    OpenAIRE

    Mansour, Mansour

    2009-01-01

    The Organizational Safety Space Model (OSSM) was developed as a tool to investigate the factors which influence the safety of industrial operations. It is applied in this study to investigate the safety of medication administration in adult critical care settings, including Intensive Care Units and High Dependency Units. In this study, semi-structured interviews were conducted with 33 adult critical care nurses. The participants’ views on the safety of medication administration were analyzed ...

  2. Update in Critical Care 2015.

    Science.gov (United States)

    Dres, Martin; Mancebo, Jordi; Curley, Gerard F

    2016-07-01

    This review documents important progress made in 2015 in the field of critical care. Significant advances in 2015 included further evidence for early implementation of low tidal volume ventilation as well as new insights into the role of open lung biopsy, diaphragmatic dysfunction, and a potential mechanism for ventilator-induced fibroproliferation. New therapies, including a novel low-flow extracorporeal CO2 removal technique and mesenchymal stem cell-derived microparticles, have also been studied. Several studies examining the role of improved diagnosis and prevention of ventilator-associated pneumonia also showed relevant results. This review examines articles published in the American Journal of Respiratory and Critical Care Medicine and other major journals that have made significant advances in the field of critical care in 2015. PMID:27367886

  3. Critical issues in burn care.

    Science.gov (United States)

    Holmes, James H

    2008-01-01

    Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. Burn centers have been operational for over 50 years, but the complexity and costs of providing specialized burn care have given rise to a number of critical administrative and political issues. These include logistical limitations imposed by the uneven national distribution of burn centers and a potential shortage of burn beds, both during everyday conditions and in the event of a mass disaster. Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.

  4. Glucose control in critical care

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Glycemic control among critically-ill patients has beena topic of considerable attention for the past 15 years.An initial focus on the potentially deleterious effects ofhyperglycemia led to a series of investigations regardingintensive insulin therapy strategies that targeted tightglycemic control. As knowledge accumulated, the pursuitof tight glycemic control among critically-ill patients cameto be seen as counterproductive, and moderate glycemiccontrol came to dominate as the standard practice inintensive care units. In recent years, there has beenincreased focus on the importance of hypoglycemicepisodes, glycemic variability, and premorbid diabeticstatus as factors that contribute to outcomes amongcritically-ill patients. This review provides a survey ofkey studies on glucose control in critical care, and aimsto deliver perspective regarding glycemic managementamong critically-ill patients.

  5. What Is a Pediatric Critical Care Specialist?

    Science.gov (United States)

    ... in a pediatric intensive care unit (PICU). Pediatric critical care specialists coordinate the care of these children which is provided by a team of doctors, nurses, and other health care specialists. They use the ...

  6. Critical Discourse Analysis, Adult Education and "Fitba"

    Science.gov (United States)

    Player, John

    2013-01-01

    In this article I will use an example of current adult education practice, the Glory and Dismay Football Literacies Programme (GDFLP) to appraise the value of critical discourse analysis (CDA) for adult learners, both individually and collectively, and for adult education practitioners with an interest in developing critical literacy skills. The…

  7. The Affordable Care Act and implications for young adult health

    OpenAIRE

    Monaghan, Maureen

    2013-01-01

    In the USA, young adults are most likely to be uninsured and least likely to report a usual source of medical care than any age group. The Patient Protection and Affordable Care Act (ACA) recognizes the critical need for expanded insurance coverage for this age group, and multiple provisions of the ACA address insurance coverage and health care utilization in young adults. This paper presents a brief overview of the challenges of maintaining health insurance coverage and accessing health care...

  8. Burnout in critical care nurses: a literature review.

    Science.gov (United States)

    Epp, Kirstin

    2012-01-01

    Burnout and its development in critical care nurses is a concept that has received extensive study, yet remains a problem in Canada and around the world. Critical care nurses are particularly vulnerable to developing burnout due to the chronic occupational stressors they are exposed to, including high patient acuity, high levels of responsibility, working with advanced technology, caring for families in crisis, and involved in morally distressing situations, particularly prolonging life unnecessarily. The purpose of this article is to explore how the chronic stressors that critical care nurses are exposed to contribute to the development of burnout, and strategies for burnout prevention. A review of the literature between the years 2007 and 2012 was conducted and included the search terms burnout, moral distress, compassion fatigue, intensive care, critical care, and nursing. The search was limited to the adult population, English language, and Western cultures. The results revealed that nurse managers play a crucial role in preventing burnout by creating a supportive work environment for critical care nurses. Strategies for nurse managers to accomplish this include being accessible to critical care nurses, fostering collegial relationships among the different disciplines, and making a counsellor or grief team available to facilitate debriefing after stressful situations, such as a death. In addition, critical care nurses can help prevent burnout by being a support system for each other and implementing self-care strategies.

  9. Year in review 2013: Critical Care - respirology

    OpenAIRE

    Curley, Gerard F; Slutsky, Arthur S.

    2014-01-01

    This review documents important progress made in 2013 in the field of critical care respirology, in particular with regard to acute respiratory failure and acute respiratory distress syndrome. Twenty-five original articles published in the respirology and critical care sections of Critical Care are discussed in the following categories: pre-clinical studies, protective lung ventilation – how low can we go, non-invasive ventilation for respiratory failure, diagnosis and prognosis in acute resp...

  10. Critical care procedure logging using handheld computers

    OpenAIRE

    Carlos Martinez-Motta, J; Walker, Robin; Stewart, Thomas E; Granton, John; Abrahamson, Simon; Lapinsky, Stephen E

    2004-01-01

    Introduction We conducted this study to evaluate the feasibility of implementing an internet-linked handheld computer procedure logging system in a critical care training program. Methods Subspecialty trainees in the Interdepartmental Division of Critical Care at the University of Toronto received and were trained in the use of Palm handheld computers loaded with a customized program for logging critical care procedures. The procedures were entered into the handheld device using checkboxes an...

  11. MEDEVAC: critical care transport from the battlefield.

    Science.gov (United States)

    Higgins, R A

    2010-01-01

    In current military operations, the survival rates of critically injured casualties are unprecedented. An often hidden aspect of casualty care is safe transport from the point of injury to a field hospital and subsequently on to higher levels of care. This en route critical care, which is provided by flight medics under the most austere and rigorous conditions, is a crucial link in the care continuum. This article introduces the role and capabilities of US Army MEDEVAC and reflects the author's recent experience in Afghanistan as a flight medic. This article provides an assessment of the operational issues, medical capabilities, and transport experiences to provide a real-world view of critical care transport from the battlefield. The MEDEVAC helicopter environment is one of the most difficult, if not the most demanding, critical care environments. This overview brings to light a small but important piece of the care continuum.

  12. Adolescent and young adult cancer: principles of care

    OpenAIRE

    Ramphal, R; Aubin, S.; Czaykowski, P.; Pauw, S; Johnson, A.; McKillop, S.; Szwajcer, D; Wilkins, K; ROGERS, P.

    2016-01-01

    Adolescents and young adults (ayas) with cancer in active treatment face a number of barriers to optimal care. In the present article, we focus on the 3 critical domains of care for ayas—medical, psychosocial, and research—and how changes to the system could overcome barriers. We summarize the current literature, outline recommended principles of care, raise awareness of barriers to optimal care, and suggest specific changes to the system to overcome those barriers in the Canadian context. Ma...

  13. Opportunities for pharmaceutical care with critical pathways.

    Science.gov (United States)

    Koch, K E

    1995-01-01

    Critical pathways are multidisciplinary tools designed to improve patient care and efficiency. Almost every path requires some type of pharmacotherapeutic intervention, from selection of surgical prophylaxis to management of anticoagulation. Pharmacists should become involved with the critical pathway process because it offers an excellent opportunity to incorporate pharmaceutical care and to meet Joint Commission on Accreditation of Healthcare Organization compliance criteria.

  14. [Severe infection in critical emergency care].

    Science.gov (United States)

    Matsuda, Naoyuki; Takatani, Yudai; Higashi, Tomoko; Inaba, Masato; Ejima, Tadashi

    2016-02-01

    In the emergency and critical care medicine, infection is easy to merge to various basic conditions and diseases. In the social structure aging in critical care, the immune weakness was revealed as the result of severe infection and septic shock in the reduced function of neutrophils and lymphocytes. In the life-saving emergency care, cardiovascular diseases, diabetes, chronic renal failure and lever dysfunction are often observed, and the underlying diseases have the foundation of biological invasion after a first inflammatory attack of surgery, trauma, burn, and systemic injury. It will be placed into a susceptible situation such as artificial respiratory management. In this review, we discussed severe infection in emergency and critical care. It is necessary to pay attention to the drug resistance bacterias in own critical care setting by trends.

  15. [Severe infection in critical emergency care].

    Science.gov (United States)

    Matsuda, Naoyuki; Takatani, Yudai; Higashi, Tomoko; Inaba, Masato; Ejima, Tadashi

    2016-02-01

    In the emergency and critical care medicine, infection is easy to merge to various basic conditions and diseases. In the social structure aging in critical care, the immune weakness was revealed as the result of severe infection and septic shock in the reduced function of neutrophils and lymphocytes. In the life-saving emergency care, cardiovascular diseases, diabetes, chronic renal failure and lever dysfunction are often observed, and the underlying diseases have the foundation of biological invasion after a first inflammatory attack of surgery, trauma, burn, and systemic injury. It will be placed into a susceptible situation such as artificial respiratory management. In this review, we discussed severe infection in emergency and critical care. It is necessary to pay attention to the drug resistance bacterias in own critical care setting by trends. PMID:26915247

  16. Critical care issues in cervical cancer management.

    Science.gov (United States)

    Mirhashemi, R; Janicek, M F; Schoell, W M

    1999-01-01

    Radical pelvic surgery in gynecologic oncology patients poses a challenge to the surgeon and the ancillary team in charge of the peri-operative care. The high frequency of medical problems observed in this patient population, in conjunction with the stresses of radical surgery, necessitates careful monitoring of patients' medical status. A comprehensive team approach in the perioperative period is critical to patient care. Early intervention and anticipation of potential problems for the patient at risk in the postoperative period minimizes morbidity and mortality. This article will review the essentials of critical care as it relates to patients undergoing radical pelvic operations. PMID:10225307

  17. Surviving sepsis in the critical care environment.

    Science.gov (United States)

    Benedict, Lara

    2015-01-01

    The management of sepsis and septic shock in the intensive care environment is a complex task requiring the cooperation of a multidisciplinary team. The Surviving Sepsis Campaign provides systematic guidelines for the recognition, early intervention, and supportive management of sepsis. Critical care nurses are instrumental in ensuring that these guidelines and other sources of evidence-based practice are used for patients with severe sepsis or septic shock. This article discusses the pathophysiologic processes in severe sepsis and septic shock and discusses the appropriate interventions as recommended by the Surviving Sepsis Campaign. Recommended early treatments are reviewed along with interventions related to hemodynamics, perfusion, and supportive care in the critical care environment.

  18. Taiwanese nurses' appraisal of a lecture on spiritual care for patients in critical care units.

    Science.gov (United States)

    Shih, F J; Gau, M L; Mao, H C; Chen, C H

    1999-04-01

    The purpose of this study is to develop a lecture on spiritual care for adult critical care trainees, and to evaluate the trainees' appraisal of the effectiveness of this lecture in preparing them to provide spiritual care for their clients in a critical care setting. A between-method triangulation research design encompassing a questionnaire and descriptive qualitative content analysis was used. A convenience sample consisting of 64 registered nurses who attended an adult critical care nurse training programme in a leading medical centre in northern Taiwan were invited to participate in this study. A total of 64 female participants completed the questionnaire. Ninety-two per cent (59) of the subjects considered the lecture on spiritual care to be helpful in assisting them to provide holistic care for critically ill patients in the Intensive Care Unit (ICU). Three types of help were identified by the subjects: (1) help in clarifying the abstract concepts related to spiritual care (86%); (2) help in self-disclosing the nurses' personal beliefs and values regarding life goals, nursing, and spiritual needs (67%); (3) help in learning how to provide spiritual care to patients in a critical care setting (34%). Twenty per cent of the subjects thought that inclusion of the following content in the lecture would have been helpful to provide a more comprehensive picture of spiritual care: religious practices and rituals (11%); the culturally bonded nursing care plan (9%); the development of human spirituality (3%); patients' families' spiritual needs in the ICU (3%); and resources for nurses in providing spiritual care (2%). Thirteen per cent of the subjects suggested that the instructor might employ the following strategies to improve the quality of teaching: providing more empirical examples (5%); discussion with the students in classes of smaller size following the lecture or extending the instruction time (5%); and providing a syllabus with detailed information (3%).

  19. Medicaid Adult Health Care Quality Measures

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid...

  20. American Association of Critical-Care Nurses

    Science.gov (United States)

    ... of Certification APRN Resources Education State-of-the-art educational programs provide evidence- based knowledge, directly applicable to practice ... Policy Disclaimer © American Association of Critical-Care Nurses Learn ...

  1. Critical Care Glucose Point-of-Care Testing.

    Science.gov (United States)

    Narla, S N; Jones, M; Hermayer, K L; Zhu, Y

    2016-01-01

    Maintaining blood glucose concentration within an acceptable range is a goal for patients with diabetes mellitus. Point-of-care glucose meters initially designed for home self-monitoring in patients with diabetes have been widely used in the hospital settings because of ease of use and quick reporting of blood glucose information. They are not only utilized for the general inpatient population but also for critically ill patients. Many factors affect the accuracy of point-of-care glucose testing, particularly in critical care settings. Inaccurate blood glucose information can result in unsafe insulin delivery which causes poor glucose control and can be fatal. Healthcare professionals should be aware of the limitations of point-of-care glucose testing. This chapter will first introduce glucose regulation in diabetes mellitus, hyperglycemia/hypoglycemia in the intensive care unit, importance of glucose control in critical care patients, and pathophysiological variables of critically ill patients that affect the accuracy of point-of-care glucose testing. Then, we will discuss currently available point-of-care glucose meters and preanalytical, analytical, and postanalytical sources of variation and error in point-of-care glucose testing. PMID:27645817

  2. February 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-02-01

    Full Text Available No abstract available. Article truncated after 150 words. Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A, Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, Slutsky AS, Meade MO; the OSCILLATE Trial Investigators and the Canadian Critical Care Trials Group. High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome. N Engl J Med. 2013;368:795-805. Young D, Lamb SE, Shah S, Mackenzie I, Tunnicliffe W, Lall R, Rowan K, Cuthbertson BH; the OSCAR Study Group. High-Frequency Oscillation for Acute Respiratory Distress Syndrome. N Engl J Med. 2013;368:806-13. Malhotra A, Drazen JM. High-Frequency Oscillatory Ventilation on Shaky Ground. N Engl J Med. 2013;368:863-5. Two articles and an accompanying editorial, the later co-authored by none less than the editor, appeared in the New England Journal of Medicine this week. These all dealt with the use of high-frequency oscillatory ventilation (HFOV in the adult respiratory distress syndrome (ARDS. As the editorial points …

  3. Critical paths: maximizing patient care coordination.

    Science.gov (United States)

    Spath, P L

    1995-01-01

    1. With today's emphasis on horizontal and vertical integration of patient care services and the new initiatives prompted by these challenges, OR nurses are considering new methods for managing the perioperative period. One such method is the critical path. 2. A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff members for a particular diagnosis or procedure, designed to better use resources, maximize quality of care, and minimize delays. 3. Hospitals implementing path-based patient care have reported cost reductions and improved team-work. Critical paths have been shown to reduce patient care costs by improving hospital efficiency, not merely by reducing physician practice variations.

  4. Selenium supplementation for critically ill adults

    DEFF Research Database (Denmark)

    Allingstrup, Mikkel; Afshari, Arash

    2015-01-01

    BACKGROUND: Selenium is a trace mineral essential to health and has an important role in immunity, defence against tissue damage and thyroid function. Improving selenium status could help protect against overwhelming tissue damage and infection in critically ill adults. This Cochrane review...... was originally published in 2004 updated in 2007 and again 2015. OBJECTIVES: The primary objective was to examine the effect of nutrition supplemented with selenium or ebselen on mortality in critically ill patients.The secondary objective was to examine the relationship between selenium or ebselen...

  5. A leadership programme for critical care.

    Science.gov (United States)

    Crofts, Linda

    2006-08-01

    This paper describes the genesis, design and implementation of a leadership programme for critical care. This was an initiative funded by the National Health Service (NHS) Nursing Leadership Project and had at the core of its design flexibility to meet the needs of the individual hospitals, which took part in it. Participation was from the multi-disciplinary critical care team. Six NHS hospitals took part in the programme which was of 20 days duration and took place on hospital sites. The programme used the leadership model of as its template and had a number of distinct components; a baseline assessment, personal development, principles of leadership and critical case reviews. The programme was underpinned by three themes; working effectively in multi-professional teams to provide patient focussed care, managing change through effective leadership and developing the virtual critical care service. Each group set objectives pertinent to their own organisation's needs. The programme was evaluated by a self-reporting questionnaire; group feedback and feedback from stakeholders. Programme evaluation was positive from all the hospitals but it was clear that the impact of the programme varied considerably between the groups who took part. It was noted that there was some correlation between the success of the programme and organisational 'buy in' as well as the organisational culture within which the participants operated. A key feature of the programme success was the critical case reviews, which were considered to be a powerful learning tool and medium for group learning and change management. PMID:16621563

  6. A leadership programme for critical care.

    Science.gov (United States)

    Crofts, Linda

    2006-08-01

    This paper describes the genesis, design and implementation of a leadership programme for critical care. This was an initiative funded by the National Health Service (NHS) Nursing Leadership Project and had at the core of its design flexibility to meet the needs of the individual hospitals, which took part in it. Participation was from the multi-disciplinary critical care team. Six NHS hospitals took part in the programme which was of 20 days duration and took place on hospital sites. The programme used the leadership model of as its template and had a number of distinct components; a baseline assessment, personal development, principles of leadership and critical case reviews. The programme was underpinned by three themes; working effectively in multi-professional teams to provide patient focussed care, managing change through effective leadership and developing the virtual critical care service. Each group set objectives pertinent to their own organisation's needs. The programme was evaluated by a self-reporting questionnaire; group feedback and feedback from stakeholders. Programme evaluation was positive from all the hospitals but it was clear that the impact of the programme varied considerably between the groups who took part. It was noted that there was some correlation between the success of the programme and organisational 'buy in' as well as the organisational culture within which the participants operated. A key feature of the programme success was the critical case reviews, which were considered to be a powerful learning tool and medium for group learning and change management.

  7. Reimbursement for critical care services in India

    Directory of Open Access Journals (Sweden)

    Raja Jayaram

    2013-01-01

    Full Text Available There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India.

  8. Dopamine in heart failure and critical care

    NARCIS (Netherlands)

    Smit, AJ

    2000-01-01

    Dopamine is widely used in critical care to prevent renal function loss. Nevertheless sufficient evidence is still lacking of reduction in end points like mortality or renal replacement therapy. Dopaminergic treatment in chronic heart failure (CHF) has provided an example of unexpected adverse outco

  9. Intrahospital Transit Care of the Critically Ill

    Directory of Open Access Journals (Sweden)

    Nagappan R

    2003-01-01

    Full Text Available An ideal patient transport system should indeed be a mobile ICU. Optimal features to be desired are light weight, unhindered access for patient evaluation and management, uncluttered environment for cardiopulmonary resuscitation in transit, low cost and, where relevant, adaptability to surface and air transportation. In appropriate situations, suitability for inter-hospital and intra-hospital transport of the critically ill with the same transit-care equipment will be an added advantage. Such systems could also be adapted for pre-hospital evacuation of the critically ill. The investment of time, intellect and technological labour in devising and maintaining a good transit care team with affordable equipment and trained medical and nursing staff is an integral part of running an intensive care service.

  10. Pain: advances and issues in critical care.

    Science.gov (United States)

    Harrison, M; Cotanch, P H

    1987-09-01

    The milieu of the critical care unit is stressful for both the patient and health care professionals. As such, it has the potential to increase pain perception in patients, and decrease the nurse's awareness of pain relief needs of the patient. Several physical and pharmacologic methods of pain relief were discussed in this article. Nontechnologic analgesia such as hypnosis and relaxation were introduced as adjuncts or alternatives to more familiar methods of pain relief. Although critically ill patients are not always able to express their discomfort, it is the responsibility of the nurse to recognize the potential for pain, and plan treatment accordingly. This article suggests several strategies for dealing with pain in critically ill patients. PMID:3302958

  11. An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health Care Professionals: A Call for Action.

    Science.gov (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of health care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health care professionals and diminish the harmful consequences of BOS, both for critical care health care professionals and for patients. PMID:27369038

  12. A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action.

    Science.gov (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients. PMID:27367887

  13. Integrating Adolescents and Young Adults into Adult-Centered Care for IBD.

    Science.gov (United States)

    Trivedi, Itishree; Holl, Jane L; Hanauer, Stephen; Keefer, Laurie

    2016-05-01

    Planned healthcare transition, initiated in pediatric care, is a gradual process aimed at fostering the adolescent patient's disease knowledge and skills with the ultimate objective of preparing patients and families for adult-centered care. The process is critical in inflammatory bowel diseases (IBD) where there is an increased risk of non-adherence, hospitalizations, and emergency department use as young adult patients graduate from pediatric to adult-centered care. While evidence for healthcare transition in IBD is mounting, important gaps remain in the understanding of this process from the perspective of the adult gastroenterologist. This paper summarizes what is known about healthcare transition in IBD and explores the unanswered questions-a conceptual and methodological framework for transition interventions, relevant outcomes that define successful transition, and key stakeholder perspectives. For the adult gastroenterologist managing the young adult patient population, this paper presents the paradigm of "care integration"-a process of ongoing, multi-modality support for the patient, initiated in the adult care setting, with the goal of improving self-management skills and active participation in medical decision-making.

  14. Frailty in Pulmonary and Critical Care Medicine.

    Science.gov (United States)

    Singer, Jonathan P; Lederer, David J; Baldwin, Matthew R

    2016-08-01

    Conceptualized first in the field of geriatrics, frailty is a syndrome characterized by a generalized vulnerability to stressors resulting from an accumulation of physiologic deficits across multiple interrelated systems. This accumulation of deficits results in poorer functional status and disability. Frailty is a "state of risk" for subsequent disproportionate declines in health status following new exposure to a physiologic stressor. Two predominant models have emerged to operationalize the measurement of frailty. The phenotype model defines frailty as a distinct clinical syndrome that includes conceptual domains such as strength, activity, wasting, and mobility. The cumulative deficit model defines frailty by enumerating the number of age-related things wrong with a person. The biological pathways driving frailty include chronic systemic inflammation, sarcopenia, and neuroendocrine dysregulation, among others. In adults with chronic lung disease, frailty is independently associated with more frequent exacerbations of lung disease, all-cause hospitalization, declines in functional status, and all-cause mortality. In addition, frail adults who become critically ill are more likely develop chronic critical illness or severe disability and have higher in-hospital and long-term mortality rates. The evaluation of frailty appears to provide important prognostic information above and beyond routinely collected measures in adults with chronic lung disease and the critically ill. The study of frailty in these populations, however, requires multipronged efforts aimed at refining clinical assessments, understanding the mechanisms, and developing therapeutic interventions. PMID:27104873

  15. Incorporating educational theory into critical care orientation.

    Science.gov (United States)

    Rashotte, Judy; Thomas, Margot

    2002-01-01

    This article describes the development and implementation of a critical care total education system, which includes an orientation program. The educational process in this unit reflects Benner's model of novice to expert integrated with Schon's theory of reflective practice and Cranton's transformational learning theory. This program reflects an educational philosophy that facilitates learning on entry into the new workplace, and an established continuum of expected acquisition of knowledge, practice skills, attitudes, and critical thinking abilities promoting the transition from novice to expert. PMID:12046715

  16. Year in review in Critical Care, 2003 and 2004: respirology and critical care

    OpenAIRE

    Brander, Lukas; Slutsky, Arthur

    2005-01-01

    We summarize all original research in the field of respirology and critical care published in 2003 and 2004 in Critical Care. Articles were grouped into the following categories to facilitate a rapid overview: pathophysiology, therapeutic approaches, and outcome in acute lung injury and acute respiratory distress syndrome; hypoxic pulmonary arterial hypertension; mechanical ventilation; liberation from mechanical ventilation and tracheostomy; ventilator-associated pneumonia; multidrug-resista...

  17. "They'll Grow up and Be Adults Wanting to Take Care of Our Environment": The Story of Jan and Critical Literacy

    Science.gov (United States)

    Gove, Mary K.; Still, Kristine L.

    2014-01-01

    Two university professors and 11 urban school faculty collaborated on a professional development (PD) effort focused on critical literacy to explore literacy practices aimed to reshape definitions of literacy that involved questioning power relationships concerning the environment and social justice. We examined the journey of a veteran teacher,…

  18. Respiratory Review of 2013: Critical Care Medicine

    OpenAIRE

    Choi, Hye Sook

    2013-01-01

    Several papers on respiratory and critical care published from March 2012 to February 2013 were reviewed. From these, this study selected and summarized ten articles, in which the findings were notable, new, and interesting: effects of high-frequency oscillation ventilation on acute respiratory distress syndrome (ARDS); safety and efficacy of hydroxyethyl starch as a resuscitation fluid; long-term psychological impairments after ARDS; safety and efficacy of dexmedetomidine for sedation; B-typ...

  19. Year in review 2009: Critical Care - shock

    OpenAIRE

    Stahl, Wolfgang; Bracht, Hendrik; Radermacher, Peter; Thomas, Jörg

    2010-01-01

    The research papers on shock that have been published in Critical Care throughout 2009 are related to four major subjects: first, alterations of heart function and, second, the role of the sympathetic central nervous system during sepsis; third, the impact of hemodynamic support using vasopressin or its synthetic analog terlipressin, and different types of fluid resuscitation; as well as, fourth, experimental studies on the treatment of acute respiratory distress syndrome. The present review ...

  20. Critical care in the emergency department.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle

    2012-02-01

    BACKGROUND: The volume and duration of stay of the critically ill in the emergency department (ED) is increasing and is affected by factors including case-mix, overcrowding, lack of available and staffed intensive care beds and an ageing population. The purpose of this study was to describe the clinical activity associated with these high-acuity patients and to quantify resource utilization by this patient group. METHODS: The study was a retrospective review of ED notes from all patients referred directly to the intensive care team over a 6-month period from April to September 2004. We applied a workload measurement tool, Therapeutic Intervention Scoring System (TISS)-28, which has been validated as a surrogate marker of nursing resource input in the intensive care setting. A nurse is considered capable of delivering nursing activities equal to 46 TISS-28 points in each 8-h shift. RESULTS: The median score from our 69 patients was 19 points per patient. Applying TISS-28 methodology, we estimated that 3 h 13 min nursing time would be spent on a single critically ill ED patient, with a TISS score of 19. This is an indicator of the high levels of personnel resources required for these patients in the ED. ED-validated models to quantify nursing and medical staff resources used across the spectrum of ED care is needed, so that staffing resources can be planned and allocated to match service demands.

  1. Paroxysmal sympathetic hyperactivity in neurological critical care

    Directory of Open Access Journals (Sweden)

    Rajesh Verma

    2015-01-01

    Full Text Available Introduction: Paroxysmal sympathetic hyperactivity (PSH is a clinical disorder mainly caused by traumatic brain injury, stroke, encephalitis and other types of brain injury. The clinical features are episodes of hypertension, tachycardia, tachypnea, fever and dystonic postures. In this study, we described clinical profile and outcome of six patients of PSH admitted in neurocritical care unit. Materials and Methods: This was a prospective observational study conducted at neurology critical care unit of a tertiary care center. All patients admitted at neurology critical unit during 6-month period from August 2013 to January 2014 were screened for the occurrence of PSH. The clinical details and outcome was documented. Results: PSH was observed in 6 patients. Male to female ratio was 5:1. Mean age ± SD was 36.67 ± 15.19 years. The leading causes were traumatic brain injury (two patients, stroke (two patients and Japanese encephalitis (JE (one patient and tuberculous meningitis (one patient. Conclusion: PSH is an unusual complication in neurocritical care. It prolonged the hospitalization and hampers recovery. The other life-threatening conditions that mimic PSH should be excluded. The association with JE and tuberculous meningitis was not previously described in literature.

  2. Physiotherapy in critical care in australia.

    Science.gov (United States)

    Berney, Susan; Haines, Kimberley; Denehy, Linda

    2012-03-01

    A physiotherapist is part of the multidisciplinary team in most intensive care units in Australia. Physiotherapists are primary contact practitioners and use a comprehensive multisystem assessment that includes the respiratory, cardiovascular, neurological, and musculoskeletal systems to formulate individualized treatment plans. The traditional focus of treatment has been the respiratory management of both intubated and spontaneously breathing patients. However, the emerging evidence of the longstanding physical impairment suffered by survivors of intensive care has resulted in physiotherapists re-evaluating treatment priorities to include exercise rehabilitation as a part of standard clinical practice. The goals of respiratory physiotherapy management are to promote secretion clearance, maintain or recruit lung volume, optimize oxygenation, and prevent respiratory complications in both the intubated and spontaneously breathing patient. In the intubated patient, physiotherapists commonly employ manual and ventilator hyperinflation and positioning as treatment techniques whilst in the spontaneously breathing patients there is an emphasis on mobilization. Physiotherapists predominantly use functional activities for the rehabilitation of the critically ill patient in intensive care. While variability exists between states and centers, Australian physiotherapists actively treat critically ill patients targeting interventions based upon research evidence and individualized assessment. A trend toward more emphasis on exercise rehabilitation over respiratory management is evident. PMID:22807651

  3. Repositioning Ideology Critique in a Critical Theory of Adult Learning.

    Science.gov (United States)

    Brookfield, Stephen

    2001-01-01

    Reexamines critical theory as a response to Marxism and repositions ideology critique as a crucial adult learning process. Argues that a critical theory of adult learning should focus on how adults learn to recognize and challenge ideological domination and manipulation. (Contains 31 references.) (SK)

  4. Critical Care In Korea: Present and Future.

    Science.gov (United States)

    Lim, Chae-Man; Kwak, Sang-Hyun; Suh, Gee Young; Koh, Younsuck

    2015-11-01

    Critical (or intensive) care medicine (CCM) is a branch of medicine concerned with the care of patients with potentially reversible life-threatening conditions. Numerous studies have demonstrated that adequate staffing is of crucial importance for patient outcome. Adequate staffing also showed favorable cost-effectiveness in terms of ICU stay, decreased use of resources, and lower re-admission rates. The current status of CCM of our country is not comparable to that of advanced countries. The global pandemic episodes in the past decade showed that our society is not well prepared for severe illnesses or mass casualty. To improve CCM in Korea, reimbursement of the government must be amended such that referral hospitals can hire sufficient number of qualified intensivists and nurses. For the government to address these urgent issues, public awareness of the role of CCM is also required.

  5. 25 CFR 20.331 - What is Adult Care Assistance?

    Science.gov (United States)

    2010-04-01

    ... SOCIAL SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.331 What is Adult Care Assistance... require personal care and supervision due to advanced age, infirmity, physical condition, or mental... 25 Indians 1 2010-04-01 2010-04-01 false What is Adult Care Assistance? 20.331 Section...

  6. Experiences of critical care nurses caring for unresponsive patients.

    Science.gov (United States)

    Villanueva, N E

    1999-08-01

    Grounded theory methodology was utilized to explore the experiences of critical care nurses caring for patients who were unable to respond due to a traumatic brain injury or receiving neuromuscular blocking agents. The registered nurses participating in the study worked in a neuroscience intensive care unit. Saturation of the categories was achieved with 16 interviews. The core category that emerged from the study is Giving the Patient a Chance. The subcategories of Learning about My Patient, Maintaining and Monitoring, Talking to My Patient, Working with Families, Struggling with Dilemmas and Personalizing the Experience all centered upon the focus of doing everything to help the patient attain the best possible outcome. Factors influencing each of the subcategories were identified such as the acuity of the patient, experience level of the nurse and the presence or absence of family members or significant others. These factors accounted for the variations in the nurses' experience. Several reasons accounting for the variations were determined. The study identified areas that need to be addressed in both general nursing education and nursing practice, such as instruction on talking to comatose patients, working with families and orientation information for nurses new to caring for these populations. Recommendations for improvement in these areas, as well as for future studies are discussed. PMID:10553569

  7. Critical care ultrasonography in acute respiratory failure.

    Science.gov (United States)

    Vignon, Philippe; Repessé, Xavier; Vieillard-Baron, Antoine; Maury, Eric

    2016-01-01

    Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript. PMID:27524204

  8. Critical care ultrasonography in acute respiratory failure.

    Science.gov (United States)

    Vignon, Philippe; Repessé, Xavier; Vieillard-Baron, Antoine; Maury, Eric

    2016-08-15

    Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript.

  9. August 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Seth H

    2012-01-01

    Full Text Available No abstract available. Article truncated at 150 words. Dr. Raschke took a well-deserved vacation, and in his absence we did another quick-fire critical care journal club reviewing 7 articles.Davies AR, Morrison SS, Bailey MJ, Bellomo R, Cooper DJ, Doig GS, Finfer SR, Heyland DK; for the ENTERIC Study Investigators and the ANZICS Clinical Trials Group. A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness. Crit Care Med 2012;40:2342-8. (Click here for abstractThis was a randomized control trial, which enrolled 181 patients from multiple medical-surgical ICUs to receive either nasojejunal or nasogastric nutrition. The number of patients selected for this study provided an 80% power to detect a 12% difference in mean energy delivery. Inclusion criteria for the study were patient that were admitted to the ICU, needing mechanically ventilated, narcotic drips for sedation as well as elevated gastric residuals (>150ml. Patients were excluded if patient had abnormal anatomy or imminent death…

  10. October 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Bajo TM

    2012-10-01

    Full Text Available No abstract available. Article truncated at 150 words. Dr. Raschke was out of town when Critical Care Journal Club was held this month. Dr. Tom Bajo, the senior critical care physician at Good Samaritan, moderated the journal club. We reviewed 5 articles and 1 editorial. Thiele H, Zeymer U, Neumann FJ. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012 ;367:1287-96. This is an important article for those who manage myocardial infarction with cardiogenic shock. The ACA/AHA guidelines recommend intraaortic balloon counterpulsation as a class I treatment for cardiogenic shock complicating acute myocardial infarction. However, the evidence is based mainly on registry data, and there is a paucity of randomized clinical trials. In this randomized, prospective, open-label, multicenter trial, 600 patients with cardiogenic shock complicating acute myocardial infarction were randomized to intraaortic balloon counterpulsation or no intraaortic balloon counterpulsation. All patients were expected to undergo early revascularization (by means of percutaneous coronary intervention …

  11. Pulmonary Hypertension in Pregnancy: Critical Care Management

    Directory of Open Access Journals (Sweden)

    Adel M. Bassily-Marcus

    2012-01-01

    Full Text Available Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.

  12. Critical care: advances and future perspectives.

    Science.gov (United States)

    Vincent, Jean-Louis; Singer, Mervyn

    2010-10-16

    Intensive care offers a standard of monitoring, intervention, and organ support that cannot be readily delivered in a general ward. Its expansion in the past few decades, including the creation of emergency and outreach teams, emphasises that intensive care has an increasingly prominent role within the hospital. Although outcomes are clearly improving, intensive care remains a nascent specialty in which we are still learning how to harness a powerful ability to manipulate physiology, biochemistry, and immunology to achieve best outcomes for the patient. The results of many multicentre studies have not lent support to, or have even confounded, expectations, drawing attention to several issues related to patient heterogeneity, trial design, and elucidation of underlying pathophysiological processes. However, these results have generated constructive introspection and reappraisal of treatments and management strategies that have benefited the patient. In addition to the medical, financial, and logistical challenges in the future, exciting opportunities will arise as new developments in diagnostic tests, therapeutic interventions, and technology are used to exploit an increasing awareness of how critical illness should be managed.

  13. May 2016 Phoenix critical care journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-06-01

    Full Text Available No abstract available. Article truncated at 150 words. Panwar R, Hardie M, Bellomo R, Barrot L, Eastwood GM, Young PJ, Capellier G, Harrigan PW, Bailey M; CLOSE Study Investigators; ANZICS Clinical Trials Group. Conservative versus liberal oxygenation targets for mechanically ventilated patients. A pilot multicenter randomized controlled trial. Am J Respir Crit Care Med. 2016 Jan 1;193(1:43-51. We continue to debate the appropriate level of oxygenation for a variety of patients. This study attempted to address the question of appropriate oxygenation targets for intensive care unit (ICU patients. At four multidisciplinary ICUs, 103 adult patients were randomly allocated to either a conservative oxygenation strategy with target oxygen saturation as measured by pulse oximetry (SpO2 of 88-92% (n = 52 or a liberal oxygenation strategy with target SpO2 of greater than or equal to 96% (n = 51. There were no significant between-group differences in any measures of new organ dysfunction, or ICU or 90-day mortality. Although the study is underpowered, it does ...

  14. Factors influencing job valuation: a comparative study of critical care and non-critical care nurses.

    Science.gov (United States)

    Chaboyer, W; Najman, J; Dunn, S

    2001-04-01

    This study sought to identify the relationship between three predictor variables, perceived collaboration with medical staff, autonomy and independent actions and an outcome, the value hospital nurses placed on their work. In total 189 critical care and 366 non-critical care nurses completed a mailed survey. Critical care nurses perceived themselves to have a more collaborative relationship with the medical staff, described performing actions independent of medical orders more frequently and perceived their jobs to have more value than non-critical care nurses. However the latter group perceived themselves to have more autonomy in their work. Within both groups collaboration and autonomy were significantly, but weak to moderately correlated with job valuation. Simply expanding the work hospital nurses do is unlikely to result in nurses valuing their jobs more, however promoting an environment of respect and sharing between the medical and nursing staff and supporting nurses when they act in an autonomous fashion may positively influence nurses' perceptions of their work. PMID:11223056

  15. Providing care for critically ill surgical patients: challenges and recommendations.

    Science.gov (United States)

    Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

    2013-07-01

    Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed. PMID:23754675

  16. April 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2013-04-01

    Full Text Available No abstract available. Article truncated at 150 words. We welcomed intensivists from Banner Health to video-conference with us as we discussed several articles, and evaluated the ACP Journal Club – another good resource for keeping up to date.Hill NS. Review: Lower rather than higher tidal volume benefits ventilated patients without ARDS. Ann Intern Med. 2013;158:JC4. AbstractLauzier F. Hydroxyethyl starch 130/0.4 and saline did not differ for mortality at 90 days in ICU patients. Ann Intern Med. 2013;158:JC5. AbstractThe April ACP Journal Club reviewed two critical care articles – a meta-analysis that concluded that low tidal volume ventilation reduced mortality in patients without ARDS, and a large RCT that showed no mortality difference between critically-ill patients resuscitated with hydroxyethyl starch versus saline. Both articles were awarded 6/7 stars for “clinical impact”, yet neither article had any impact on our clinical practice. This troubled us.We could think of 4 necessary criteria in order for research to have legitimate …

  17. November 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2012-12-01

    Full Text Available No abstract available. Article truncated at 150 words. Mehta S, Burry L, Cook D, Fergusson D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol. JAMA 2012;308:1985-92. PDFThis study was a multi-center, randomized controlled trial that compared protocolized sedation with protocolized sedation plus daily sedation interruption. The protocol used to titrate benzodiazepine and opioid infusions incorporated a validated scale (Sedation-agitation Scale (SAS or Richmond Agitation Sedation Scale (RASS in order to maintain a comfortable but arousable state. Four hundred and thirty mechanically ventilated, critically ill patients were recruited from medical and surgical ICUs in 16 institutions in North America. The study showed no benefit in the group that underwent daily sedation interruption - length of intubation was 7 days, length of ICU stay was 10 days and length of hospital stay was 20 days in both groups. There was no significant difference in the incidence of delirium (53 vs. ...

  18. A step ahead: strategies for excellence in critical care nursing practice.

    Science.gov (United States)

    Albano, Amy; Elliott, Sheila; Lusardi, Paula; Scott, Susan; Thomas, Diane

    2005-06-01

    The adult intensive care unit (ICU) at Baystate Medical Center is a 24-bed medical-surgical-trauma ICU that provides high-quality care to critically ill patients. Collaboration and expertise among the nursing staff, intensivists, and interdisciplinary colleagues have contributed to its development into a Beacon Award-winning unit. Its primary goal is reflected in the unit's mission: "Care for our patients is guided by knowledge, motivated by compassion, and performed in collaboration with others." Common interests, values, and purposes have created an environment of communication that supports the delivery of exceptional critical care to patients and their families. PMID:15862740

  19. Perception of older adults receiving palliative care

    Directory of Open Access Journals (Sweden)

    Fernanda Laporti Seredynskyj

    2014-06-01

    Full Text Available The present study aimed at understanding the perception of older adults who are receiving palliative oncological care on self care in relation to different stages of the disease and how such perception affected their lives. This is a qualitative study using oral history conducted with 15 older adults receiving palliative chemotherapy treatment in a health institution. The following categories emerged: social network, perspectives for confronting life, changes and spirituality. It is necessary for nursing staff to understand this process so that the measures implemented take into account all of the implications of the disease and aim at improving quality of life.   doi: 10.5216/ree.v16i2.22795.

  20. Home care to Older adult with cancer

    International Nuclear Information System (INIS)

    Objective: Home care of the elderly with cancer. After the development of a program of oncology home care and over a period of five years, we believe that the evaluation allows us to have our proposal and challenges in the continuity of the program. This evidence is based in our old advanced Uruguayan population, and consequently increase this cancer population, we should define which pointed toward our objective, in order to get the best quality life. After one year with a project based on general rules, the evidence threw an evaluation, that we should review the model of care with which we were working. We continue to Auto-care model Dorothea Orem. The main objective became quality of life:Take care as the primary Older Adult; Specific care their cancer to become symptomatic secondary complications to the evolution of tumor biology; Secondary prevention of cause therapeutic effect; Family integration, without changing the pace of life that the elderly had before being with cancer. Nursing challenge: Maintain autonomy achieved in these 5 years. Deepen the social equilibrium that we are committed daily between patient and family.Do not miss the professionalism achieved today.Proposal for nursing: Consider a wide field of nursing and for this achievement is need knowledge of 2nd level of community work, knowledge Clinical knowledge in Oncology Nursing, autonomy in decision making. For older adults with cancer: No out of its middle. Maintain priority habits and customs. Do not let it lose their self-esteem with their own values. Caution changes must take care to better manage the evolution of their illness. Conclusion: Oncology nursing is a specialty. Without this formation will be ever more away the development of these programs in our environment, or fall in applying for only economic convenience, losing professionalism. Our population is increasing

  1. 重症加强治疗病房成人患者浅镇静治疗进展%The progress of light sedation for critically ill adult patients in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    李双玲; 王东信; 杨拔贤

    2016-01-01

    The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: ① the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; ② light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; ③ light sedation strategies and pain, agitation, delirium control bundles; ④ the problems and prospects of light sedation. Light sedation is the main principle of currently ICU sedation strategy in critically ill adult patients. Goal-directed light sedation should be considered as a routine therapy in most clinical situation, and its goal should be achieved as early as possible in the early stage of sedation. Routine use of benzodiazepines should be avoided, especially in patients with or at a risk of delirium. Prevention and treatment of agitation with a combination of non-pharmacologic or pharmacologic methods; ICU specification rules for pain, agitation and delirium prevention and treatment should be made. Light sedation is the main ICU sedation strategy in adult patients now, but must be individualized for each patient.%对重症加强治疗病房(ICU)成人患者镇静方面的最新进展进行综述,强调浅镇静策略是目前ICU危重患者镇静的主要治疗原则,其主要内容包括:①目标导向的浅镇静应常规化,尽可能在镇静早期即达标;②应摒弃常规使用苯二氮类药物,尤其对有谵妄风险或已经有谵妄的患者;③联合药物或非药物的有效方法预防和治疗躁动;④制定纳入疼痛、躁动和谵

  2. The Critical Care Obesity Paradox and Implications for Nutrition Support.

    Science.gov (United States)

    Patel, Jayshil J; Rosenthal, Martin D; Miller, Keith R; Codner, Panna; Kiraly, Laszlo; Martindale, Robert G

    2016-09-01

    Obesity is a leading cause of preventable death worldwide. The prevalence of obesity has been increasing and is associated with an increased risk for other co-morbidities. In the critical care setting, nearly one third of patients are obese. Obese critically ill patients pose significant physical and on-physical challenges to providers, including optimization of nutrition therapy. Intuitively, obese patients would have worse critical care-related outcome. On the contrary, emerging data suggests that critically ill obese patients have improved outcomes, and this phenomenon has been coined "the obesity paradox." The purposes of this review will be to outline the historical views and pathophysiology of obesity and epidemiology of obesity, describe the challenges associated with obesity in the intensive care unit setting, review critical care outcomes in the obese, define the obesity-critical care paradox, and identify the challenges and role of nutrition support in the critically ill obese patient. PMID:27422122

  3. Palliative care for adolescents and young adults with cancer

    Directory of Open Access Journals (Sweden)

    Rosenberg AR

    2013-03-01

    Full Text Available Abby R Rosenberg,1–3 Joanne Wolfe4–61Division of Pediatric Hematology/Oncology, Seattle Children’s Hospital, Seattle, WA; 2Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; 3Department of Pediatrics, University of Washington, Seattle, WA; 4Department of Psychosocial Oncology and Palliative Care/Division of Pediatric Palliative Care, Dana-Farber Cancer Institute, Boston, MA; 5Department of Medicine/Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA; 6Department of Pediatrics, Harvard University School of Medicine, Boston, MA, USAAbstract: Adolescents and young adults (AYAs with cancer represent a unique and challenging group of patients with distinct developmental and psychosocial needs that may be unrecognized or unmet during their cancer experience. Palliative care refers to the total care of a patient, regardless of his or her disease status, and aims to improve quality of life by controlling symptoms and alleviating physical, social, psychological, and spiritual suffering. Integrating palliative care into standard oncology practice for AYAs is therefore valuable, if not imperative, in improving their overall cancer experience. In this review, we aimed to describe the scope, benefits, and challenges of palliative care for AYA oncology patients. We provide a broad impression of the existing literature describing or investigating palliative care in this population. Put together, the evidence suggests that palliative care is not only needed, but can also be critically beneficial to patients, families, and health care professionals alike. As we increase public and professional awareness of the needs and applications of palliative care for AYA patients with cancer, we will ultimately enable better psychosocial outcomes of the AYA patients and their larger communities.Keywords: supportive care, end of life, psychosocial outcomes, psychosocial oncology, psychosocial needs, quality of life

  4. Spirituality, stress, and retention of nurses in critical care.

    Science.gov (United States)

    Campbell, Duane

    2013-01-01

    Providing care to patients in critical care units generates stress. Helping the critical care nurse manage this stress can lead to better patient experiences and higher nursing retention. While providing holistic care to patients produces better outcomes, addressing the holistic needs of the caregiver must also be considered. Included in the holistic needs of the nurse is their spiritual well-being. A study that measures spiritual well-being, stress, and nursing retention is the focus of this review.

  5. July 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2012-07-01

    Full Text Available No abstract available. Article truncated at 150 words.Over the past thirty years or so, we have seen multiple therapies related to sepsis management that appeared beneficial in initial clinical trials but were later found to be useless or even harmful. Examples include goal-directed resuscitation to achieve maximal oxygen delivery, steroids for ARDS, tight glycemic control, and adrenal replacement therapy, among others. An overview of the history of evidence-based critical care medicine provides a strong argument for humility and caution. The story of Xigris provides another chapter for the fellows to consider as they move forward in their careers, and are asked to appraise new therapies that come along.The story of activated protein C – also designated as drotrecogin alfa (recombinant - or Xigris® began with stellar expectations. The PROWESS trial was published in the NEJM in 2001 (1. It was a randomized controlled trial that enrolled 1690 patients, comparing 28-day survival of patients treated with Xigris vs. …

  6. The impact of informal care-giving networks on adult children's care-giver burden

    OpenAIRE

    Tolkacheva, N.; Broese van Groenou, M. I.; Boer; Tilburg, van, P.J.A.

    2011-01-01

    Previous research on the care-giver burden experienced by adult children has typically focused on the adult child and parent dyad. This study uses information on multiple informal care-givers and examines how characteristics of the informal care-giving network affect the adult child's care-giver burden. In 2007, 602 Dutch care-givers who were assisting their older parents reported on parental and personal characteristics, care activities, experienced burden and characteristics of other inform...

  7. Ten years of specialized adult care for phenylketonuria

    OpenAIRE

    Mütze, Ulrike; Thiele, Alena Gerlinde; Baerwald, Christoph; Ceglarek, Uta; Kiess, Wieland; Beblo, Skadi

    2016-01-01

    Background: Specialized adult care of phenylketonuria (PKU) patients is of increasing importance. Adult outpatient clinics for inherited errors of metabolism can help to achieve this task, but experience is limited. Ten years after establishment of a coordinated transition process and specialised adult care for inherited metabolic diseases, adult PKU care was evaluated with respect to metabolic control, therapy satisfaction, life satisfaction, sociodemographic data, economical welfare as well...

  8. French validation of the critical care family needs inventory.

    Science.gov (United States)

    Coutu-Wakulczyk, G; Chartier, L

    1990-03-01

    This study is a contribution to the French validation of Molter and Leske Critical Care Family Needs Inventory (CCFNI). The importance of this validation study is based on the presumption that evaluation of family needs relies on the use of measures that are reliable and valid for a specific population. The preliminary validation of the French text of the CCFNI was carried out by back translation method of the French form into English by three translators. Then the final French version was selected. The study was conducted in the surgical intensive care unit of the University Hospital in Sherbrooke, Canada. The sample consisted of 207 voluntary subjects selected from adult members of the immediate family visiting a patient in the intensive care unit. The data collection was spread over a 10-week period. The French version of the CCFNI was given to subjects for self-reporting at the end of a 15-minute face-to-face interview. The reliability of the French version yielded 0.91 as Cronbach alpha coefficient. The Spearman-Brown split-half coefficient was 0.89, and the Guttman split-half coefficient was 0.88. Principal-component analysis and factorial matrices were used to examine the clustering structure of the French version of this instrument.

  9. False alarm reduction in critical care.

    Science.gov (United States)

    Clifford, Gari D; Silva, Ikaro; Moody, Benjamin; Li, Qiao; Kella, Danesh; Chahin, Abdullah; Kooistra, Tristan; Perry, Diane; Mark, Roger G

    2016-08-01

    High false alarm rates in the ICU decrease quality of care by slowing staff response times while increasing patient delirium through noise pollution. The 2015 PhysioNet/Computing in Cardiology Challenge provides a set of 1250 multi-parameter ICU data segments associated with critical arrhythmia alarms, and challenges the general research community to address the issue of false alarm suppression using all available signals. Each data segment was 5 minutes long (for real time analysis), ending at the time of the alarm. For retrospective analysis, we provided a further 30 seconds of data after the alarm was triggered. A total of 750 data segments were made available for training and 500 were held back for testing. Each alarm was reviewed by expert annotators, at least two of whom agreed that the alarm was either true or false. Challenge participants were invited to submit a complete, working algorithm to distinguish true from false alarms, and received a score based on their program's performance on the hidden test set. This score was based on the percentage of alarms correct, but with a penalty that weights the suppression of true alarms five times more heavily than acceptance of false alarms. We provided three example entries based on well-known, open source signal processing algorithms, to serve as a basis for comparison and as a starting point for participants to develop their own code. A total of 38 teams submitted a total of 215 entries in this year's Challenge. This editorial reviews the background issues for this challenge, the design of the challenge itself, the key achievements, and the follow-up research generated as a result of the Challenge, published in the concurrent special issue of Physiological Measurement. Additionally we make some recommendations for future changes in the field of patient monitoring as a result of the Challenge. PMID:27454172

  10. The essential nature of healthcare databases in critical care medicine

    OpenAIRE

    Martin, Greg S.

    2008-01-01

    Medical databases serve a critical function in healthcare, including the areas of patient care, administration, research and education. The quality and breadth of information collected into existing databases varies tremendously, between databases, between institutions and between national boundaries. The field of critical care medicine could be advanced substantially by the development of comprehensive and accurate databases.

  11. Book review: Learning with adults: A critical pedagogical introduction.

    OpenAIRE

    Saragoça, José

    2014-01-01

    Written at a time when, for many, the neoliberal policies and globalization lead to an increasing confusion between education and training, as well as to the reification of the “theories of human capital”, this book addresses the critical pedagogy in the context of adult education in several fields. (...)Book review about the book "Learning with adults: A critical pedagogical introduction", written by Leona M. English and Peter Mayo. (Rotterdam: Sense Publishers., 2012) 269 pp.,

  12. Critical care clinical trials: getting off the roller coaster.

    Science.gov (United States)

    Goodwin, Andrew J

    2012-09-01

    Optimizing care in the ICU is an important goal. The heightened severity of illness in patients who are critically ill combined with the tremendous costs of critical care make the ICU an ideal target for improvement in outcomes and efficiency. Incorporation of evidence-based medicine into everyday practice is one method to optimize care; however, intensivists have struggled to define optimal practices because clinical trials in the ICU have yielded conflicting results. This article reviews examples where such conflicts have occurred and explores possible causes of these discrepant data as well as strategies to better use critical care clinical trials in the future. PMID:22948575

  13. Reassessing Subjectivity, Criticality, and Inclusivity: Marcuse's Challenge to Adult Education.

    Science.gov (United States)

    Brookfield, Stephen

    2002-01-01

    Although Herbert Marcuse did not write as an adult educator, his analysis of subjectivity, criticality, and inclusivity has implications for adult education. He demonstrated how apparently humanistic tolerance for diversity can be manipulated to reinforce dominant ideology, and he made a case for aesthetic education as a site for critical…

  14. Global Health Education in Pulmonary and Critical Care Medicine Fellowships.

    Science.gov (United States)

    Siddharthan, Trishul; North, Crystal M; Attia, Engi F; Christiani, David C; Checkley, William; West, T Eoin

    2016-06-01

    A growing number of pulmonary and critical care medicine fellowship programs in the United States offer global health training opportunities. Formal, integrated global health programs within pulmonary and critical care fellowships are relatively new but are built on principles and ideals of global health that focus on the mutually beneficial exchange of knowledge and social justice. Although core competencies consistent with these overarching themes in global health education have not been formalized for pulmonary and critical care trainees, relevant competency areas include clinical knowledge, international research training, cultural competency, and clinical and research capacity building. Existing global health education in U.S. pulmonary and critical care medicine training programs can generally be classified as one of three different models: integrated global health tracks, global health electives, and additional research years. Successful global health education programs foster partnerships and collaborations with international sites that emphasize bidirectional exchange. This bidirectional exchange includes ongoing, equitable commitments to mutual opportunities for training and professional development, including a focus on the particular knowledge and skill sets critical for addressing the unique priorities of individual countries. However, barriers related to the availability of mentorship, funding, and dedicated time exist to expanding global health education in pulmonary and critical care medicine. The implementation of global health training within pulmonary and critical care medicine programs requires continued optimization, but this training is essential to prepare the next generation of physicians to address the global aspects of respiratory disease and critical illness. PMID:26974557

  15. Year in review 2010: Critical Care - infection

    DEFF Research Database (Denmark)

    Pagani, Leonardo; Afshari, Arash; Harbarth, Stephan

    2011-01-01

    ABSTRACT: Infections remain among the most important concerns in critically ill patients. Early and reliable diagnosis of infection still poses difficulties in this setting but also represents a crucial step toward appropriate antimicrobial therapy. Increasing antimicrobial resistance challenges ...

  16. Opportunity and health care: criticisms and suggestions.

    Science.gov (United States)

    Stern, L

    1983-11-01

    orman Daniels' proposal to distribute health care on the basis of fair equality of opportunity, is, in this writer's opinion, unworkable. His concepts of species-typical activity and normal opportunity range are unclear; so is the relationship between them. His view that justice accords disease a better claim on the health dollar than other causes of death, pain, and disability, commits him unknowingly to indefensible positions on particular sorts of health care, such as the care of the aging and of pregnant women. Daniels' concept of opportunity is so inclusive, his notion of balancing opportunities so vague, that his theory loses systematic power. I offer a different account from Daniels' concerning why health care needs are objective and of special importance. I also argue for a voucher system which levels out class inequalities and which finances current medical practices more or less uncritically, but allows for change through a diversity of insurance plans available to consumers. This system is just, and more practical than rating health care needs by impact on opportunity.

  17. The Certified Clinical Nurse Leader in Critical Care.

    Science.gov (United States)

    L'Ecuyer, Kristine M; Shatto, Bobbi J; Hoffmann, Rosemary L; Crecelius, Matthew L

    2016-01-01

    Challenges of the current health system in the United States call for collaboration of health care professionals, careful utilization of resources, and greater efficiency of system processes. Innovations to the delivery of care include the introduction of the clinical nurse leader role to provide leadership at the point of care, where it is needed most. Clinical nurse leaders have demonstrated their ability to address needed changes and implement improvements in processes that impact the efficiency and quality of patient care across the continuum and in a variety of settings, including critical care. This article describes the role of the certified clinical nurse leader, their education and skill set, and outlines outcomes that have been realized by their efforts. Specific examples of how clinical nurse leaders impact critical care nursing are discussed. PMID:27487750

  18. The Certified Clinical Nurse Leader in Critical Care.

    Science.gov (United States)

    L'Ecuyer, Kristine M; Shatto, Bobbi J; Hoffmann, Rosemary L; Crecelius, Matthew L

    2016-01-01

    Challenges of the current health system in the United States call for collaboration of health care professionals, careful utilization of resources, and greater efficiency of system processes. Innovations to the delivery of care include the introduction of the clinical nurse leader role to provide leadership at the point of care, where it is needed most. Clinical nurse leaders have demonstrated their ability to address needed changes and implement improvements in processes that impact the efficiency and quality of patient care across the continuum and in a variety of settings, including critical care. This article describes the role of the certified clinical nurse leader, their education and skill set, and outlines outcomes that have been realized by their efforts. Specific examples of how clinical nurse leaders impact critical care nursing are discussed.

  19. Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review

    Science.gov (United States)

    Dellefield, Mary Ellen

    2006-01-01

    Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…

  20. Physiotherapy in Critical Care in Australia

    OpenAIRE

    Berney, Susan; Haines, Kimberley; Denehy, Linda

    2012-01-01

    A physiotherapist is part of the multidisciplinary team in most intensive care units in Australia. Physiotherapists are primary contact practitioners and use a comprehensive multisystem assessment that includes the respiratory, cardiovascular, neurological, and musculoskeletal systems to formulate individualized treatment plans. The traditional focus of treatment has been the respiratory management of both intubated and spontaneously breathing patients. However, the emerging evidence of the l...

  1. Critical care: Are we customer friendly?

    Science.gov (United States)

    Venkataraman, Ramesh; Ranganathan, Lakshmi; Rajnibala, V.; Abraham, Babu K.; Rajagopalan, Senthilkumar; Ramakrishnan, Nagarajan

    2015-01-01

    Objective: Assessing and enhancing family satisfaction are imperative for the provision of comprehensive intensive care. There is a paucity of Indian data exploring family's perception of Intensive Care Unit (ICU) patients. We wanted to explore family satisfaction and whether it differed in families of patients admitted under intensivists and nonintensivists in our semi-open ICU. Methodology: We surveyed family members of 200 consecutive patients, between March and September 2009 who were in ICU for >3 days. An internationally validated family satisfaction survey was adapted and was administered to a family member, on day 4 of the patient's stay. The survey consisted of 15 questions in five categories - patient care, medical counseling, staff interaction, visiting hours, and facilities and was set to a Likert scale of 1–4. Mean, median, and proportions were computed to describe answers for each question and category. Results: A total of 515 patients were admitted during the study period, of which 200 patients stayed in the ICU >3 days. One family member each of the 200 patients completed the survey with 100% response rate. Families reported the greatest satisfaction with patient care (94.5%) and least satisfaction with visiting hours (60.5%). Chi-square tests performed for each of the five categories revealed no significant difference between satisfaction scores of intensivists and nonintensivists' patients. Conclusion: Family members of ICU patients were satisfied with current care and communication, irrespective of whether they were admitted under intensivists or nonintensivists. Family members preferred open visiting hours policy than a time limited one. PMID:26430335

  2. May 2016 Phoenix critical care journal club

    OpenAIRE

    Robbins RA; Rashke RA

    2016-01-01

    No abstract available. Article truncated at 150 words. Panwar R, Hardie M, Bellomo R, Barrot L, Eastwood GM, Young PJ, Capellier G, Harrigan PW, Bailey M; CLOSE Study Investigators; ANZICS Clinical Trials Group. Conservative versus liberal oxygenation targets for mechanically ventilated patients. A pilot multicenter randomized controlled trial. Am J Respir Crit Care Med. 2016 Jan 1;193(1):43-51. We continue to debate the appropriate level of oxygenation for a variety of patients. This study a...

  3. An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Healthcare Professionals: A Call for Action.

    Science.gov (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of healthcare professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other healthcare professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care healthcare professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care healthcare professionals and diminish the harmful consequences of BOS, both for critical care healthcare professionals and for patients. PMID:27309157

  4. Supporting Nutrition in Early Care and Education Settings: The Child and Adult Care Food Program (CACFP)

    Science.gov (United States)

    Stephens, Samuel A.

    2016-01-01

    Child care centers, Head Start programs, and family child care providers serving young children--as well as after school programs and homeless shelters that reach older children, adults, and families--are supported in providing healthy meals and snacks by reimbursements through the Child and Adult Care Food Program (CACFP). Administered by the…

  5. Teaching and evaluating critical thinking in respiratory care.

    Science.gov (United States)

    Mishoe, Shelley C; Hernlen, Kitty

    2005-09-01

    The capacity to perform critical thinking in respiratory care may be enhanced through awareness and education to improve skills, abilities, and opportunities. The essential skills for critical thinking in respiratory care include prioritizing, anticipating, troubleshooting, communicating, negotiating, decision making, and reflecting. In addition to these skills, critical thinkers exhibit certain characteristics such as critical evaluation, judgment,insight, motivation, and lifelong learning. The teaching of critical thinking may be accomplished though problem-based learning using an evidenced-based approach to solve clinical problems similar to those encountered in professional practice. Other traditional strategies such as discussion, debate, case study, and case presentations can be used. Web-based curriculum and technologic advances have created opportunities such as bulletin boards, real-time chats, and interactive media tools that can incorporate critical thinking. Many concerns and controversies surround the assessment of critical thinking, and individuals who administer critical thinking tests must be aware of the strengths and limitations of these assessment tools, as well as their relevance to the workplace. The foundational works reported in this article summarize the current status of assessment of critical thinking and can stimulate further investigation and application of the skills, characteristics, educational strategies, and measurement of critical thinking in respiratory care. PMID:16168915

  6. Up Close and Personal: Theorising Care Work in Adult Education

    Science.gov (United States)

    John, Vaughn M.

    2016-01-01

    How do we account for the close personal bonds and deeply caring relationships forged by educators with learners in many adult educational encounters? The literature is relatively silent on the emotional and relational basis to adult educator work. This is a serious silence, given the stressful nature of adult education in developing contexts such…

  7. Familism and Health Care Provision to Hispanic Older Adults.

    Science.gov (United States)

    Savage, Brittany; Foli, Karen J; Edwards, Nancy E; Abrahamson, Kathleen

    2016-01-01

    The Hispanic older adult population's rapid growth calls for an awareness of values that can affect the rendering and receipt of care. Familism, or familismo, a traditional Hispanic value, places importance of family over the self and can potentially affect health care perceptions and practices for Hispanic older adults. The current article discusses familism, which is upheld by some Hispanic older adults, and the potential for underuse of health care services. The traditional feminine role, marianismo, and masculine role, machismo, are considered, as well as implications for how decision making may be made by family members rather than the patient. Clinical implications for the provision of health care to Hispanic older adults are provided, along with the importance of considering acculturation and ethnic heterogeneity. Health care management strategies that reflect recognition and respect of familism, yet emphasize optimization of adherence and self-care, are described.

  8. Integration of Early Specialist Palliative Care in Cancer Care and Patient Related Outcomes: A Critical Review of Evidence

    Science.gov (United States)

    Salins, Naveen; Ramanjulu, Raghavendra; Patra, Lipika; Deodhar, Jayita; Muckaden, Mary Ann

    2016-01-01

    Introduction: World Health Organization and American Society of Clinical Oncology recommend early integration of specialist palliative care in patients with cancer. This paper focuses on critical review of evidence on integration of early specialist palliative care in cancer care and patient-related outcomes. Methods: The question for the literature search was – Does integration of early specialist palliative care in cancer care influences patient-related outcomes? 31 articles related to literature search review question were included in this paper. Results: Ten patient-related outcomes of early specialist palliative care in adult cancer care was studied. Studies by Temel et al. (2012), Bakitas et al. (2009), Zimmermann et al. (2014), Rugno et al. (2014), Lowery et al. (2013) and Walker et al. (2014) showed early specialist palliative care improves health-related quality of life (HRQOL). Studies by Pirl et al. (2012), Lowery et al. (2013), and Walker et al. (2014) showed early specialist palliative care improved mood depression and anxiety. Studies by Zimmermann et al. and Rugno et al. (2014) showed symptom control benefit of early specialist palliative care. Studies by Temel (2010), Bakitas (2015) and Rugno et al. (2014) showed survival improvement with early specialist palliative care. All these studies were carried in ambulatory palliative care setting. No survival benefit of palliative care intervention was seen in inpatient palliative care setting. The studies by Geer et al. (2012), Rugno et al. (2014), and Lowery et al. (2013) showed that early palliative care intervention positively influences treatment decision making. All the studies showed that palliative care intervention group received less intravenous chemotherapy in last few weeks of life. Studies by Yoong et al. and Temel et al. (2011) shows early specialist palliative care improves advanced care planning. Studies by Temel et al. (2010), Greer et al. (2012), McNamara et al. (2013), Hui et al. (2014

  9. An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action.

    Science.gov (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients. PMID:27396776

  10. Critical care computing. Past, present, and future.

    Science.gov (United States)

    Seiver, A

    2000-10-01

    With rapidly increasing processing power, networks, and bandwidth, we have ever more powerful tools for ICU computing. The challenge is to use these tools to build on the work of the Innovators and Early Adopters, who pioneered the first three generations of systems, and extend computing to the Majority, who still rely on paper. What is needed is compelling evidence that these systems reduce cost and improve quality. The experience of other industries suggests that we need to address fundamental issues, such as clinical organization, roles, behavior, and incentives, before we will be able to prove the benefits of computing technology. When these preconditions are met, the promise of computing will be realized, perhaps with the upcoming fourth-generation systems. ICU computing can then finally cross the chasm and become the standard of care. PMID:11070807

  11. Ultrasound for critical care physicians: tiny bubbles

    Directory of Open Access Journals (Sweden)

    Aslam K

    2015-05-01

    Full Text Available No abstract available. Article truncated after first page. A 59 year old woman with a past medical history significant for stage IV MALT lymphoma (after chemotherapy and in remission presented from a long term care facility for respiratory distress and altered mental status. The patient was in hypercarbic respiratory failure with a severe lactic acidosis. Her blood pressure deteriorated, she was begun on vasopressors and intubated. Pertinent labs demonstrated a white blood cell count of 0.9 X106 /ml, a hemoglobin of 7.1 g/dl, and a platelet count 66 X106 /ml. The patient was started on Cefepime and Linezolid presumptively for septic shock. Ultrasounds of her thorax were performed (Videos 1 & 2. What is the best explanation for the ultrasound findings shown above?1. Large pleural effusion; 2. Pneumothorax; 3. Consolidation due to pneumonia; 4. Ruptured diaphragm; 5. Lung abscess

  12. [Antibiotic multiresistance in critical care units].

    Science.gov (United States)

    López-Pueyo, M J; Barcenilla-Gaite, F; Amaya-Villar, R; Garnacho-Montero, J

    2011-01-01

    The presence of microorganisms with acquired resistance to multiple antibiotics complicates the management and outcome of critically ill patients. The intensivist, in his/her daily activity, is responsible for the prevention and control of the multiresistance and the challenge of prescribing the appropriate treatment in case of an infection by these microorganisms. We have reviewed the literature regarding the definition, important concepts related to transmission, recommendations on general measures of control in the units and treatment options. We also present data on the situation in our country known primarily through the ENVIN-UCI register. Addressing the multiresistance not only requires training but also teamwork with other specialists and adaptation to the local environment. PMID:21215489

  13. Glutamine: An Obligatory Parenteral Nutrition Substrate in Critical Care Therapy

    Directory of Open Access Journals (Sweden)

    Peter Stehle

    2015-01-01

    Full Text Available Critical illness is characterized by glutamine depletion owing to increased metabolic demand. Glutamine is essential to maintain intestinal integrity and function, sustain immunologic response, and maintain antioxidative balance. Insufficient endogenous availability of glutamine may impair outcome in critically ill patients. Consequently, glutamine has been considered to be a conditionally essential amino acid and a necessary component to complete any parenteral nutrition regimen. Recently, this scientifically sound recommendation has been questioned, primarily based on controversial findings from a large multicentre study published in 2013 that evoked considerable uncertainty among clinicians. The present review was conceived to clarify the most important questions surrounding glutamine supplementation in critical care. This was achieved by addressing the role of glutamine in the pathophysiology of critical illness, summarizing recent clinical studies in patients receiving parenteral nutrition with intravenous glutamine, and describing practical concepts for providing parenteral glutamine in critical care.

  14. Glutamine: An Obligatory Parenteral Nutrition Substrate in Critical Care Therapy

    Science.gov (United States)

    Stehle, Peter; Kuhn, Katharina S.

    2015-01-01

    Critical illness is characterized by glutamine depletion owing to increased metabolic demand. Glutamine is essential to maintain intestinal integrity and function, sustain immunologic response, and maintain antioxidative balance. Insufficient endogenous availability of glutamine may impair outcome in critically ill patients. Consequently, glutamine has been considered to be a conditionally essential amino acid and a necessary component to complete any parenteral nutrition regimen. Recently, this scientifically sound recommendation has been questioned, primarily based on controversial findings from a large multicentre study published in 2013 that evoked considerable uncertainty among clinicians. The present review was conceived to clarify the most important questions surrounding glutamine supplementation in critical care. This was achieved by addressing the role of glutamine in the pathophysiology of critical illness, summarizing recent clinical studies in patients receiving parenteral nutrition with intravenous glutamine, and describing practical concepts for providing parenteral glutamine in critical care. PMID:26495301

  15. November 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-11-01

    Full Text Available No abstract available. Article truncated at 150 words. Four manuscripts were reviewed. The first two were review articles from the New England Journal of Medicine. Both are good assessments of the current state of the art of fluid resuscitation and shock in the intensive care unit. Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369 (13:1243-51. Fluid administration is one of the most common interventions in medicine. The authors review the use of resuscitation fluids and point out that until recently that the evidence basis for the selection, timing, and doses of intravenous fluids was empiric, based more on training and preference than data. The authors summarize the literature nicely in Table 2 of their manuscript with the following being major points of the manuscript: No currently available resuscitation fluid can be considered to be ideal. Fluids should be administered with the same caution that is used with any intravenous drug. Fluid resuscitation is a component …

  16. January 2014 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2014-02-01

    Full Text Available No abstract available. Article truncated at 150 words. Kamps MJ, Horn J, Oddo M, Fugate JE, Storm C, Cronberg T, Wijman CA, Wu O, Binnekade JM, Hoedemaekers CW. Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature. Intensive Care Med. 2013;39(10:1671-82. [CrossRef] [PubMed] Cohort studies performed prior to the advent of therapeutic hypothermia had shown that severe deficits in motor response to painful stimuli, or deficits in certain cranial nerve reflexes, could be used to rule-out the possibility of meaningful neurological recovery in patients who did not regain consciousness within 48-72 hours after cardiac arrest. However, subsequent reports have challenged the reliability of these findings in patients who received therapeutic hypothermia – some of whom recovered despite grim neurological findings. These authors performed a meta-analysis to determine whether neurological findings performed 72 hours after cardiac arrest (of all causes could be used to prognosticate neurological outcome in patients who received ...

  17. Transition from Pediatric to Adult OI Care

    Science.gov (United States)

    ... example, preparing for adult employment begins with the process of learning responsibility by doing chores and helping at home. As ... Similarly, developing satisfying adult relationships is a gradual process that begins ... social experiences in school and throughout adolescence. Some of ...

  18. New media and critical care ultrasound.

    Science.gov (United States)

    Pawlak, Michał

    2014-12-01

    The paper discusses the issue of spreading medical knowledge, connected particularly with ultrasonography, by the social media. Such a way of sharing knowledge and experience results from the needs of recipients - physicians who daily have limited free time. The paper presents the phenomenon of the free open access medical education (FOAM) along with its genesis, an open and global nature as well as the main communication channels. It is emphasized that education via the social media is becoming an element of the mainstream medical didactics. The aforementioned phenomenon is depicted in greater detail in the context of emergency ultrasonography. US imaging is one of the more popular issues in the FOAM community. The paper focuses on the Ultrasound Podcast and the initiative associated with it. Our native (Polish) project, CriticalUSG, is also presented together with its numerous editions. Apart from these two projects, other initiatives, which are equally important not only due to ultrasonography, are also briefly mentioned. The aim of the paper is to interest the reader with the FOAM phenomenon as an open access, free and global medical discussion. PMID:26673154

  19. Primary care for young adult cancer survivors: an international perspective

    DEFF Research Database (Denmark)

    Hølge-Hazelton, Bibi; Blake-Gumbs, Lyla; Miedema, Baujke;

    2010-01-01

    PURPOSE: Internationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement. METHODS: Comparative descriptions and literature review. RESULTS: Cancer among YAs is rare ...... continuing medical education (CME) initiatives, and an enhanced cooperative effort between those delivering and coordinating cancer care.......PURPOSE: Internationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement. METHODS: Comparative descriptions and literature review. RESULTS: Cancer among YAs is rare...... and usually not the first thing that comes into the FP's mind. Youth is sometimes mistakenly regarded as a protective factor. Across the countries, almost all YACs are treated in tertiary health care facilities with specialists providing the majority of care. Health care services are covered by the universal...

  20. Carbapenemase-producing Enterobacteriaceae in Irish critical care units: results of a pilot prevalence survey, June 2011.

    LENUS (Irish Health Repository)

    Burns, K

    2012-11-10

    The epidemiology of carbapenemase-producing Enterobacteriaceae (CPE) in Ireland is changing, with an increase in the number of reported cases in late 2010 and early 2011. Reported cases were predominantly linked to critical care units. In June 2011, a four-week national pilot survey took place in 40 Irish critical care units (37 adult and three paediatric) to examine the prevalence of rectal carriage of CPE and inform national CPE screening guidelines. A total of 760 screening swabs were taken over the study period, and CPE were not detected in any of the participating critical care units.

  1. Skin tears: care and management of the older adult at home.

    Science.gov (United States)

    Holmes, Regina F; Davidson, Martha W; Thompson, Bonnie J; Kelechi, Teresa J

    2013-02-01

    Skin tears experienced by older adults require special skills to promote healing. Home healthcare providers are in key positions to manage skin tears and prevent further skin trauma. Several guidelines, risk assessments, classifications, and products exist to manage high-risk patients. Frequent evaluation of the effectiveness of the treatment and prevention strategies in an overall skin care protocol for home care patients is critical to reduce skin tear incidence and promote prompt healing when skin tears are present.

  2. 25 CFR 20.332 - Who can receive Adult Care Assistance?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Who can receive Adult Care Assistance? 20.332 Section 20... AND SOCIAL SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.332 Who can receive Adult Care Assistance? An adult Indian is eligible to receive adult care assistance under this part if...

  3. Compassion fatigue: A Study of critical care nurses in Turkey

    OpenAIRE

    Dikmen, Yurdanur; Aydın, Yasemin; Tabakoğlu, Pınar

    2016-01-01

    This study was conducted to determine the level of compassion fatigue which experienced by nurses who work in intensive care units and factors that affecting it.In a cross sectional design, critical nurses were surveyed by using questionnaire and  compassion fatigue (CF) subscale of the Professional Quality of Life Scale (ProQOL R-IV) to measure levels of compassion fatigueat a large National Education and ResearchHospital located in northwestof Turkey. A total of 69 critical care nurses part...

  4. Foster Care Experiences and Educational Outcomes of Young Adults Formerly Placed in Foster Care

    Science.gov (United States)

    Havalchak, Anne; White, Catherine Roller; O'Brien, Kirk; Pecora, Peter J.; Sepulveda, Martin

    2009-01-01

    This study contributes to the body of research on the educational outcomes of young adults who were formerly placed in foster care. Telephone interviews were conducted with 359 young adults (a 54.6% response rate). Participants must have been served for at least one year by one private foster care agency in one of its twenty-two offices. Results…

  5. Diarrhea - what to ask your health care provider - adult

    Science.gov (United States)

    What to ask your health care provider about diarrhea - adult; Loose stools - what to ask your health ... medicines, vitamins, herbs, or supplements I take cause diarrhea? Should I stop taking any of them? What ...

  6. Keep Your Mouth Healthy: Oral Care for Older Adults

    Science.gov (United States)

    ... please review our exit disclaimer . Subscribe Keep Your Mouth Healthy Oral Care for Older Adults Oral health ... decay. You can take steps to keep your mouth healthy throughout your lifetime. And if you’re ...

  7. The neurologist's role in supporting transition to adult health care: A consensus statement.

    Science.gov (United States)

    Brown, Lawrence W; Camfield, Peter; Capers, Melissa; Cascino, Greg; Ciccarelli, Mary; de Gusmao, Claudio M; Downs, Stephen M; Majnemer, Annette; Miller, Amy Brin; SanInocencio, Christina; Schultz, Rebecca; Tilton, Anne; Winokur, Annick; Zupanc, Mary

    2016-08-23

    The child neurologist has a critical role in planning and coordinating the successful transition from the pediatric to adult health care system for youth with neurologic conditions. Leadership in appropriately planning a youth's transition and in care coordination among health care, educational, vocational, and community services providers may assist in preventing gaps in care, delayed entry into the adult care system, and/or health crises for their adolescent patients. Youth whose neurologic conditions result in cognitive or physical disability and their families may need additional support during this transition, given the legal and financial considerations that may be required. Eight common principles that define the child neurologist's role in a successful transition process have been outlined by a multidisciplinary panel convened by the Child Neurology Foundation are introduced and described. The authors of this consensus statement recognize the current paucity of evidence for successful transition models and outline areas for future consideration. PMID:27466477

  8. Year in review 2007: Critical Care – shock

    OpenAIRE

    Wagner, Florian; Baumgart, Katja; Simkova, Vladislava; Georgieff, Michael; Radermacher, Peter; Calzia, Enrico

    2008-01-01

    The research papers on shock published in Critical Care throughout 2007 are related to three major subjects: the modulation of the macrocirculation and microcirculation during shock, focusing on arginine vasopressin, erythropoietin and nitric oxide; studies on metabolic homeostasis (acid–base status, energy expenditure and gastrointestinal motility); and basic supportive measures in critical illness (fluid resuscitation and sedation, and body-temperature management). The present review summar...

  9. Diabetes Self-Care and the Older Adult

    OpenAIRE

    Weinger, Katie; Beverly, Elizabeth A.; Smaldone, Arlene

    2014-01-01

    The prevalence of diabetes is highest in older adults, a population that is increasing. Diabetes self-care is complex with important recommendations for nutrition, physical activity, checking glucose levels, and taking medication. Older adults with diabetes have unique issues which impact self-care. As people age, their health status, support systems, physical and mental abilities, and nutritional requirements change. Furthermore, comorbidities, complications, and polypharmacy complicate diab...

  10. Mobilizing Patients Along the Continuum of Critical Care.

    Science.gov (United States)

    Reames, Christina D; Price, Deborah M; King, Elizabeth A; Dickinson, Sharon

    2016-01-01

    The progressive care unit implemented an evidenced-based intensive care unit mobility protocol with their chronically critically ill patient population. The labor/workload necessary to meet mobility standards was an identified barrier to implementation. Workflow redesign of patient care technicians, interdisciplinary teamwork, and creating a culture of meeting mobility standards led to the successful implementation of this protocol. Data revealed that mobility episodes increased from 1.4 at preinitiative to 4.7 at 12 months postinitiative, surpassing the goal of 3 episodes per 24 hours. PMID:26627065

  11. [Systematization of nursing assistance in critical care unit].

    Science.gov (United States)

    Truppel, Thiago Christel; Meier, Marineli Joaquim; Calixto, Riciana do Carmo; Peruzzo, Simone Aparecida; Crozeta, Karla

    2009-01-01

    This is a methodological research, which aimed at organizing the systematization of nursing assistance in a critical care unit. The following steps were carried out: description of the nursing practice; transcription of nursing diagnoses; elaboration of a protocol for nursing diagnosis based in International Classification for Nursing Practice (ICNP); determination of nursing prescriptions and the elaboration of guidelines for care and procedures. The nursing practice and care complexity in ICU were characterized. Thus, systematization of nursing assistance is understood as a valuable tool for nursing practice.

  12. Optimizing Health Care for Adults with Spina Bifida

    Science.gov (United States)

    Webb, Thomas S.

    2010-01-01

    Survival into adulthood for individuals with spina bifida has significantly improved over the last 40 years with the majority of patients now living as adults. Despite this growing population of adult patients who have increased medical needs compared to the general population, including spina bifida (SB)-specific care, age-related secondary…

  13. Dental Care among Young Adults with Intellectual Disability

    Science.gov (United States)

    Kancherla, Vijaya; Van Naarden Braun, Kim; Yeargin-Allsopp, Marshalyn

    2013-01-01

    Dental care among young adults with intellectual disability (ID) is poorly documented and largely unmet. By using population-based data from the Metropolitan Atlanta Developmental Disabilities Follow-Up Study, we assessed factors associated with at least one or two dental visits per year among young adults with and without ID. Significantly fewer…

  14. Compassion fatigue: A Study of critical care nurses in Turkey

    Directory of Open Access Journals (Sweden)

    Yurdanur Dikmen

    2016-06-01

    Full Text Available This study was conducted to determine the level of compassion fatigue which experienced by nurses who work in intensive care units and factors that affecting it. In a cross sectional design, critical nurses were surveyed by using questionnaire and  compassion fatigue (CF subscale of the Professional Quality of Life Scale (ProQOL R-IV to measure levels of compassion fatigueat a large National Education and ResearchHospital located in northwestof Turkey. A total of 69 critical care nurses participated in the study, for a response rate of 78%.A series of cross tab analyses examined the relationship between nurses demographics and compassion fatigue (CF subscale. To analyze the data further, participants were recategorized into 2 groups for CF scores: (1 higher than 17: high risk and (2 lower than 17: low risk. Findings show that critical care nurses were at high risk (52.7% and low risk (47.3% for CF. Nurses informed significant differences in compassion fatigue on the basis of age, years of critical care experience, working hours (weekly.

  15. Starting with Self: Teaching Autoethnography to Foster Critically Caring Literacies

    Science.gov (United States)

    Camangian, Patrick

    2010-01-01

    This article illustrates the application of critical literacy (Freire & Macedo, 1987; Gutierrez, 2008; Morrell, 2007) pedagogies that draw from young people's funds of knowledge (Moll, Amanti, Neff, & Gonzalez, 1992) to actively nurture personally, authentically, and culturally caring relationships (Howard, 2002; Noddings, 1992; Valenzuela, 1999)…

  16. Year in review 2006: Critical Care – respirology

    OpenAIRE

    Vasquez, Daniela; Singh, Jeffrey M; Ferguson, Niall D

    2007-01-01

    The present article summarises and places in context original research articles from the respirology section published in Critical Care in 2006. Twenty papers were identified and were grouped by topic into those addressing acute lung injury and ventilator-induced lung injury, those examining high-frequency oscillation, those studying pulmonary physiology and mechanics, those assessing tracheostomy, and those exploring other topics.

  17. Physical outcome measure for critical care patients following intensive care discharge

    OpenAIRE

    Devine, H.; MacTavish, P.; Quasim, T.; Kinsella, J; Daniel, M; McPeake, J.

    2016-01-01

    Introduction: The aim of this study was to evaluate the most suitable physical outcome measures to be used with critical care patients following discharge. ICU survivors experience physical problems such as reduced exercise capacity and intensive care acquired weakness. NICE guideline ‘Rehabilitation after critical illness’ (1) recommends the use of outcome measures however does not provide any specific guidance. A recent Cochrane review noted wide variability in measures...

  18. Adult Day Care and Medical and Hospital Claims.

    Science.gov (United States)

    Chappell, Neena L.; Blandford, Audrey A.

    1987-01-01

    Examined effect of adult day care (ADC) on utilization of health care practitioner and inpatient hospital services. Data from three separate ADC studies revealed that, when operative for some time, ADC may result in dramatic decreases in hospital inpatient stays. Findings warrant further research. (Author/NB)

  19. Care-related pain in critically ill mechanically ventilated patients.

    Science.gov (United States)

    Ayasrah, S

    2016-07-01

    Despite advances in pain management, critically ill patients continue to have unacceptably high rates of uncontrolled pain. Using the Behavioural Pain Scale and physiological indicators of pain, this study examines pain levels in mechanically ventilated patients prior to and during routine nursing procedures. A prospective descriptive design was used to assess and describe care-related pain associated with nociceptive procedures (repositioning, endotracheal suctioning, and vascular punctures) and non-nociceptive procedures (mouth care, eye care and dressing change). A sample of 247 mechanically ventilated Jordanian patients was recruited from intensive care units in a military hospital. The overall mean procedural pain score of 6.34 (standard deviation [SD] 2.36) was significantly higher than the mean preprocedural pain score of 3.43 (SD 0.67, t[246]=20.82, Pindicating that patients were either anxious or responsive to command only. The mean physiological indicators of pain increased during repositioning and endotracheal suctioning and decreased during the rest of the procedures. Mechanically ventilated patients experience pain prior to and during routine nursing procedures. Harmless and comfort procedures are actually painful. When caring for nonverbal critically ill patients, clinicians need to consider care-related pain associated with their interventions. Relying on changes in vital signs as a primary indicator of pain can be misleading. PMID:27456175

  20. Diagnostic and prognostic biomarkers of sepsis in critical care.

    Science.gov (United States)

    Kibe, Savitri; Adams, Kate; Barlow, Gavin

    2011-04-01

    Sepsis is a leading cause of mortality in critically ill patients. Delay in diagnosis and initiation of antibiotics have been shown to increase mortality in this cohort. However, differentiating sepsis from non-infectious triggers of the systemic inflammatory response syndrome (SIRS) is difficult, especially in critically ill patients who may have SIRS for other reasons. It is this conundrum that predominantly drives broad-spectrum antimicrobial use and the associated evolution of antibiotic resistance in critical care environments. It is perhaps unsurprising, therefore, that the search for a highly accurate biomarker of sepsis has become one of the holy grails of medicine. Procalcitonin (PCT) has emerged as the most studied and promising sepsis biomarker. For diagnostic and prognostic purposes in critical care, PCT is an advance on C-reactive protein and other traditional markers of sepsis, but is not accurate enough for clinicians to dispense with clinical judgement. There is stronger evidence, however, that measurement of PCT has a role in reducing the antibiotic exposure of critical care patients. For units intending to incorporate PCT assays into routine clinical practice, the cost-effectiveness of this is likely to depend on the pre-implementation length of an average antibiotic course and the subsequent impact of implementation on emerging antibiotic resistance. In most of the trials to date, the average baseline duration of the antibiotic course was longer than is currently standard practice in many UK critical care units. Many other biomarkers are currently being investigated. To be highly useful in clinical practice, it may be necessary to combine these with other novel biomarkers and/or traditional markers of sepsis.

  1. The role of chiropractic care in older adults

    Directory of Open Access Journals (Sweden)

    Dougherty Paul E

    2012-02-01

    Full Text Available Abstract There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.

  2. Care of Adult Refugees with Chronic Conditions.

    Science.gov (United States)

    Terasaki, Genji; Ahrenholz, Nicole Chow; Haider, Mahri Z

    2015-09-01

    Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees. PMID:26320045

  3. Care of Adult Refugees with Chronic Conditions.

    Science.gov (United States)

    Terasaki, Genji; Ahrenholz, Nicole Chow; Haider, Mahri Z

    2015-09-01

    Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees.

  4. 25 CFR 20.335 - What is the payment standard for Adult Care Assistance?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What is the payment standard for Adult Care Assistance... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.335 What is the payment standard for Adult Care Assistance? The approved payment for adult care assistance...

  5. 25 CFR 20.333 - How do I apply for Adult Care Assistance?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false How do I apply for Adult Care Assistance? 20.333 Section... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.333 How do I apply for Adult Care Assistance? To apply for adult care assistance, you or someone acting on your behalf...

  6. 7 CFR 226.19a - Adult day care center provisions.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Adult day care center provisions. 226.19a Section 226..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.19a Adult day care center provisions. (a) Adult day care centers may participate in the...

  7. Gastric Versus Small Bowel Feeding in Critically Ill Adults.

    Science.gov (United States)

    Schlein, Kirsten

    2016-08-01

    Critically ill patients often require enteral feedings as a primary supply of nutrition. Whether enteral nutrition (EN) should be delivered as a gastric versus small bowel feeding in the critically ill patient population remains a contentious topic. The Society of Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the Canadian Clinical Practice Guidelines (CCPG) are not in consensus on this topic. No research to date demonstrates a significant difference between the two feeding routes in terms of patient mortality, ventilator days, or length of stay in the intensive care unit (ICU); however, studies provide some evidence that there may be other benefits to using a small bowel feeding route in critically ill patients. The purpose of this paper is to examine both sides of this debate and review advantages and disadvantages of both small bowel and gastric routes of EN. Practical issues and challenges to small bowel feeding tube placement are also addressed. Finally, recommendations are provided to help guide the clinician when selecting a feeding route, and suggestions are made for future research. PMID:26920643

  8. Preventive Care Recommendations for Adults with MS

    Science.gov (United States)

    ... Examination Every 6 months. (Note: Make sure your dentist has a current list of all the medications ... care provider) Self Breast Exam Mammogram Prostate exam (digital rectal exam) PSA (prostate specific antigen) test Clinical ...

  9. Communication Needs of Critical Care Patients Who Are Voiceless.

    Science.gov (United States)

    Koszalinski, Rebecca S; Tappen, Ruth M; Hickman, Candice; Melhuish, Tracey

    2016-08-01

    Voice is crucial for communication in all healthcare settings. Evidence-based care highlights the need for clear communication. Clear communication methods must be applied when caring for special populations in order to assess pain effectively. Communication efforts also should be offered to patients who are in end-of-life care and would like to make independent decisions. A computer communication application was offered to patients in intensive care/critical care units in three hospitals in South Florida. Inclusion criteria included the age of 18 years or older, Richmond Agitation Sedation Scale between -1 and +1, ability to read and write English, and willingness to use the computer application. Exclusion criteria included inability to read and write English, agitation as defined by the Richmond Agitation Sedation Scale, and any patient on infection isolation protocol. Four qualitative themes were revealed, which directly relate to two published evidence-based guidelines. These are the End of Life Care and Decision Making Evidence-Based Care Guidelines and the Pain Assessment in Special Populations Guidelines. This knowledge is important for developing effective patient-healthcare provider communication. PMID:27315366

  10. Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: recommendations of the Working Group on Emergency Mass Critical Care.

    Science.gov (United States)

    Rubinson, Lewis; Nuzzo, Jennifer B; Talmor, Daniel S; O'Toole, Tara; Kramer, Bradley R; Inglesby, Thomas V

    2005-10-01

    The Working Group on Emergency Mass Critical Care was convened by the Center for Biosecurity of the University of Pittsburgh Medical Center and the Society of Critical Care Medicine to provide recommendations to hospital and clinical leaders regarding the delivery of critical care services in the wake of a bioterrorist attack resulting in hundreds or thousands of critically ill patients. In these conditions, traditional hospital and clinical care standards in general, and critical care standards in particular, likely could no longer be maintained, and clinical guidelines for U.S. hospitals facing these situations have not been developed. The Working Group offers recommendations for this situation.

  11. The experience of transition in adolescents and young adults transferring from paediatric to adult care

    DEFF Research Database (Denmark)

    Fegran, Liv; Ludvigsen, Mette Spliid; Aagaard, Hanne;

    : To synthesize qualitative studies on how adolescents and young adults with chronic diseases experience transition from paediatric to adult care. Methods: Literature search in major databases covering the years from 1999 to November 2010 was performed. Further forward citation snowballing search was conducted...... responsibility. Conclusion: Young adults’ transition experiences seem to be commensurable across diagnoses and cultures. Feelings of not belonging and being redundant during the transfer process moving from paediatric to adult ward, is striking. Appreciating young adults’ need to be acknowledged and valued......Introduction: Despite research and implementation of transition models in the last decades, transfer from paediatric to adult care still poses great challenges. Predominantly studies on health care transition have been based on the perspective of experts or health care professionals. Aim...

  12. Ethical Issues in Surgical Critical Care: The Complexity of Interpersonal Relationships in the Surgical Intensive Care Unit.

    Science.gov (United States)

    Sur, Malini D; Angelos, Peter

    2016-08-01

    A major challenge in the era of shared medical decision making is the navigation of complex relationships between the physicians, patients, and surrogates who guide treatment plans for critically ill patients. This review of ethical issues in adult surgical critical care explores factors influencing interactions among the characters most prominently involved in health care decisions in the surgical intensive care unit: the patient, the surrogate, the surgeon, and the intensivist. Ethical tensions in the surgeon-patient relationship in the elective setting may arise from the preoperative surgical covenant and the development of surgical complications. Unlike that of the surgeon, the intensivist's relationship with the individual patient must be balanced with the need to serve other acutely ill patients. Due to their unique perspectives, surgeons and intensivists may disagree about decisions to pursue life-sustaining therapies for critically ill postoperative patients. Finally, although surrogates are asked to make decisions for patients on the basis of the substituted judgment or best interest standards, these models may underestimate the nuances of postoperative surrogate decision making. Strategies to minimize conflicts regarding treatment decisions are centered on early, honest, and consistent communication between all parties.

  13. Provision of critical care services for the obstetric population.

    Science.gov (United States)

    Sultan, P; Arulkumaran, N; Rhodes, A

    2013-12-01

    Management of the peripartum patient is a challenging aspect of critical care that requires consideration of both the physiological changes associated with pregnancy as well as the well-being of the foetus. In the UK, for every maternal death, approximately 118 near-miss events or severe acute maternal morbidities (SAMMs) occur. While a dedicated anaesthetic cover is usually provided on larger labour wards in the UK and US, a close communication with intensive care and other medical specialties must still be maintained. Medical outreach teams and early warning scores may help facilitate the early identification of clinical deterioration and prompt treatment. Ultimately level of care is allocated according to the clinical need, not the location, which may be a designated room, a normal labour room or a recovery area. Specialist obstetric units that provide high-dependency care facilities show lower rates of maternal transfer to critical care units and improved continuity of care before and after labour. The benefits of obstetric high-dependency units (HDUs) are likely to be determined by a number of logistic aspects of the hospital organisation, including hospital size and available resources. There remains a striking contrast in the burden of maternal mortality and morbidity and intensive care unit (ICU) resources between high- and low-income countries. The countries with the highest maternal mortality rates have the lowest number of ICU beds per capita. In under-resourced countries, patients admitted to ICUs tend to have higher illness severity scores, suggesting delayed admission to the ICU. The appropriate training of midwives is essential for successful HDUs located within labour wards. PMID:23972289

  14. Supportive Care in Older Adults with Cancer: Across the Continuum.

    Science.gov (United States)

    Koll, Thuy; Pergolotti, Mackenzi; Holmes, Holly M; Pieters, Huibrie C; van Londen, G J; Marcum, Zachary A; MacKenzie, Amy R; Steer, Christopher B

    2016-08-01

    Supportive care is an essential component of anticancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anticancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent. PMID:27342609

  15. Advances in the Care of Adults With Congenital Heart Disease.

    Science.gov (United States)

    Nasr, Viviane G; Kussman, Barry D

    2015-09-01

    The significant decline in mortality among children and adolescents with congenital heart disease (CHD) is associated with an increasing prevalence of CHD in adults, particularly those with moderate to severe defects. As a significant percentage of adolescents and young adults are lost to follow-up in the transition from pediatric to adult care, they may present for elective procedures with substantial CHD-associated morbidity. In addition to the specific cardiac defect, the procedures performed, and the current pathophysiological status, several factors should be considered when managing the adult with CHD. These include the type of setting (adult vs pediatric institution); surgeon (pediatric vs adult cardiac surgeon); coexisting diseases associated with CHD, such as coronary artery disease, hepatic dysfunction, renal dysfunction, cerebrovascular accidents, myopathy, and coagulation disorders; acquired diseases of aging; pregnancy; and psychosocial functioning. The current status of the management of common and important congenital cardiac defects is also described. PMID:25542866

  16. Milrinone for cardiac dysfunction in critically ill adult patients

    DEFF Research Database (Denmark)

    Koster, Geert; Bekema, Hanneke J; Wetterslev, Jørn;

    2016-01-01

    review was performed according to The Cochrane Handbook for Systematic Reviews of Interventions. Searches were conducted until November 2015. Patients with cardiac dysfunction were included. The primary outcome was serious adverse events (SAE) including mortality at maximum follow-up. The risk of bias...... analyses displayed statistical and/or clinical heterogeneity of patients, interventions, comparators, outcomes, and/or settings and all featured missing data. DISCUSSION: The current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks...

  17. Increasing Registered Nurse Retention Using Mentors in Critical Care Services.

    Science.gov (United States)

    Schroyer, Coreena C; Zellers, Rebecca; Abraham, Sam

    2016-01-01

    Recruiting and training 1 newly hired registered nurse can cost thousands of dollars. With a high percentage of these newly hired nurses leaving their first place of employment within their first year, the financial implications may be enormous. It is imperative that health care facilities invest in recruiting and retention programs that retain high-quality nurses. Mentorship programs in retaining and easing the transition to practice for new graduate nurses, re-entry nurses, and nurses new to a specialty area are critical in nurse retention. Discussion in this study includes the effect of implementing a mentor program into the critical care services area of a 325-bed not-for-profit community hospital in northern Indiana. Based on this study, nurses with a mentor were retained at a 25% higher rate than those not mentored. Implementation of a mentor program reduced the training cost to the facility and increased retention and morale. PMID:27455367

  18. The role of melatonin in anaesthesia and critical care

    Directory of Open Access Journals (Sweden)

    Madhuri S Kurdi

    2013-01-01

    Full Text Available Melatonin is a neurohormone secreted by the pineal gland. It is widely present in both plant and animal sources. In several countries, it is sold over the counter as tablets and as food supplement or additive. Currently, it is most often used to prevent jet lag and to induce sleep. It has been and is being used in several clinical trials with different therapeutic approaches. It has sedative, analgesic, anti-inflammatory, anti-oxidative and chronobiotic effects. In the present review, the potential therapeutic benefits of melatonin in anaesthesia and critical care are presented. This article aims to review the physiological properties of melatonin and how these could prove useful for several clinical applications in perioperative management, critical care and pain medicine. The topic was handsearched from textbooks and journals and electronically from PubMed, and Google scholar using text words.

  19. Bedside ultrasonography-Applications in critical care: Part II

    Directory of Open Access Journals (Sweden)

    Jose Chacko

    2014-01-01

    Full Text Available Point of care ultrasonography, performed by acute care physicians, has developed into an invaluable bedside tool providing important clinical information with a major impact on patient care. In Part II of this narrative review, we describe ultrasound guided central venous cannulation, which has become standard of care with internal jugular vein cannulation. Besides improving success rates, real-time guidance also significantly reduces the incidence of complications. We also discuss compression ultrasonography - a quick and effective bedside screening tool for deep vein thrombosis of the lower extremity. Abdominal ultrasound offers vital clues in the emergency setting; in the unstable trauma victim, a focused examination may provide immediate answers and has largely superseded diagnostic peritoneal lavage in diagnosing intraperitoneal bleed. From estimation of intracranial pressure to transcranial Doppler studies, ultrasound is becoming increasingly relevant to neurocritical care. Ultrasound may also help with airway management in several situations, including percutaneous tracheostomy. Clearly, bedside ultrasonography has become an indispensable part of intensive care practice - in the rapid assessment of critically ill-patients as well as in enhancing the safety of invasive procedures.

  20. Introducing Critical Care Forum's ongoing review of medical statistics

    OpenAIRE

    Whitley, Elise; Ball, Jonathon

    2002-01-01

    Statistics is increasingly used in all fields of medicine but is often poorly understood and incorrectly applied. Critical Care is therefore launching a series of articles aimed at providing a simple introduction or refresher to some of the more commonly used statistical tools and ideas. This series does not aim to be an exhaustive review of medical statistics but rather a starting point to inform readers and stimulate more thought and investigation as to the most appropriate statistical meth...

  1. [Critical issues in clinical practice guidelines for geriatric care].

    Science.gov (United States)

    Zanetti, Ermellina

    2014-01-01

    Behavioral and psychological symptoms of dementia(BPSD) are one of the most disturbing issues in the management of patients, both for caregivers and health care personnel. Aim of this paper is to critically appraise the available guidelines on the non pharmacological management of BPSD. Some effective interventions such as person centred care, communication skills e dementia care mapping are not mentioned while interventions of dubious efficacy (aromatherapy, per therapy, light therapy or music therapy) are proposed. The variability in the expression of behavioral disorders and the different causes suggest an accurate tailoring of the interventions, based on the assessment of the patient, the organization and the environment. Further studies are necessary to improve the implementation of the non drug strategies for the management of BPSDs. PMID:25532924

  2. [Critical issues in clinical practice guidelines for geriatric care].

    Science.gov (United States)

    Zanetti, Ermellina

    2014-01-01

    Behavioral and psychological symptoms of dementia(BPSD) are one of the most disturbing issues in the management of patients, both for caregivers and health care personnel. Aim of this paper is to critically appraise the available guidelines on the non pharmacological management of BPSD. Some effective interventions such as person centred care, communication skills e dementia care mapping are not mentioned while interventions of dubious efficacy (aromatherapy, per therapy, light therapy or music therapy) are proposed. The variability in the expression of behavioral disorders and the different causes suggest an accurate tailoring of the interventions, based on the assessment of the patient, the organization and the environment. Further studies are necessary to improve the implementation of the non drug strategies for the management of BPSDs.

  3. February 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Stewart TM

    2016-02-01

    Full Text Available No abstract available. Article truncated after the first page. A 32 year-old, previously healthy, female hospital visitor had been participating in a family care conference regarding her critically ill grandmother admitted to the cardiac intensive care unit. During the care conference, she felt unwell and had some mild chest discomfort; she collapsed and cardiopulmonary resuscitation (CPR was initiated (1. Upon arrival of the code team, she was attached to the monitor and mask ventilation was initiated. Her initial rhythm is shown in Figure 1. In addition to DC cardioversion which of the following should be administered immediately? 1. Lidocaine; 2. Magnesium sulfate; 3. Procainamide ; 4. 1 and 3; 5. All of the above. ...

  4. Billing, coding, and documentation in the critical care environment.

    Science.gov (United States)

    Fakhry, S M

    2000-06-01

    Optimal conduct of modern-day physician practices involves a thorough understanding and application of the principles of documentation, coding, and billing. Physicians' role in these activities can no longer be secondary. Surgeons practicing critical care must be well versed in these concepts and their effective application to ensure that they are competitive in an increasingly difficult and demanding environment. Health care policies and regulations continue to evolve, mandating constant education of practicing physicians and their staffs and surgical residents who also will have to function in this environment. Close, collaborative relationships between physicians and individuals well versed in the concepts of documentation, coding, and billing are indispensable. Similarly, ongoing educational and review processes (whether internal or consultative from outside sources) not only can decrease the possibility of unfavorable outcomes from audit but also will likely enhance practice efficiency and cash flow. A financially viable practice is certainly a prerequisite for a surgical critical care practice to achieve its primary goal of excellence in patient care. PMID:10897279

  5. Targeted temperature management: Current evidence and practices in critical care

    Directory of Open Access Journals (Sweden)

    Saurabh Saigal

    2015-01-01

    Full Text Available Targeted temperature management (TTM in today′s modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21 st century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI, meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.

  6. Targeted temperature management: Current evidence and practices in critical care.

    Science.gov (United States)

    Saigal, Saurabh; Sharma, Jai Prakash; Dhurwe, Ritika; Kumar, Sanjay; Gurjar, Mohan

    2015-09-01

    Targeted temperature management (TTM) in today's modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21(st) century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI), meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios. PMID:26430341

  7. Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care.

    Science.gov (United States)

    Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S

    2015-07-01

    In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided. PMID:25803647

  8. August 2013 critical care journal club: less is more

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2013-09-01

    Full Text Available No abstract available. Article truncated at 150 words. Our August journal club reviewed failed efforts to impact the mortality of critical illness over the past 25 years. We looked at six landmark randomized controlled trials with certain things in common. They each addressed treatment of a major aspect of critical illness. Each was well-supported by previous literature, and biologically plausible. Each resulted in a statistically-significant mortality benefit, and was published in a well-respected journal. And each had an immediate, and in many cases, lasting effect on the bedside practice of critical care. Yet the positive result of each of these six studies was subsequently convincingly refuted. It is important to note, that these studies make up a good part of what we’ve learned in critical care over the past 25 years. There have been some influential positive studies as well, but a great deal of effort has been spent implementing evidence-based practice, based on studies that were later …

  9. Prioritization of care in adults with diabetes and comorbidity

    OpenAIRE

    Laiteerapong, Neda; Huang, Elbert S.; Chin, Marshall H

    2011-01-01

    Approximately half of adults with diabetes have at least one comorbid condition. However, diabetes care guidelines focus on diabetes-specific care, and their recommendations may not be appropriate for many patients with diabetes and comorbidity. We describe Piette and Kerr's typology of comorbid conditions, which categorizes conditions based on if they are clinically dominant (eclipse diabetes management), symptomatic versus asymptomatic, and concordant (similar pathophysiologic processes as ...

  10. Transfer to Adult Care--Experiences of Young Adults with Congenital Heart Disease.

    Science.gov (United States)

    Asp, Ann; Bratt, Ewa-Lena; Bramhagen, Ann-Cathrine

    2015-01-01

    More than 90% of children born with congenital heart disease survive into adulthood due to successes of cardiac surgery and medical management. Interviews with 16 young adults with congenital heart disease to explore their experiences of transfer from pediatric to adult care were performed. The analysis identified five themes; Feeling secure during the transfer process, Experiencing trust in the care, Expecting to be involved, Assuming responsibility for one's health is a process and Lack of knowledge leads to uncertainty. In conclusion; a structured and gradual transfer process was necessary to enable the informants to shoulder the responsibility for self-care.

  11. Pediatric Liver Transplantation: Unique Concerns for the Critical Care Team.

    Science.gov (United States)

    Bilhartz, Jacob L; Shieck, Victoria L

    2016-01-01

    Liver transplantation originated in children more than 50 years ago, and these youngest patients, while comprising the minority of liver transplant recipients nationwide, can have some of the best and most rewarding outcomes. The indications for liver transplantation in children are generally more diverse than those seen in adult patients. This diversity in underlying cause of disease brings with it increased complexity for all who care for these patients. Children, still being completely dependent on others for survival, also require a care team that is able and ready to work with parents and family in addition to the patient at the center of the process. In this review, we aim to discuss diagnoses of particular uniqueness or importance to pediatric liver transplantation. We also discuss the evaluation of a pediatric patient for liver transplant, the system for allocating them a new liver, and also touch on postoperative concerns that are unique to the pediatric population. PMID:27254643

  12. Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition)

    OpenAIRE

    Muntinga Maaike E; Hoogendijk Emiel O; van Leeuwen Karen M; van Hout Hein PJ; Twisk Jos WR; van der Horst Henriette E; Nijpels Giel; Jansen Aaltje PD

    2012-01-01

    Abstract Background Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling...

  13. Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

    Directory of Open Access Journals (Sweden)

    Henry T Stelfox

    Full Text Available Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap. We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare.We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14 and pediatric (n = 2 medical-surgical intensive care units (ICUs in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38 and frontline providers (n = 1,790. Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback.Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate evaluated the priorities, and rated 9 as 'necessary' (median score 7-9. Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs.A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

  14. Describing the sublanguage of wound care in an adult ICU.

    Science.gov (United States)

    Danielsson-Ojala, Riitta; Lundgren-Laine, Heljä; Salanterä, Sanna

    2012-01-01

    Comprehensive wound documentation is an important tool in evaluating and planning patient care. The sublanguage used in ICUs may affect negatively to the wound care and thus to the healing process. We made a quantitative content analysis of nursing documentation of cardiac surgery adult patients (n=60) who had stayed over four days in the ICU. The sublanguage used in nursing documentation of wounds and ulcers in the ICU was unstructured with many words of colloquial language, misspellings and abbreviations. The documentation did not cover all aspects of proper wound care. The information technology could be helpful for nurses to document right things with plain language. PMID:22874364

  15. Complications in critically ill adult patients’ transportations reported in the recent literature

    Directory of Open Access Journals (Sweden)

    Stefano Bambi

    2015-06-01

    Full Text Available The transport of critically ill patients is a complex process, made up by several phases involving the healthcare professionals. It requires a careful planning for the prevention of potential complications undermining the patients’ safety outside critical care environment. Literature review about complications and adverse events reported during intra and inter-hospital transport of critically ill adult patients. Intra-hospital transfers are affected by adverse events rates ranging from 22.2 to 75.7% in the published literature. Major adverse events, defined as life threatening conditions that require urgent therapeutic intervention, vary from 4.2 to 31%. Death is a rare occurrence. Adverse events during interhospital have a maximum rate of 34%. Technical incidents represent a typical feature of these transports. Authors reported problems to gas supply, ambulance electric system, equipment. There is a lack of studies about the complications related to rotary wing inter-hospital transports. While extracorporeal membrane oxygenation/extracorporeal life support patients seem to be the most complex category of critically ill to be transported outside the hospital, 11 papers revealed only 29 adverse events ranging from 0 to 17%. No deaths were recorded. Currently, research must explore more accurately how much transports affect the outcome of patients, and what are the most appropriate time-frames to assess the consequences of transfers on patients’ clinical conditions.

  16. Adult Day Care Program(高二适用)

    Institute of Scientific and Technical Information of China (English)

    孙启禄

    2004-01-01

    David Brown and Anne are two patients in the Adult Day Care Pro-gram at Mercy Hospitals. David Brown is seventy-two years old. He'sfriendly and likes to talk. He lives with his wife in the city. But David is

  17. Adult Basic Education. Child Care, Transportation, Support Services Workbook.

    Science.gov (United States)

    Porter, Deborah; Morris, Jamie, Ed.

    This workbook focuses on two primary needs of adult basic education (ABE) students--child care and transportation--and provides ideas to assist program administrators (especially in Texas) to develop appropriate, workable, community-based strategies to meet these needs. The book contains five chapters. Each chapter addresses a particular aspect of…

  18. Central Line-Associated Bloodstream Infections (CLABSI) In Critical Care Areas, 2013

    Data.gov (United States)

    U.S. Department of Health & Human Services — Critical Care Areas (CCAs) are nursing care areas that provide intensive observation, diagnosis, and therapeutic procedures for patients who are critically ill....

  19. Update on the critical care management of severe burns.

    Science.gov (United States)

    Kasten, Kevin R; Makley, Amy T; Kagan, Richard J

    2011-01-01

    Care of the severely injured patient with burn requires correct diagnosis, appropriately tailored resuscitation, and definitive surgical management to reduce morbidity and mortality. Currently, mortality rates related to severe burn injuries continue to steadily decline due to the standardization of a multidisciplinary approach instituted at tertiary health care centers. Prompt and accurate diagnoses of burn wounds utilizing Lund-Browder diagrams allow for appropriate operative and nonoperative management. Coupled with diagnostic improvements, advances in resuscitation strategies involving rates, volumes, and fluid types have yielded demonstrable benefits related to all aspects of burn care. More recently, identification of comorbid conditions such as inhalation injury and malnutrition have produced appropriate protocols that aid the healing process in severely injured patients with burn. As more patients survive larger burn injuries, the early diagnosis and successful treatment of secondary and tertiary complications are becoming commonplace. While advances in this area are exciting, much work to elucidate immune pathways, diagnostic tests, and effective treatment regimens still remain. This review will provide an update on the critical care management of severe burns, touching on accurate diagnosis, resuscitation, and acute management of this difficult patient population.

  20. Obtaining a critical care pharmacist position: a marketing case study.

    Science.gov (United States)

    Stratton, T P; Wu, B; Nakagawa, R S

    1993-06-01

    Marketing theory is used to explain how Pharmacy Department managers at a Vancouver-area hospital secured a new ICU pharmacist position in a period of severe fiscal constraint. Market segmentation, target marketing and pull marketing strategy were combined to obtain support for the new position. Improved drug information services for ICU nurses were promoted to Nursing Administration and enhanced pharmacotherapy monitoring was promoted to the two critical care physicians primarily responsible for patient care in the ICU. These physicians and Nursing Administration voiced their support for the new position to the V.P. of Nursing (the functional officer for Pharmacy), who then promoted the new position to Hospital Administration. A half-time DUR commitment by the ICU pharmacist was offered to Hospital Administration, expanding this already successful service and guaranteeing cost recovery for the new position. Hospital Administration approved the new ICU clinical pharmacist position in a budget which saw other hospital departments lose several positions. PMID:10126865

  1. A critical appraisal of point-of-care coagulation testing in critically ill patients.

    Science.gov (United States)

    Levi, M; Hunt, B J

    2015-11-01

    Derangement of the coagulation system is a common phenomenon in critically ill patients, who may present with severe bleeding and/or conditions associated with a prothrombotic state. Monitoring of this coagulopathy can be performed with conventional coagulation assays; however, point-of-care tests have become increasingly attractive, because not only do they yield a more rapid result than clinical laboratory testing, but they may also provide a more complete picture of the condition of the hemostatic system. There are many potential areas of study and applications of point-of-care hemostatic testing in critical care, including patients who present with massive blood loss, patients with a hypercoagulable state (such as in disseminated intravascular coagulation), and monitoring of antiplatelet treatment for acute arterial thrombosis, mostly acute coronary syndromes. However, the limitations of near-patient hemostatic testing has not been fully appreciated, and are discussed here. The currently available evidence indicates that point-of-care tests may be applied to guide appropriate blood product transfusion and the use of hemostatic agents to correct the hemostatic defect or to ameliorate antithrombotic treatment. Disappointingly, however, only in cardiac surgery is there adequate evidence to show that application of near-patient thromboelastography leads to an improvement in clinically relevant outcomes, such as reductions in bleeding-related morbidity and mortality, and cost-effectiveness. More research is required to validate the utility and cost-effectiveness of near-patient hemostatic testing in other areas, especially in traumatic bleeding and postpartum hemorrhage.

  2. Novel biomarkers in critical care: utility or futility?

    Science.gov (United States)

    Ackland, Gareth L; Mythen, Michael G

    2007-01-01

    One of the holy grails of modern medicine, across a range of clinical sub-specialties, is establishing highly sensitive and specific biomarkers for various diseases. Significant success has been achieved in some of these clinical areas, most notably identifying high-sensitivity C-reactive peptide, troponin I/T and brain natriuretic peptide as significant prognosticators for both the acute outcome and the development of cardiovascular pathology. However, it is highly debatable whether this translates to complex, multi-system pathophysiological insults. Is critical care immune from the application of these novel biomarkers, given the numerous confounding factors interfering with their interpretation?

  3. [Risk management in anesthesia and critical care medicine].

    Science.gov (United States)

    Eisold, C; Heller, A R

    2016-06-01

    Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems. PMID:27273109

  4. Caring for independent lives: geographies of caring for young adults with intellectual disabilities.

    Science.gov (United States)

    Power, Andrew

    2008-09-01

    This paper engages with the emerging disciplinary clash between 'care' and 'independence' within disability studies by examining the geography of home care for young adults with intellectual disabilities. The care system as a whole is viewed as central to disablist structures within disability studies (see Thomas, C. (2007). Sociologies of disability and illness: Contested ideas in disability studies and medical sociology. Hampshire: Palgrave Macmillan.). However, despite the theorisation of dependency as being in antipathy to the goals of the disability movement, caregiving at home still continues to dominate community care. The paper attempts to address how family carers are 'caught-in-the-middle' between their 'duty' to care and at the same time, perpetuating dependency; the reality being that parents have to deal with issues of being overprotective and confronting various social assumptions about disability. It examines the narratives from 25 family caregivers in Ireland who provide personal assistance to young adults with intellectual disabilities. PMID:18573581

  5. Fetal Programming of Adult Disease: Implications for Prenatal Care

    Science.gov (United States)

    The obesity epidemic, including a marked increase in the prevalence of obesity among pregnant women, represents a critical public health problem in the United States and throughout the world. Over the past two decades, it has been increasingly recognized that the risk of adult ...

  6. 6. Oral care competency and practices among critical care nurses for mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    L. Abed-Eddin

    2016-07-01

    Result: A total of 131 nurses out of 150 completed the questioners, 100% were females, 86% of nurses are Baccalaureate degree, 93% with 7–9 years’ experience in critical care units, 80% of nurses have adequate time to provide oral care at least once a day, 20.4% only of the nurses are using a toothbrush with 2% Chlorhexidine Solution every 2–4 h for oral care at least Once a Day, 75.8% of nurses prefer to use oral swab with 2% Chlorhexidine Solution q 2–4 h, 98% has positive attitude toward mouth care practice.Conclusions The survey provided useful information on the oral care knowledge and practices of nurses caring for Mechanically Ventilated Patients. Almost all the nurses perceived oral care to be a high priority. Very low number of nurses are using the toothbrush with 2% Chlorhexidine Solution every 2–4 h, this figure must be studied for further action. The majority of nurses had some formal training in oral care, but would appreciate an opportunity to improve their knowledge and skills.

  7. Critical care nurses’ perceptions of stress and stress-related situations in the workplace

    Directory of Open Access Journals (Sweden)

    S Moola

    2008-09-01

    Full Text Available Critical care nurses (CCNs experience stressful situations in their daily working environments. A qualitative research approach (exploratory, descriptive and contextual was used to explore and describe the stressful situations experienced by critical care nurses in the Tshwane metropolitan are of South Africa. Focus group interviews were conducted with critical care nurses.

  8. Satisfaction survey on the critical care response team services in a teaching hospital

    OpenAIRE

    Saad Al Qahtani

    2011-01-01

    Saad Al Qahtani1,21Intensive Care Department, Critical Care Response Team, King Abdulaziz Medical City (KAMC), National Guard Health Affairs, 2King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Kingdom of Saudi ArabiaIntroduction: Patient care and safety is the main goal and mission of any health care provider. We surveyed nurses in the wards and obtained their feedback about the quality of care delivered by the Critical Care Response Team (CCRT).Methods: Our...

  9. Mental health care Monitor Older adults (MEMO) : monitoring patient characteristics and outcome in Dutch mental health services for older adults

    NARCIS (Netherlands)

    Veerbeek, Marjolein; Voshaar, Richard Oude; Depla, Marja; Pot, Anne Margriet

    2013-01-01

    Information on which older adults attend mental health care and whether they profit from the care they receive is important for policy-makers. To assess this information in daily practice, the Mental health care Monitor Older adults (MEMO) was developed in the Netherlands. The aim of this paper is t

  10. Critical thinking: optimal outcomes through end user involvement in the design of critical care areas.

    Science.gov (United States)

    Braun, Debra; Barnhardt, Kim

    2014-01-01

    Including end users in evidence-based design is vital to outcomes. The physical environment impacts caregiver efficiencies, safety, satisfaction, and quality of patient outcomes. End users are more than members of the organization: patients should have representation as well. Patients bring value by offering insight from a different perspective. Timing is key; therefore, it is critical in obtaining desired outcomes, to include end users as early as possible, gaining the most insight into the design of the build. Consideration should also be given to best practice standards, regulatory compliance, progressive sciences, and technologies. Another vital factor is education of the end users on their role and expectations for participation in a design team. When end users are educated and understand the significance of input, the design team will be able to conceive a critical care unit that will meet needs for today and be able to adapt to needs for the future. PMID:24309458

  11. Handover patterns: an observational study of critical care physicians

    Directory of Open Access Journals (Sweden)

    Ilan Roy

    2012-01-01

    Full Text Available Abstract Background Handover (or 'handoff' is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, have been widely promoted. However, these recommendations are based mostly on expert opinion and research on medical trainees. By examining handover communication of experienced physicians, we aim to inform future research, education and quality improvement. Thus, our objective is to describe handover communication patterns used by attending critical care physicians in an academic centre and to compare them with currently popular, standardized schemes for handover communication. Methods Prospective, observational study using video recording in an academic intensive care unit in Ontario, Canada. Forty individual patient handovers were randomly selected out of 10 end-of-week handover sessions of attending physicians. Two coders independently reviewed handover transcripts documenting elements of three communication schemes: SBAR (Situation, Background, Assessment, Recommendations; SOAP (Subjective, Objective, Assessment, Plan; and a standard medical admission note. Frequency and extent of questions asked by incoming physicians were measured as well. Analysis consisted of descriptive statistics. Results Mean (± standard deviation duration of patient-specific handovers was 2 min 58 sec (± 57 sec. The majority of handovers' content consisted of recent and current patient status. The remainder included physicians' interpretations and advice. Questions posed by the incoming physicians accounted for 5.8% (± 3.9% of the handovers' content. Elements of all three standardized communication schemes appeared repeatedly throughout the handover dialogs with no consistent pattern. For example, blocks of SOAP's Assessment appeared 5.2 (± 3.0 times in patient handovers; they followed Objective blocks in only 45

  12. Children as partners with adults in their medical care

    OpenAIRE

    Alderson, P.; Sutcliffe, K; Curtis, K.

    2006-01-01

    Aims: To investigate the seldom published views of children with type 1 diabetes about their condition and ways in which they share in managing their medical and health care with adults. Methods: Semi-structured, tape recorded interviews, during 2003, with a purposive sample of 24 children aged 3–12 years who have type I diabetes and who attend two inner London hospitals and one hospital in a commuter town. Results: The children reported high levels of understanding, knowledge, and ...

  13. Accessibility of mental health care for adults with cerebral palsy

    OpenAIRE

    Pihlaja, Kimmo; Päivärinta, Paula

    2014-01-01

    The purpose of this thesis is to describe the accessibility in mental health care from the point of view of an adult with cerebral palsy. The theoretical framework of this thesis is constructed from the related literature and previous studies closely linked to the topic. Research was done to clarify the concepts of disability, cerebral palsy, and mental health. The research showed cerebral palsy as a multidimensional physical disability which may include different types of accompanying im...

  14. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

    Directory of Open Access Journals (Sweden)

    Monaghan M

    2016-04-01

    Full Text Available Maureen Monaghan,1,2 Katherine Baumann2 1Center for Translational Science, Children's National Health System, 2George Washington University School of Medicine, Washington, DC, USA Abstract: Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care. However, challenges remain and evidence-based practices for preparing youth for adult health care are still emerging. Qualitative research suggests that adolescent and young adult patients rely on health care providers to guide them through the transition process and appreciate a gradual approach to preparing for adult-oriented health care, keeping parents in supportive roles into young adulthood. Patients also benefit from specific referrals and contact information for adult care providers. Promising models of transition care include provision of transition navigators, attendance at a young adult bridge clinic, or joint visits with pediatric and adult care providers. However, much of this research is in its early stages, and more rigorous trials need to be conducted to evaluate health outcomes during transition into adult health care. The purpose of this review is to provide an overview of the transition process, patient and health care provider perceptions of transition care, and emerging evidence of successful models of care for engagement in adult-oriented health care. Recommendations and resources for health care providers are also presented. Keywords: type 1 diabetes

  15. Integration of early specialist palliative care in cancer care and patient related outcomes: A critical review of evidence

    Directory of Open Access Journals (Sweden)

    Naveen Salins

    2016-01-01

    Conclusions: In adult oncology, there is evidence to suggest early specialist palliative care improves HRQOL, mood, treatment decision-making, health care utilization, advanced care planning, patient satisfaction, and end-of-life care. There is moderate evidence to support the role of early specialist palliative care intervention in improvement of symptoms, survival, and health-related communication. There is limited evidence at present to support role of early specialist palliative care interventions in pediatric and geriatric oncology. Qualitative studies on barriers and negative patient outcomes may provide useful insights toward restructuring early specialist palliative care interventions.

  16. How critical care nurses' roles and education affect organ donation.

    Science.gov (United States)

    Jawoniyi, Oluwafunmilayo Ololade; Gormley, Kevin

    Organ and tissue dysfunction and failure cause high mortality rates around the world. Tissue and organs transplantation is an established, cost-effective, life-saving treatment for patients with organ failure. However, there is a large gap between the need for and the supply of donor organs. Acute and critical care nurses have a central role in the organ donation process, from identifying and assessing potential donors and supporting their families to involvement in logistics. Nurses with an in-depth knowledge of donation understand its clinical and technical aspects as well as the moral and legal considerations. Nurses have a major role to play in tackling organ and tissue shortages. Such a role cannot be adequately performed if nurses are not fully educated about donation and transplant. Such education could be incorporated into mandatory training and completed by all nurses. PMID:26153810

  17. Effect of caring behavior on disposition toward critical thinking of nursing students.

    Science.gov (United States)

    Pai, Hsiang-Chu; Eng, Cheng-Joo; Ko, Hui-Ling

    2013-01-01

    The purpose of this study was to explore the relationship between caring behavior and the disposition toward critical thinking of nursing students in clinical practice. A structural equation model was used to test the hypothesized relationship between caring behavior and critical thinking skills. Caring is the core of nursing practice, and the disposition toward critical thinking is needed for competent nursing care. In a fast-paced and complex environment, however, "caring" may be lost. Because nursing students will become professional nurses, it is essential to explore their caring behaviors and critical thinking skills and to understand how to improve their critical thinking skills based on their caring behavior. A cross-sectional study was used, with convenience sampling of students who were participating in associate degree nursing programs at 3 colleges of nursing. The following instruments were used: critical thinking disposition inventory Chinese version and caring behaviors scale. The study found that individuals with a higher frequency of caring behaviors had a higher score on critical thinking about nursing practice (β = .44, t = 5.14, P critical thinking. The findings of this study revealed the importance of caring behavior and its relationship with the disposition toward critical thinking. Thus, it is recommended that nursing education should emphasize a curriculum related to caring behavior to improve the disposition toward critical thinking of nursing students.

  18. The Three-Part Harmony of Adult Learning, Critical Thinking, and Decision-Making

    Science.gov (United States)

    Moore, Kyle

    2010-01-01

    Adult learning, critical thinking, and decision-making are fields that receive attention individually, although they are interspersed with elements of each other's theories and philosophies. In addressing adult learning precepts, it is essential to include critical thinking and decision-making. One without the other creates weakness; all must be…

  19. The organizational culture of emergency departments and the effect on care of older adults: a modified scoping study.

    Science.gov (United States)

    Skar, Pål; Bruce, Anne; Sheets, Debra

    2015-04-01

    How does the organizational micro culture in emergency departments (EDs) impact the care of older adults presenting with a complaint or condition perceived as non-acute? This scoping study reviews the literature and maps three levels of ED culture (artifacts, values and beliefs, and assumptions). Findings on the artifact level indicate that EDs are poorly designed for the needs of older adults. Findings on the ED value and belief level indicate that EDs are for urgent cases (not geriatric care), that older adults do not receive the care and respect they should be given, that older adults require too much time, and that the basic nursing needs of older adults are not a priority for ED nurses. Finally, finding on the assumptions level underpinning ED behaviors suggest that older adults do not belong in the ED, most older adults in the ED are not critically ill and therefore can wait, and staff need to be available for acute cases at all times. A systematic review on the effect of ED micro culture on the quality of geriatric care is warranted.

  20. Integrated Care for Older Adults Improves Perceived Quality of Care : Results of a Randomized Controlled Trial of Embrace

    NARCIS (Netherlands)

    Uittenbroek, Ronald J; Kremer, Hubertus P H; Spoorenberg, Sophie L W; Reijneveld, Sijmen A; Wynia, Klaske

    2016-01-01

    BACKGROUND: All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care. OBJECTIVE: To examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care.

  1. Ten years of specialized adult care for phenylketonuria – a single-centre experience

    OpenAIRE

    Mütze, Ulrike; Thiele, Alena Gerlinde; Baerwald, Christoph; Ceglarek, Uta; Kiess, Wieland; Beblo, Skadi

    2016-01-01

    Background Specialized adult care of phenylketonuria (PKU) patients is of increasing importance. Adult outpatient clinics for inherited errors of metabolism can help to achieve this task, but experience is limited. Ten years after establishment of a coordinated transition process and specialised adult care for inherited metabolic diseases, adult PKU care was evaluated with respect to metabolic control, therapy satisfaction, life satisfaction, sociodemographic data, economical welfare as well ...

  2. Effect of the essentials of critical care orientation (ECCO) program on the development of nurses' critical thinking skills.

    Science.gov (United States)

    Kaddoura, Mahmoud A

    2010-09-01

    It is essential for nurses to develop critical thinking skills to ensure their ability to provide safe and effective care to patients with complex and variable needs in ever-changing clinical environments. To date, very few studies have been conducted to examine how nursing orientation programs develop the critical thinking skills of novice critical care nurses. Strikingly, no research studies could be found about the American Association of Critical Care Nurses Essentials of Critical Care Orientation (ECCO) program and specifically its effect on the development of nurses' critical thinking skills. This study explored the perceptions of new graduate nurses regarding factors that helped to develop their critical thinking skills throughout their 6-month orientation program in the intensive care unit. A convenient non-probability sample of eight new graduates was selected from a hospital that used the ECCO program. Data were collected with demographic questionnaires and semi-structured interviews. An exploratory qualitative research method with content analysis was used to analyze the data. The study findings showed that new graduate nurses perceived that they developed critical thinking skills that improved throughout the orientation period, although there were some challenges in the ECCO program. This study provides data that could influence the development and implementation of future nursing orientation programs.

  3. Critical Review about Thematic Relations in Adults'Concepts

    Institute of Scientific and Technical Information of China (English)

    王莎瑷

    2016-01-01

    The general area investigated by Lin and Murphy was thematic relations used for classification in adults'category con-struction. The present study aims to discover whether thematic categorization could be found in American adult college students and whether thematic groupings have significant conceptual content. Most of the previous studies focus on children's classifica-tion, while the current study explores that of adults'. That is the significance of the current study.

  4. Care of adolescents and young adults with diabetes - much more than transitional care: a personal view.

    Science.gov (United States)

    Winocour, Peter H

    2014-06-01

    There is increasing recognition that type 1 diabetes mellitus (T1DM) acquired in childhood and adolescence requires a sophisticated approach that facilitates better self-management through adherence to generic principles in managing chronic disease in this age group, allied to the complex clinical needs of managing T1DM and related conditions. Transitional care should be seen as a process over time supported by both paediatric and adult diabetologists within a multidisciplinary team, given the complementary skills that can be brought to bear. Undoubtedly, there is a need for more effective training of all healthcare professionals working in this service. However, the accumulation of older teenagers over time and new diagnoses in those aged 19 years or more confirms that a new paradigm is necessary for the successful care of young adults beyond transitional care. Traditional clinical models will often not work for those in employment and higher education, with evidence that ongoing engagement following transfer to adult services often ceases. The alarming evidence of progressive complications in T1DM of longer duration in patients under the age of 40 years is a wake-up call to transform the care of this most vulnerable group. PMID:24889572

  5. Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness

    OpenAIRE

    Corner, Evelyn J; Soni, Neil; Handy, Jonathan M.; Stephen J Brett

    2014-01-01

    Introduction Intensive care unit-acquired weakness (ICU-AW) is common in survivors of critical illness, resulting in global weakness and functional deficit. Although ICU-AW is well described subjectively in the literature, the value of objective measures has yet to be established. This project aimed to evaluate the construct validity of the Chelsea Critical Care Physical Assessment tool (CPAx) by analyzing the association between CPAx scores and hospital-discharge location, as a measure of fu...

  6. Introduction and executive summary: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

    Science.gov (United States)

    Christian, Michael D; Devereaux, Asha V; Dichter, Jeffrey R; Rubinson, Lewis; Kissoon, Niranjan

    2014-10-01

    Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This supplement provides suggestions for all of those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, professional societies, and public health or government officials. The current Task Force included a total of 100 participants from nine countries, comprised of clinicians and experts from a wide variety of disciplines. Comprehensive literature searches were conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert-opinion-based suggestions that are presented in this supplement using a modified Delphi process. The ultimate aim of the supplement is to expand the focus beyond the walls of ICUs to provide recommendations for the management of all critically ill or injured adults and children resulting from a pandemic or disaster wherever that care may be provided. Considerations for the management of critically ill patients include clinical priorities and logistics (supplies, evacuation, and triage) as well as the key enablers (systems planning, business continuity, legal framework, and ethical considerations) that facilitate the provision of this care. The supplement also aims to illustrate how the concepts of mass critical care are integrated across the spectrum of surge events from conventional through contingency to crisis standards of care. PMID:25144202

  7. Critical care 24 × 7: But, why is critical nutrition interrupted?

    Directory of Open Access Journals (Sweden)

    Nagarajan Ramakrishnan

    2014-01-01

    Full Text Available Background and Aims: Adequate nutritional support is crucial in prevention and treatment of malnutrition in critically ill-patients. Despite the intention to provide appropriate enteral nutrition (EN, meeting the full nutritional requirements can be a challenge due to interruptions. This study was undertaken to determine the cause and duration of interruptions in EN. Materials and Methods: Patients admitted to a multidisciplinary critical care unit (CCU of a tertiary care hospital from September 2010 to January 2011 and who received EN for a period >24 h were included in this observational, prospective study. A total of 327 patients were included, for a total of 857 patient-days. Reasons and duration of EN interruptions were recorded and categorized under four groups-procedures inside CCU, procedures outside CCU, gastrointestinal (GI symptoms and others. Results: Procedure inside CCU accounted for 55.9% of the interruptions while GI symptoms for 24.2%. Although it is commonly perceived that procedures outside CCU are the most common reason for interruption, this contributed only to 18.4% individually; ventilation-related procedures were the most frequent cause (40.25%, followed by nasogastric tube aspirations (15.28%. Although GI bleed is often considered a reason to hold enteral feed, it was one of the least common reasons (1% in our study. Interruption of 2-6 h was more frequent (43% and most of this (67.1% was related to "procedures inside CCU". Conclusion: Awareness of reasons for EN interruptions will aid to modify protocol and minimize interruptions during procedures in CCU to reach nutrition goals.

  8. [Self-care and the asthmatic adult: systematization of nursing care].

    Science.gov (United States)

    Monteiro, Estela Maria Leite Meirelles; da Nóbrega, Maria Miriam Lima; de Lima, Luciane Soares

    2002-01-01

    This research aims at the systematization of nursing assistance under Orem's nursing theory of self-care deficit. In order to conduct this study, the convergent approach was used through the performance of the nursing processes in an adult with asthma. Interviews, physical examinations, observations, data record, observation of nursing assistance in policlinics along with home visits were the techniques used to gather data. After the observation of the nursing assistance, self-care deficits were identified and a new assistance plan and objectives were established, as well as a system and methods of support. The assistance plan was performed through the implementation of nursing assistance, prioritizing educational support. Based on the results, it was concluded that the application of the nursing processes through Orem's self-care referential is feasible and necessary for the engagement of clients and their family in self-care.

  9. Critical Environmental Adult Education in Canada: Student Environmental Activism

    Science.gov (United States)

    Lange, Elizabeth; Chubb, Aaron

    2009-01-01

    Today recent polls have indicated that the Canadian public considers the environment and climate change as their top concern (De Souza, 2007), perhaps eclipsed only by recent economic fears. In keeping with the historical responsiveness of adult educators, environmental adult education (EAE) is widespread across North America. However, this area…

  10. Using Concept Maps to Engage Adult Learners in Critical Analysis

    Science.gov (United States)

    Yelich Biniecki, Susan M.; Conceição, Simone C. O.

    2016-01-01

    An understanding of learning theories can help adult educators become more effective practitioners and meet the needs of the learners they serve. Adult educators who understand how individuals learn can be better prepared to use effective strategies during the learning process. This article addresses the use of concept maps as a strategy to engage…

  11. ROLE OF DEXMEDETOMIDINE IN ANESTHESIA AND CRITICAL CARE

    Directory of Open Access Journals (Sweden)

    Baljit Singh

    2014-09-01

    Full Text Available The potential uses of dexmedetomidine (DEX, a highly selective α2- adrenoceptor agonist are very diverse Although not orally active, DEX shows good bioavailability when administered via various other routes like intranasal, buccal, IM than intra-venous. DEX has similar pharmacokinetics in all age groups. Its side effects are predictable and easily treatable; hence it has found a place as a part of fast-tracking anesthesia regimens in children. DEX is the sedative of choice for peri-operative use in high- risk patients, since it is cardioprotective, neuroprotective and renoprotective. Premedication with DEX obtunds the autonomic pressor responses due to laryngoscopy and endotracheal intubation when used as an adjuvant to general anesthesia. DEX in high doses offers another approach to manage morbidly obese patients and patients with a compromised airway; without causing any cardiorespiratory depression. It is near ideal hypotensive agent used for controlled hypotension. Availability of an antidote (Atipamezole with similar elimination half-life is taking the drug into new frontiers .The aim of this review is to present the most recent topics regarding the advantages in using dexmedetomidine in clinical anesthesia and in critical care, while discussing the controversial issues of its harmful effects.

  12. February 2014 Phoenix critical care journal club: subgroup analysis

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-02-01

    Full Text Available No abstract available. Article truncated at 150 words. Sun X, Ioannidis JP, Agoritsas T, Alba AC, Guyatt G. How to use a subgroup analysis: users' guide to the medical literature. JAMA. 2014;311(4:405-11. One of Dr. Raschke's pet peeves is unplanned subgroup analysis. In the September 2013 Banner Good Samaritan / Phoenix VA Critical Care Journal Club (1 he commented on an article by Hung et al. (2 that used a post hoc subgroup analysis. He felt strongly enough to write to the editor about why post hoc subgroup analysis should not be acceptable as a basis for scientific conclusions and his letter was published this month (3. Therefore, we have been on the lookout for a review article to discuss subgroup analysis and came across this timely publication in JAMA. The authors cite a number of examples and provide 5 criteria to use when assessing the validity of subgroup analyses: 1. Can chance explain the apparent subgroup effect ...

  13. Feasibility of Eyetracking in Critical Care Environments - A Systematic Review.

    Science.gov (United States)

    Klausen, Andreas; Röhrig, Rainer; Lipprandt, Myriam

    2016-01-01

    Achieving a good understanding of the socio-technical system in critical or emergency situations is important for patient safety. Research in human-computer interaction in the field of anesthesia or surgery has the potential to improve usability of the user interfaces and enhance patient safety. Therefore eye-tracking is a technology for analyzing gaze patterns. It can also measure what is being perceived by the physician during medical procedures. The aim of this review is the applicability of eye-tracker in the domain of simulated or real environments of anesthesia, surgery or intensive care. We carried out a literature research in PubMed. Two independent researchers screened the titles and abstracts. The remaining 8 full-papers were analyzed based on the applicability of eye-trackers. The articles contain topics like training of surgeons, novice vs. experts or the cognitive workload. None of the publications address our goal. The applicability or limitations of the eye-tracker technology were stated incidentally. PMID:27577455

  14. 76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-20

    ..., 2010, at 75 FR 41793. Child and Adult Care Food Program (CACFP) [Per meal rates in whole or fractions... 48 FR 29114, June 24, 1983.) This notice has been determined to be not significant and was reviewed... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  15. 75 FR 41793 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2010-07-19

    ..., 2009, at 74 FR 34295. Child and Adult Care Food Program (CACFP) Lunch and Centers Breakfast supper \\1... related notice published at 48 FR 29114, June 24, 1983.) This notice has been determined to be not... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  16. Objectively Measured Activity Patterns among Adults in Residential Aged Care

    Directory of Open Access Journals (Sweden)

    Natasha Reid

    2013-12-01

    Full Text Available Objectives: To determine the feasibility of using the activPAL3TM activity monitor, and, to describe the activity patterns of residential aged care residents. Design: Cross-sectional. Setting: Randomly selected aged care facilities within 100 km of the Gold Coast, Queensland, Australia. Participants: Ambulatory, older (≥60 years residential aged care adults without cognitive impairment. Measurements: Feasibility was assessed by consent rate, sleep/wear diary completion, and through interviews with staff/participants. Activity patterns (sitting/lying, standing, and stepping were measured via activPAL3TM monitors worn continuously for seven days. Times spent in each activity were described and then compared across days of the week and hours of the day using linear mixed models. Results: Consent rate was 48% (n = 41. Activity patterns are described for the 31 participants (mean age 84.2 years who provided at least one day of valid monitor data. In total, 14 (45% completed the sleep/wear diary. Participants spent a median (interquartile range of 12.4 (1.7 h sitting/lying (with 73% of this accumulated in unbroken bouts of ≥30 min, 1.9 (1.3 h standing, and 21.4 (36.7 min stepping during their monitored waking hours per day. Activity did not vary significantly by day of the week (p ≥ 0.05; stepping showed significant hourly variation (p = 0.018. Conclusions: Older adults in residential aged care were consistently highly sedentary. Feasibility considerations for objective activity monitoring identified for this population include poor diary completion and lost monitors.

  17. Critical care in the ED: potentially fatal asthma and acute lung injury syndrome

    Directory of Open Access Journals (Sweden)

    Hodder R

    2012-08-01

    Full Text Available Rick Hodder*Divisions of Pulmonary and Critical Care, University of Ottawa and The Ottawa Hospital, Ottawa, Canada, *Dr Rick Hodder passed away on Tuesday April 17,2012. Please see the Dedication for more information on Dr Hodder.Abstract: Emergency department clinicians are frequently called upon to assess, diagnose, and stabilize patients who present with acute respiratory failure. This review describes a rapid initial approach to acute respiratory failure in adults, illustrated by two common examples: (1 an airway disease – acute potentially fatal asthma, and (2 a pulmonary parenchymal disease – acute lung injury/acute respiratory distress syndrome. As such patients are usually admitted to hospital, discussion will be focused on those initial management aspects most relevant to the emergency department clinician.Keywords: acute asthma, acute lung injury, ARDS, acute respiratory failure

  18. 7 CFR 240.4 - Cash in lieu of donated foods for nonresidential child and adult care institutions.

    Science.gov (United States)

    2010-01-01

    ... and adult care institutions. 240.4 Section 240.4 Agriculture Regulations of the Department of... LIEU OF DONATED FOODS § 240.4 Cash in lieu of donated foods for nonresidential child and adult care... or adult care institutions participating in the Child and Adult Care Food Program. FNS shall pay...

  19. Quality Improvement in Critical Care: Selection and Development of Quality Indicators

    Directory of Open Access Journals (Sweden)

    Carla A. Chrusch

    2016-01-01

    Full Text Available Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  20. Quality Improvement in Critical Care: Selection and Development of Quality Indicators.

    Science.gov (United States)

    Chrusch, Carla A; Martin, Claudio M; Project, The Quality Improvement In Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  1. Who Are the Clients?: Goal Displacement in an Adult Care Center for Elders with Dementia

    Science.gov (United States)

    Abramson, Corey M.

    2009-01-01

    This ethnographic study of "goal displacement" in an adult day care center explains how and why certain goals come to surpass others in the organizational practices of elder day care settings. Adult day care is often oriented towards providing family caregivers with respite rather than attempting to directly improve the lives of the elders…

  2. Brief Report: The Medical Care of Adults with Autism Spectrum Disorders--Identifying the Needs

    Science.gov (United States)

    Bruder, Mary Beth; Kerins, Gerard; Mazzarella, Cynthia; Sims, Jessica; Stein, Neil

    2012-01-01

    There is a lack of information concerning adults with autism spectrum disorder (ASD), especially with regards to their access to health care. A paper and electronic survey was sent to 1,580 primary care physicians in Connecticut. 346 respondents returned a survey and provided care to adults with an ASD. This physician survey provides data on…

  3. A CRITICAL ANALYSIS OF PATIENT SATISFACTION WITH DIABETES CARE

    Directory of Open Access Journals (Sweden)

    Cotiu Madalina-Alexandra

    2015-07-01

    Full Text Available Consumer satisfaction represents one of the core principles of marketing as it is acknowledged that organizations survive and prosper only by properly meeting the needs and wants of their customers. The same logic can be applied to the healthcare sector, especially in the current context of increased public scrutiny and funding pressure. Furthermore, research shows that patient satisfaction is linked to positive effects from both a marketing and a medical point of view. From a marketing point of view, patient satisfaction is closely linked to positive word of mouth and likelihood to recommend, while from a medical poinbt of view, research suggests that satisfied patients are more inclined toward treatment adherence, are less likely to seek another opinion elsewhere thus delaying treatment, while medical staff tend to have a higher morale. Yet, research regarding patient satisfaction with a particular illness is scarce with studies rarely building on previous results. The article takes on this challenge and aims to critically analyse several empirical studies conducted on patient satisfaction with diabetes care in order to synthesize results on particular determinants and suggest areas for further research. Diabetes is currently one of the most spread chronic disease around the world, while also affecting both old and younger patients. At the same time, it is a chronic disease characterised by the need for disease management efforts on behalf of the patients as well as high treatment adherence in order to avoid complications. It is also a costly chronic disease especially because of the numerous complications which patients may arrive to face during their struggle with this disease. In order to achieve the aim of this article we have chosen to adopt a marketing approach meaning that we see diabetes patients as clients of the medical institutions. Results show that diabetes particularities call for a broader view on patient satisfaction

  4. High rates of unsuccessful transfer to adult care among young adults with juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Duffy Ciarán M

    2010-01-01

    Full Text Available Abstract Background This study aimed to describe the proportion of patients with juvenile idiopathic arthritis (JIA who had experienced an unsuccessful transfer from a pediatric rheumatology team to an adult rheumatologist and to compare the characteristics of those who achieved successful transfer to those who did not. Methods We conducted a systematic chart review of all patients with JIA who attended their final Montreal Children's Hospital JIA clinic appointment between 1992 and 2005. We tracked these patients for the two years after transfer to an adult rheumatologist. We then compared characteristics of patients with successful and unsuccessful transfers of care. Variables pertaining to disease characteristics, disease severity and psychosocial factors were examined. Univariate analyses were performed to determine if any single factor was associated with the outcome of unsuccessful transfer of care. Results 52% of patients fulfilled our criteria for unsuccessful transfer. Of the variables tested, an active joint count (AJC of zero at last visit was associated with the outcome of unsuccessful transfer (OR = 2.67 (CI 1.16-6.16; p = 0.0199. Conclusions Despite the presence of a coordinated process of transfer from pediatric to adult health care for the majority of the patients in this study, there was a high rate of unsuccessful transfer and/or sustained follow up which is disheartening. We found that patients with less active disease at the time of transfer, as indicated by a lower AJC, were more likely to be lost to follow up. Recent literature suggests that even in the least severe categories of JIA, 50% of patients persist with active disease into adulthood. Thus educating all JIA patients about the possibility of disease flare in adulthood may improve their adherence to recommendations for sustained follow-up in the adult milieu. This may lead to improvement of longitudinal outcomes for all JIA patients.

  5. Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity.

    Science.gov (United States)

    Lum, Hillary D; Sudore, Rebecca L

    2016-05-01

    This article provides an approach to advance care planning (ACP) and goals of care communication in older adults with cardiovascular disease and multi-morbidity. The goal of ACP is to ensure that the medical care patients receive is aligned with their values and preferences. In this article, the authors outline common benefits and challenges to ACP for older adults with cardiovascular disease and multimorbidity. Recognizing that these patients experience diverse disease trajectories and receive care in multiple health care settings, the authors provide practical steps for multidisciplinary teams to integrate ACP into brief clinic encounters.

  6. The Development of a Critical Care Resident Research Curriculum: A Needs Assessment

    Directory of Open Access Journals (Sweden)

    Sangeeta Jain

    2016-01-01

    Full Text Available Background. Conducting research is expected from many clinicians’ professional profile, yet many do not have advanced research degrees. Research training during residency is variable amongst institutions and research education needs of trainees are not well understood. Objective. To understand needs of critical care trainees regarding research education. Methods. Canadian critical care trainees, new critical care faculty, program directors, and research coordinators were surveyed regarding research training, research expectations, and support within their programs. Results. Critical care trainees and junior faculty members highlighted many gaps in research knowledge and skills. In contrast, critical care program directors felt that trainees were prepared to undertake research careers. Major differences in opinion amongst program directors and other respondent groups exist regarding preparation for designing a study, navigating research ethics board applications, and managing a research budget. Conclusion. We demonstrated that Canadian critical care trainees and junior faculty reported gaps in knowledge in all areas of research. There was disagreement amongst trainees, junior faculty, research coordinators, and program directors regarding learning needs. Results from this needs assessment will be used to help redesign the education program of the Canadian Critical Care Trials Group to complement local research training offered for critical care trainees.

  7. The Development of a Critical Care Resident Research Curriculum: A Needs Assessment.

    Science.gov (United States)

    Jain, Sangeeta; Menon, Kusum; Piquette, Dominique; Gottesman, Ronald; Hutchison, James; Gilfoyle, Elaine; Group, Canadian Critical Care Trials

    2016-01-01

    Background. Conducting research is expected from many clinicians' professional profile, yet many do not have advanced research degrees. Research training during residency is variable amongst institutions and research education needs of trainees are not well understood. Objective. To understand needs of critical care trainees regarding research education. Methods. Canadian critical care trainees, new critical care faculty, program directors, and research coordinators were surveyed regarding research training, research expectations, and support within their programs. Results. Critical care trainees and junior faculty members highlighted many gaps in research knowledge and skills. In contrast, critical care program directors felt that trainees were prepared to undertake research careers. Major differences in opinion amongst program directors and other respondent groups exist regarding preparation for designing a study, navigating research ethics board applications, and managing a research budget. Conclusion. We demonstrated that Canadian critical care trainees and junior faculty reported gaps in knowledge in all areas of research. There was disagreement amongst trainees, junior faculty, research coordinators, and program directors regarding learning needs. Results from this needs assessment will be used to help redesign the education program of the Canadian Critical Care Trials Group to complement local research training offered for critical care trainees. PMID:27610029

  8. Challenges in conducting end-of-life research in critical care.

    Science.gov (United States)

    Wiegand, Debra Lynn-McHale; Norton, Sally A; Baggs, Judith Gedney

    2008-01-01

    Critical care units present some unique challenges to the researcher, especially when the research topic of interest is related to end-of-life care. The purpose of this article is to address some of the methodological and practical issues related to conducting end-of-life research in the critical care setting. Recruitment barriers include gaining access to a clinical site, gaining access to patients, and prognostic uncertainty. Additional barriers include challenges related to informed consent, data collection, the research team, and ethical considerations. Strategies are described that can be used to guide researchers to conduct end-of-life research successfully in critical care. PMID:18560286

  9. Popular Culture and Critical Media Literacy in Adult Education: Theory and Practice

    Science.gov (United States)

    Tisdell, Elizabeth J.

    2007-01-01

    This chapter introduces the volume, provides an overview of the theory and literature on popular culture and critical media literacy in education, and discusses ways to use popular culture in adult education.

  10. Nurses’ knowledge of the principles of acute pain assessment in critically ill adult patients who are able to self-report

    OpenAIRE

    Irene Betty Kizza; Joshua Kanaabi Muliira; Kohi, Thecla W.; Rose Chalo Nabirye

    2016-01-01

    Introduction: Nurses play a critical role in managing and alleviating acute pain among critically ill adult patients (CIAP). The purpose of this study was to determine nurses’ level of knowledge about principles of acute pain assessment in CIAP. Methods: A descriptive cross-sectional study design and questionnaire survey were employed to collect data from 170 nurses caring for CIAP at Uganda’s national hospital. Results: The mean knowledge score of nurses was 71% indicating adequate kno...

  11. Linguistic Stereotyping in Older Adults' Perceptions of Health Care Aides.

    Science.gov (United States)

    Rubin, Donald; Coles, Valerie Berenice; Barnett, Joshua Trey

    2016-07-01

    The cultural and linguistic diversity of the U.S. health care provider workforce is expanding. Diversity among health care personnel such as paraprofessional health care assistants (HCAs)-many of whom are immigrants-means that intimate, high-stakes cross-cultural and cross-linguistic contact characterizes many health interactions. In particular, nonmainstream HCAs may face negative patient expectations because of patients' language stereotypes. In other contexts, reverse linguistic stereotyping has been shown to result in negative speaker evaluations and even reduced listening comprehension quite independently of the actual language performance of the speaker. The present study extends the language and attitude paradigm to older adults' perceptions of HCAs. Listeners heard the identical speaker of Standard American English as they watched interactions between an HCA and an older patient. Ethnolinguistic identities-either an Anglo native speaker of English or a Mexican nonnative speaker-were ascribed to HCAs by means of fabricated personnel files. Dependent variables included measures of perceived HCA language proficiency, personal characteristics, and professional competence, as well as listeners' comprehension of a health message delivered by the putative HCA. For most of these outcomes, moderate effect sizes were found such that the HCA with an ascribed Anglo identity-relative to the Mexican guise-was judged more proficient in English, socially superior, interpersonally more attractive, more dynamic, and a more satisfactory home health aide. No difference in listening comprehension emerged, but the Anglo guise tended to engender a more compliant listening mind set. Results of this study can inform both provider-directed and patient-directed efforts to improve health care services for members of all linguistic and cultural groups.

  12. Linguistic Stereotyping in Older Adults' Perceptions of Health Care Aides.

    Science.gov (United States)

    Rubin, Donald; Coles, Valerie Berenice; Barnett, Joshua Trey

    2016-07-01

    The cultural and linguistic diversity of the U.S. health care provider workforce is expanding. Diversity among health care personnel such as paraprofessional health care assistants (HCAs)-many of whom are immigrants-means that intimate, high-stakes cross-cultural and cross-linguistic contact characterizes many health interactions. In particular, nonmainstream HCAs may face negative patient expectations because of patients' language stereotypes. In other contexts, reverse linguistic stereotyping has been shown to result in negative speaker evaluations and even reduced listening comprehension quite independently of the actual language performance of the speaker. The present study extends the language and attitude paradigm to older adults' perceptions of HCAs. Listeners heard the identical speaker of Standard American English as they watched interactions between an HCA and an older patient. Ethnolinguistic identities-either an Anglo native speaker of English or a Mexican nonnative speaker-were ascribed to HCAs by means of fabricated personnel files. Dependent variables included measures of perceived HCA language proficiency, personal characteristics, and professional competence, as well as listeners' comprehension of a health message delivered by the putative HCA. For most of these outcomes, moderate effect sizes were found such that the HCA with an ascribed Anglo identity-relative to the Mexican guise-was judged more proficient in English, socially superior, interpersonally more attractive, more dynamic, and a more satisfactory home health aide. No difference in listening comprehension emerged, but the Anglo guise tended to engender a more compliant listening mind set. Results of this study can inform both provider-directed and patient-directed efforts to improve health care services for members of all linguistic and cultural groups. PMID:26606170

  13. A Critical Theory of Adult Learning and Education.

    Science.gov (United States)

    Mezirow, Jack

    1981-01-01

    Interpreting the ideas of Jurgen Habermas, the nature of three generic domains of adult learning is posited, each with its own interpretive categories, ways of determining which knowledge claims are warranted, methods of inquiry as well as its own learning goals, learning needs and modes of educational intervention. (CT)

  14. Marketing in Adult Education. A Critical Review of Literature.

    Science.gov (United States)

    Wells, Rita L.

    In the literature on marketing in adult education there is much debate on the ethics of marketing educational programs; although many individuals have written about the potential negative impacts of big business and high-pressure advertising in education, others have viewed marketing as an acceptable process that attempts to establish mutually…

  15. Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

    OpenAIRE

    Vi Am Dinh; Giri, Paresh C.; Inimai Rathinavel; Emilie Nguyen; David Hecht; Ihab Dorotta; H. Bryant Nguyen; Chrissian, Ara A.

    2015-01-01

    Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS), standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM) fellows. Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows' attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ system...

  16. In Pursuit of Critical Literacy: Understanding Experiences of Exclusion for Adult Literacy Learners

    Science.gov (United States)

    Howard, Margaret; Logan, Anna

    2012-01-01

    This paper explores exclusion and equality through critical theory, in the context of adult literacy provision in Ireland, by investigating the sites of exclusion that exist for a group of five male adult literacy learners. A summary review of literacy theories, exclusion and equality is provided framing the reporting of data from this…

  17. Parents' Criticisms and Attributions about Their Adult Children with High Functioning Autism or Schizophrenia

    Science.gov (United States)

    Wasserman, Stephanie; Weisman de Mamani, Amy; Mundy, Peter

    2010-01-01

    The current study examined the criticism component of expressed emotion (EE) and attributions in parents of adults diagnosed with schizophrenia/schizoaffective disorder (S/SA) or high functioning autism/Asperger's. Consistent with study hypotheses, parents of adults diagnosed with autism/Asperger's disorder exhibited lower levels of high…

  18. Advancing patient-centered care through transformative educational leadership: a critical review of health care professional preparation for patient-centered care

    Directory of Open Access Journals (Sweden)

    Lévesque MC

    2013-07-01

    Full Text Available Martine C Lévesque,1,2 Richard Bruce Hovey,2,3 Christophe Bedos2,4 1Faculté de médecine, Université de Montréal, Montréal, QC, Canada; 2Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada; 3Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 4Département de médecine sociale et préventive, Faculté de médicine, Université de Montréal, Montréal, QC, Canada Abstract: Following a historical brief on the development of patient-centered care (PCC, we discuss PCC's value and role in counterbalancing the evidence-based movement in health care. We in turn make a case for a philosophical shift in thinking about the PCC concept, one based on a consideration for how knowledge is produced, used, and valued within care provision processes. A “shared epistemology” foundation is presented, defined, and promoted as essential to the authentic and ethical realization of “shared decision making” between patient and health care provider, and, more generally, of PCC. In accordance with these views, this article critically reviews the literature on health care professional education for the development of PCC. We uncover the disturbing ways in which education frequently undermines the development of patient centeredness, despite curricular emphasis on professionalism and ethical PCC. We also establish the need to raise awareness of how dominant approaches to evaluating student or practitioner performance often fail to reinforce or promote patient centeredness. Finally, we identify successful and inspiring cases of teaching and learning experiences that have achieved perspective transformation on PCC and on new ways of providing care. The pertinence of adopting the theoretical foundations of adult transformative learning is argued, and a call to action is proposed to the leadership of health professional educators across all disciplines. Keywords: patient-centered care, health professional

  19. Continuous EEG in Critically Ill Children

    OpenAIRE

    Jonathan E Kurz; Wainwright, Mark S

    2015-01-01

    Investigators from the Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society reported a consensus statement on indications for the use of critical care continuous electroencephalographic monitoring (ccEEG) in adults and children.

  20. Nosocomial Candiduria in Critically Ill Patients Admitted to Intensive Care Units in Qazvin, Iran

    Directory of Open Access Journals (Sweden)

    Ghiasian

    2014-08-01

    Full Text Available Background A broad variety of fungi, especially Candida species, are becoming increasingly common causes of urinary tract infections in hospital settings. Objectives The current cross-sectional descriptive study aimed to determine the causative agents, risk factors and incidence rate of candiduria in critically ill patients, hospitalized in intensive care units (ICUs of four Iranian hospitals. Patients and Methods A total of 155 children and adult patients, admitted to ICUs of the four university educational hospitals, who demonstrated Candida-positive urine cultures, were examined. Samples were processed via mycological procedures by direct microscopy and culture. Results Candiduria was confirmed in 50 (32.26 % patients and Candida albicans was the most frequently isolated species representing 60.0% of isolates, followed by 14.0% C. glabrata, 12.0% C. parapsilosis, 10.0% C. krusei, and 4.0% C. tropicalis. Most patients were female (58% with a mean age of 46.7 years old. Generally, 39.7% and 62% of adults and children showed candiduria, respectively. The commonest predisposing factors were antibiotic therapy (98.0%, urinary catheterization (92.0%, corticotherapy (84.0%, being female (42.6 %, use of feeding tube (56%, and extended hospitalization, respectively. Conclusions The high frequency of candiduria in ICU patients can be decreased by shortening the duration of urinary catheterization, avoiding extra antibiotics and corticosteroids, as well as controlling the predisposing factors and underlying conditions.

  1. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala

    2014-02-01

    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives.Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs.Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding.Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU.Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  2. Incentivizing health care behaviors in emerging adults: a systematic review

    Directory of Open Access Journals (Sweden)

    Yu CH

    2016-03-01

    Full Text Available Catherine H Yu,1,2 Giuliana Guarna,1 Pamela Tsao,3 Jude R Jesuthasan,1 Adrian NC Lau,3,4 Ferhan S Siddiqi,1 Julie Anne Gilmour,3 Danyal Ladha,1 Henry Halapy,5 Andrew Advani1–3 1Li Ka Shing Knowledge Institute, St Michael’s Hospital, 2Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, University of Toronto, 3Department of Medicine, Faculty of Medicine, University of Toronto, 4Division of Endocrinology, Department of Medicine, University Health Network, 5Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada Purpose: For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases.Methods: The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years with chronic medical conditions including addictions, were included.Results: A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated.Conclusion: While the majority of

  3. Older Adult Education in a Maltese University of the Third Age: A Critical Perspective.

    Science.gov (United States)

    Formosa, Marvin

    2000-01-01

    Research using Freire's critical pedagogy and critical educational gerontology revealed that a Maltese University of the Third Age uses traditional one-way models of educational practice that fail to engage learners in transformative learning. Overemphasis on adult participation neglects the question of the purpose of learning. (Contains 72…

  4. Using Critical Discourse Analysis to Understand and Facilitate Identification Processes of Bilingual Adults Becoming Teachers

    Science.gov (United States)

    Cahnmann, Melisa; Rymes, Betsy; Souto-Manning, Mariana

    2005-01-01

    Our research focuses on bilingual adults enrolled in the Teachers for English Language Learners (TELL) program. TELL is a scholarship program whose goal is to increase the number of critically-minded bilingual educators in the state of Georgia in the United States. In this paper, we use critical discourse analysis to inform theoretical and…

  5. Meeting the milestones. Strategies for including high-value care education in pulmonary and critical care fellowship training.

    Science.gov (United States)

    Courtright, Katherine R; Weinberger, Steven E; Wagner, Jason

    2015-04-01

    Physician decision making is partially responsible for the roughly 30% of U.S. healthcare expenditures that are wasted annually on low-value care. In response to both the widespread public demand for higher-quality care and the cost crisis, payers are transitioning toward value-based payment models whereby physicians are rewarded for high-value, cost-conscious care. Furthermore, to target physicians in training to practice with cost awareness, the Accreditation Council for Graduate Medical Education has created both individual objective milestones and institutional requirements to incorporate quality improvement and cost awareness into fellowship training. Subsequently, some professional medical societies have initiated high-value care educational campaigns, but the overwhelming majority target either medical students or residents in training. Currently, there are few resources available to help guide subspecialty fellowship programs to successfully design durable high-value care curricula. The resource-intensive nature of pulmonary and critical care medicine offers unique opportunities for the specialty to lead in modeling and teaching high-value care. To ensure that fellows graduate with the capability to practice high-value care, we recommend that fellowship programs focus on four major educational domains. These include fostering a value-based culture, providing a robust didactic experience, engaging trainees in process improvement projects, and encouraging scholarship. In doing so, pulmonary and critical care educators can strive to train future physicians who are prepared to provide care that is both high quality and informed by cost awareness. PMID:25714122

  6. Nurses' experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit

    DEFF Research Database (Denmark)

    Laerkner, Eva; Egerod, Ingrid; Hansen, Helle Ploug

    2015-01-01

    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......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...... intubated patients included unpredictability, ambiguous needs and complex actions, while the rewarding aspects included personal interaction. Three sub-themes were identified: (i) caring for and with the patient, (ii) negotiating relational and instrumental care and (iii) managing physical and emotional...

  7. Proper care for the dying: a critical public issue.

    OpenAIRE

    Crispell, K R; Gomez, C. F.

    1987-01-01

    The ability of the medical profession to sustain life, or more appropriately, to prolong dying, in patients with terminal illness, creates a most complex and controversial situation for all involved: the patient, if mentally alert; the patient's family; and the medical care team including physicians, nurses and attendants. This situation is especially complex in large acute care hospitals where medical and nursing students, residents and house officers receive advanced medical training. A maj...

  8. Critical views on postpartum care expressed by new mothers

    Directory of Open Access Journals (Sweden)

    Waldenström Ulla

    2007-11-01

    Full Text Available Abstract Background Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of hospital postpartum care, expressed in their own words. Characteristics of the women who spontaneously gave negative comments about postpartum care were compared with those who did not. Methods Data were taken from a population-based prospective longitudinal study of 2783 Swedish-speaking women surveyed at three time points: in early pregnancy, at two months, and at one year postpartum. At the end of the two follow-up questionnaires, women were asked to add any comment they wished. Content analysis of their statements was performed. Results Altogether 150 women gave negative comments about postpartum care, and this sample was largely representative of the total population-based cohort. The women gave a diverse and detailed description of their experiences, for instance about lack of opportunity to rest and recover, difficulty in getting individualised information and breastfeeding support, and appropriate symptom management. The different statements were summarised in six categories: organisation and environment, staff attitudes and behaviour, breastfeeding support, information, the role of the father and attention to the mother. Conclusion The findings of this study underline the need to further discuss and specify the aims of postpartum care. The challenge of providing high-quality follow-up after childbirth is discussed in the light of a development characterised by a continuous reduction in the length of hospital stay, in combination with increasing public demands for information and individualised care.

  9. Health care for the indigent: overview of critical issues.

    OpenAIRE

    Bazzoli, G J

    1986-01-01

    Health care for the indigent is a major problem in the United States. This review of the literature on health care for the indigent was undertaken to determine which major questions remain unresolved. Overall, this article finds that a very large pool of individuals under age 65 are at risk of being medically indigent. A myriad of health programs for some economically disadvantaged individuals do exist, but their level of funding has fluctuated over time--and many poor individuals must rely e...

  10. Carbon dioxide kinetics and capnography during critical care

    OpenAIRE

    Anderson, Cynthia T; Breen, Peter H

    2000-01-01

    Greater understanding of the pathophysiology of carbon dioxide kinetics during steady and nonsteady state should improve, we believe, clinical care during intensive care treatment. Capnography and the measurement of end-tidal partial pressure of carbon dioxide (PETCO2) will gradually be augmented by relatively new measurement methodology, including the volume of carbon dioxide exhaled per breath (VCO2,br) and average alveolar expired PCO2 (PA̅E̅CO2). Future directions include the study of oxy...

  11. Health Literacy: Critical Opportunities for Social Work Leadership in Health Care and Research

    Science.gov (United States)

    Liechty, Janet M.

    2011-01-01

    One-third of U. S. adults do not have adequate health literacy to manage their health care needs; and low health literacy is a major concern due to its association with poor health outcomes, high health care costs, and health communication problems. Low health literacy is a potential driver of health disparities, and its alleviation is central to…

  12. Nurse′s perceptions of physiotherapists in critical care team: Report of a qualitative study

    Directory of Open Access Journals (Sweden)

    Pranati Gupte

    2016-01-01

    Full Text Available Background: Interprofessional relationship plays a major role in effective patient care. Specialized units such as critical care require multidisciplinary care where perception about every members role may affect the delivery of patient care. The objective of this study was to find out nurses′ perceptions of the role of physiotherapists in the critical care team. Methods: Qualitative study by using semi-structured interview was conducted among the qualified nurses working in the Intensive Care Unit of a tertiary care hospital. The interview consisted of 19 questions divided into 3 sections. Interviews were audio recorded and transcribed. In-depth content analysis was carried out to identify major themes in relation to the research question. Results: Analysis identified five major issues which included role and image of a physiotherapist, effectiveness of treatment, communications, teamwork, and interprofessional relations. Physiotherapists were perceived to be an important member of the critical team with the role of mobilizing the patients. The respondents admitted that there existed limitations in interprofessional relationship. Conclusion: Nurses perceived the role of physiotherapist in the critical care unit as an integral part and agreed on the need for inclusion of therapist multidisciplinary critical care team.

  13. Transition experiences and health care utilization among young adults with type 1 diabetes

    Directory of Open Access Journals (Sweden)

    Garvey KC

    2013-08-01

    Full Text Available Katharine C Garvey,1 Jonathan A Finkelstein,2,3 Lori M Laffel,1,4 Victoria Ochoa,1 Joseph I Wolfsdorf,1 Erinn T Rhodes1 1Division of Endocrinology, Boston Children's Hospital, 2Division of General Pediatrics, Boston Children's Hospital, 3Department of Population Medicine, Harvard Pilgrim Health Care Institute, 4Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA Background: The purpose of this study was to describe the current status of adult diabetes care in young adults with type 1 diabetes and examine associations between health care transition experiences and care utilization. Methods: We developed a survey to assess transition characteristics and current care in young adults with type 1 diabetes. We mailed the survey to the last known address of young adults who had previously received diabetes care at a tertiary pediatric center. Results: Of 291 surveys sent, 83 (29% were undeliverable and three (1% were ineligible. Of 205 surveys delivered, 65 were returned (response rate 32%. Respondents (mean age 26.6 ± 3.0 years, 54% male, 91% Caucasian transitioned to adult diabetes care at a mean age of 19.2 ± 2.8 years. Although 71% felt mostly/completely prepared for transition, only half received recommendations for a specific adult provider. Twenty-six percent reported gaps exceeding six months between pediatric and adult diabetes care. Respondents who made fewer than three diabetes visits in the year prior to transition (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.2–16.5 or cited moving/relocation as the most important reason for transition (OR 6.3, 95% CI 1.3–31.5 were more likely to report gaps in care exceeding six months. Patients receiving current care from an adult endocrinologist (79% were more likely to report at least two diabetes visits in the past year (OR 6.0, 95% CI 1.5–24.0 compared with those receiving diabetes care from a general internist/adult primary care doctor (17%. Two

  14. Severe Hypercapnia in Critically Ill Adult Cystic Fibrosis Patients

    OpenAIRE

    Sheikh, Hassan S.; Tiangco, Noel Dexter; Harrell, Christopher; Vender, Robert L.

    2011-01-01

    Background Cystic fibrosis (CF) is a monogenetic autosomal recessive multi-organ disease affecting approximately 50,000 patients worldwide. Overall median survival is continually increasing but pulmonary disease remains the most common cause of death. Guidelines have been published in relation to the outpatient maintenance of lung health for CF patients and treatment of acute lung exacerbations but little information exists about the management of the critically ill CF patient. Invasive mecha...

  15. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

    Science.gov (United States)

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

    2010-01-01

    Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

  16. Attaining baccalaureate competencies for nursing care of older adults through curriculum innovation.

    Science.gov (United States)

    Mauro, Ann Marie P; Hickey, Mary T; McCabe, Donna E; Ea, Emerson

    2012-01-01

    This new curriculum promotes up-to-date, evidence-based plans of care for older adults in acute care, long-term care, and community settings. Geriatric-specific content is a curricular thread and strong focus. Students have responded positively to the many opportunities they have to learn about the unique needs of older adults in multiple settings. Fortunately, we have several geriatric nurse practitioners on faculty along. Our students observe experts who are committed to promoting safe, quality, compassionate care to older adults in action on a daily basis.

  17. Knowledge, attitude and practice of pediatric critical care nurses towards pain: Survey in a developing country setting

    Directory of Open Access Journals (Sweden)

    P J Mathew

    2011-01-01

    Full Text Available Background : Nurses′ knowledge, sensitivity and attitudes about pain in children and its management affect their response and therefore management of pediatric pain. Children in critical care units undergo more painful procedures than those in general wards. Aims : To study the knowledge, attitude and practice of nursing personnel catering to critically ill children in a developing country. Settings and Design : Prospective questionnaire-based survey. Materials and Methods : The survey was carried out in a tertiary care teaching hospital on nursing personnel in three pediatric/neonatal intensive care units. The domains studied were: i. Training and experience, ii. Knowledge of pediatric pain, iii. Individual attitude towards pain in children, iv. Personal practice(s for pain alleviation, v. Pain assessment, and vi. Non-pharmacological measures adopted. Statistical Analysis : Descriptive statistics and logistic regression. Results : Of the 81 nursing personnel working in the three critical care units, 56 (69.1% responded to the questionnaire. Only one-third of them had received formal training in pediatric nursing. Fifty percent of the respondents felt that infants perceive less pain than adults. Training in pediatric nursing was a significant contributing factor in the domain of knowledge (P=0.03. Restraint and distraction were the common modalities employed to facilitate painful procedures. Scientific approaches like eutectic mixture of local anesthetic and the judicious use of sedatives were not adopted routinely. Observing a child′s face and posture were widely used parameters to assess pain (83%. None of the three critical care areas used a scoring system to assess pain. Conclusions : There are several lacunae in the knowledge and practice of nurses in developing countries which need to be improved by training.

  18. Net4Care : Towards a Mission-Critical Software Ecosystem

    DEFF Research Database (Denmark)

    Christensen, Henrik Bærbak; Hansen, Klaus Marius

    2012-01-01

    The demographics of the western world is changing: people are getting older and as a partial consequence get an increasing number of chronic diseases such as diabetes, chronic obstructive pulmonary disease (COPD), and coronary disease. At the same time, healthcare systems are stressed for resources...... propose a software ecosystem approach for telemedicine applications, providing a framework, Net4Care, encapsulating national/global design decisions with respect to standardization while allowing for local innovation. This paper presents an analysis of existing systems, of requirements for a software...... ecosystem for telemedicine, and a summary of initial design decisions for the Net4Care framework....

  19. Critical perspectives on danish early childhood education and care

    DEFF Research Database (Denmark)

    Jensen, Anders Skriver; Broström, Stig; Hansen, Ole Henrik

    2010-01-01

    This paper discusses trends in contemporary Danish early childhood education and care (ECEC). Data are sourced from various policy documents, along with material from ongoing research projects in which the authors are involved. It is claimed that contemporary policy on Danish day care services has...... a tendency to emphasize narrow curriculum improvements and standardized testing. The democratic dimensions are still relatively strong, but at the moment these dimensions are interpreted within a skills-and-testing framework, which is leading to a situation where the political masquerades as the technical....

  20. The emotional intelligence of a group of critical-care nurses in South Africa

    Directory of Open Access Journals (Sweden)

    Amanda Towell

    2013-11-01

    Full Text Available Critical-care nurses often look after three or more critically-ill patients during a shift. The workload and emotional stress can lead to disharmony between the nurse’s body, mind and spirit. Nurses with a high emotional intelligence have less emotional exhaustion and psychosomatic symptoms; they enjoy better emotional health; gain more satisfaction from their actions (both at work and at home; and have improved relationships with colleagues at work. The question arises: what is the emotional intelligence of critical-care nurses? A quantitative survey was conducted. The target population was registered nurses working in critical-care units who attended the Critical Care Congress 2009 (N = 380. Data were collected with the use of the Trait Emotional Intelligence Short Form and analysed using the Statistical Package for the Social Sciences software. The sample (n= 220 was mainly a mature, female and professionally-experienced group of registered nurses. They held a variety of job descriptions within various critical-care units. Statistics indicated that the standard deviations were small and no aberrant aspects such as demographics skewed the findings. The conclusion was made that registered nurses who are older and that have more experience in critical care appear to have a higher range of emotional intelligence.

  1. Contributors to Adult Sibling Relationships and Intention to Care of Siblings of Individuals with Down Syndrome

    Science.gov (United States)

    Cuskelly, Monica

    2016-01-01

    The contribution of childhood sibling relationships to adult sibling relationships and intention to provide care was investigated in a sample in which one member of each dyad had Down syndrome. Thirty-nine adult siblings of an adult with Down syndrome who had participated in a study of sibling relationships in childhood/adolescence provided data…

  2. A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care

    DEFF Research Database (Denmark)

    Langhorn, Leanne; Sorensen, Jens C; Pedersen, Preben U

    2010-01-01

    A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care......A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care...

  3. Incorporating Geriatric Medicine Providers into the Care of the Older Adult with Cancer.

    Science.gov (United States)

    Magnuson, Allison; Canin, Beverly; van Londen, G J; Edwards, Beatrice; Bakalarski, Pamela; Parker, Ira

    2016-11-01

    A significant proportion of cancer patients and survivors are age 65 and over. Older adults with cancer often have more complex medical and social needs than their younger counterparts. Geriatric medicine providers (GMPs) such as geriatricians, geriatric-trained advanced practice providers, and geriatric certified registered nurses have expertise in caring for older adults, managing complex medical situations, and optimizing function and independence for this population. GMPs are not routinely incorporated into cancer care for older adults; however, their particular skill set may add benefit at many points along the cancer care continuum. In this article, we review the role of geriatric assessment in the care of older cancer patients, highlight specific case scenarios in which GMPs may offer additional understanding and insight in the care of older adults with cancer, and discuss specific mechanisms for incorporating GMPs into oncology care. PMID:27613166

  4. For the Health-Care Work Force, a Critical Prognosis

    Science.gov (United States)

    Rahn, Daniel W.; Wartman, Steven A.

    2007-01-01

    The United States faces a looming shortage of many types of health-care professionals, including nurses, physicians, dentists, pharmacists, and allied-health and public-health workers. There may also be a shortage of faculty members in the health sciences. The results will be felt acutely within the next 10 years. Colleges and health-science…

  5. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations...

  6. Creating and Maintaining a Wellness Environment in Child Care Centers Participating in the Child and Adult Care Food Program

    Science.gov (United States)

    Lofton, Kristi L.; Carr, Deborah H.

    2010-01-01

    Purpose/Objectives: This study identifies issues associated with creating and maintaining a wellness environment in child care centers (CCCs) participating in the Child and Adult Care Food Program (CACFP). Methods: Structured interviews and focus groups were conducted with CCC professionals and state agency personnel to develop a survey to assess…

  7. Functional prognosis of dizziness in older adults in primary care: a prospective cohort study.

    OpenAIRE

    Dros, J.; Maarsingh, O.R.; Beem, L.; van der Horst, H.E.; Riet, G. ter; Schellevis, F G; van Weert, H.C.P.M.

    2012-01-01

    Objectives: To investigate the 6-month functional prognosis of dizziness in older adults in primary care, to identify important predictors of dizziness-related impairment, and to construct a score to assist risk prediction. Design: Prospective cohort study with 6-month follow-up. Setting: Twenty-four primary care practices in the Netherlands. Participants: Four hundred seventeen older adults (mean age 78.5, range 65–95, 74% female) presenting consecutively to primary care with dizziness. Meas...

  8. The provision of staff development programs in Virginia adult day care centers

    OpenAIRE

    Hensley, A. Dawn

    1994-01-01

    This study examined a neglected area in long term care and adult day care research: staff development. The specific purposes of this study were to describe the provision of a comprehensive staff development program in adult day care centers in Virginia in order to (a) differentiate those centers providing only the minimum required inservice training from those centers providing more comprehensive staff development programs and (b) define what meaning is placed upon sta...

  9. Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte; Kofoed, Poul-Erik; Ohm Kyvik, Kirsten;

    2012-01-01

    Scand J Caring Sci; 2012; Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care Rationale:  Despite the fact that communication has become a core topic in health care, patients still experience the information provided...... as insufficient or incorrect and a lack of involvement. Objective:  To investigate whether adult orthopaedic patients' evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods:  The study was designed as an intervention study...... limitation. Response rates were comparable to those of other studies. Conclusion:  Patients show increased satisfaction with the quality of health care after professionals have attended a communication skills training course, even when implemented in an entire department. Practice implications:  We recommend...

  10. Let’s Talk Critical. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows

    Science.gov (United States)

    Hsieh, S. Jean; Howes, Jennifer M.; Keene, Adam B.; Fausto, James A.; Pinto, Priya A.; Gong, Michelle Ng

    2015-01-01

    Rationale: Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. Objectives: We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. Methods: We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows’ self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Measurements and Main Results: Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi

  11. Critical care nurses' experiences caring for the casualties of war evacuated from the front line: lessons learned and needs identified.

    Science.gov (United States)

    Kenny, Deborah J; Hull, Mary S

    2008-03-01

    Nursing in a critical care environment is stressful, particularly when patients are young, previously healthy soldiers who have experienced multiple severe, life-threatening injuries. These injuries not only devastate the injured soldiers and their families, but also significantly impact the nurses caring for these patients. This article discusses some stressors identified by critical care nurses in two military medical treatment facilities where the most severely injured soldiers undergo definitive care, and examines the evolution of the concept of compassion fatigue, its symptoms, and methods of coping. Examples of how the nurses currently working with these young soldiers manage their own stressors are discussed and suggestions for successful coping strategies are provided. PMID:18206583

  12. The ethical dimension in published animal research in critical care: the public face of science

    OpenAIRE

    Bara, Meredith; Ari R. Joffe

    2014-01-01

    Introduction The ethical quality of animal research is important for many reasons, including for maintaining public support. We aimed to determine the reported attention to the ethical dimensions of the 3Rs (Refinement, Reduction, and Replacement) in critical care animal research published in 2012. Methods A data-collection form and instruction manual were created based on published recommendations, and completed for all consecutive critical care animal research (using mammals) publications f...

  13. The effect of neuro-linguistic programming on occupational stress in critical care nurses

    OpenAIRE

    HemmatiMaslakpak, Masumeh; Farhadi, Masumeh; Fereidoni, Javid

    2016-01-01

    Background: The use of coping strategies in reducing the adverse effects of stress can be helpful. Nero-linguistic programming (NLP) is one of the modern methods of psychotherapy. This study aimed to determine the effect of NLP on occupational stress in nurses working in critical care units of Urmia. Materials and Methods: This study was carried out quasi-experimentally (before–after) with control and experimental groups. Of all the nurses working in the critical care units of Urmia Imam Khom...

  14. The human factor: the critical importance of effective teamwork and communication in providing safe care

    OpenAIRE

    Leonard, M.; Graham, S.; Bonacum, D

    2004-01-01

    Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members...

  15. A systematic evaluation of the quality of meta-analyses in the critical care literature

    OpenAIRE

    Delaney, Anthony; Bagshaw, Sean M.; Ferland, Andre; Manns, Braden; Laupland, Kevin B; Doig, Christopher J

    2005-01-01

    Introduction Meta-analyses have been suggested to be the highest form of evidence available to clinicians to guide clinical practice in critical care. The purpose of this study was to systematically evaluate the quality of meta-analyses that address topics pertinent to critical care. Methods To identify potentially eligible meta-analyses for inclusion, a systematic search of Medline, EMBASE and the Cochrane Database of Systematic Reviews was undertaken, using broad search terms relevant to in...

  16. A Device for Automatically Measuring and Supervising the Critical Care Patient’S Urine Output

    OpenAIRE

    Roemi Fernández; Francisco Palacios; Teodor Akinfiev; Abraham Otero

    2010-01-01

    Critical care units are equipped with commercial monitoring devices capable of sensing patients’ physiological parameters and supervising the achievement of the established therapeutic goals. This avoids human errors in this task and considerably decreases the workload of the healthcare staff. However, at present there still is a very relevant physiological parameter that is measured and supervised manually by the critical care units’ healthcare staff: urine output. This paper presents a pate...

  17. Registered Nurse Care Coordination: Creating a Preferred Future for Older Adults with Multimorbidity.

    Science.gov (United States)

    Scholz, Jean; Minaudo, Judith

    2015-09-30

    The concept of care coordination is often touted as the preferred way to streamline care for complex patients. Care coordination is even more popular with the mention of it in the Affordable Care Act of 2010 and with new Medicare payment models. The purpose of this article is to define care coordination, briefly describe trends for older adults and care coordination, and explore roles for registered nurses. We describe elder-appropriate models of care coordination useful for older adults with multimorbidity. A brief exemplar provides an example of evidence-based care coordination services provided by a nursing and social work team, a model supported by recent literature. As a result of this discussion, readers will become informed about possibilities for the future of care delivery and the future of professional nursing practice.

  18. Transitions to Adult Care for Rhode Island Youth with Special Healthcare Needs.

    Science.gov (United States)

    McLaughlin, Suzanne; Terry, Christopher; Neukirch, Jodie; Garneau, Deborah; Golding, Deb; Brown, Joanna

    2016-01-01

    The transitioning of youth from pediatric to adult care systems is often fraught with discontinuity, miscommunication and gaps in care. This is most significant for youth with special health care needs. A panel discussion on transitioning youth to adult care systems that was part of a learning collaborative held by The RI Care Transformation Collaborative (CTC) is presented here, illustrated by a pertinent case of a youth with type 1 diabetes. [Full article available at http://rimed.org/rimedicaljournal-2016-08.asp, free with no login]. PMID:27472770

  19. Critical care resources in the Solomon Islands: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Westcott Mia

    2012-03-01

    Full Text Available Abstract Background There are minimal data available on critical care case-mix, care processes and outcomes in lower and middle income countries (LMICs. The objectives of this paper were to gather data in the Solomon Islands in order to gain a better understanding of common presentations of critical illness, available hospital resources, and what resources would be helpful in improving the care of these patients in the future. Methods This study used a mixed methods approach, including a cross sectional survey of respondents' opinions regarding critical care needs, ethnographic information and qualitative data. Results The four most common conditions leading to critical illness in the Solomon Islands are malaria, diseases of the respiratory system including pneumonia and influenza, diabetes mellitus and tuberculosis. Complications of surgery and trauma less frequently result in critical illness. Respondents emphasised the need for basic critical care resources in LMICs, including equipment such as oximeters and oxygen concentrators; greater access to medications and blood products; laboratory services; staff education; and the need for at least one national critical care facility. Conclusions A large degree of critical illness in LMICs is likely due to inadequate resources for primary prevention and healthcare; however, for patients who fall through the net of prevention, there may be simple therapies and context-appropriate resources to mitigate the high burden of morbidity and mortality. Emphasis should be on the development and acquisition of simple and inexpensive tools rather than complicated equipment, to prevent critical care from unduly diverting resources away from other important parts of the health system.

  20. A subtropical embayment serves as essential habitat for sub-adults and adults of the critically endangered smalltooth sawfish

    Directory of Open Access Journals (Sweden)

    Yannis P. Papastamatiou

    2015-01-01

    Full Text Available Identifying essential habitat for large, mobile endangered species is difficult, particularly marine species where visual observations are limited. Though various methods of telemetry are available, each suffers from limitations and only provides satisfactory information over a specific temporal or spatial scale. Sawfish are one of the most imperilled groups of fishes, with every species worldwide listed as endangered or critically endangered. Whereas movements of juvenile sawfish are fairly well studied, much less is known about adults due to their rarity and the challenging environments they live in. Previous encounter records have identified Florida Bay in the Everglades National Park as a potentially important habitat for adults of the critically endangered smalltooth sawfish (Pristis pectinata. We used a combination of acoustic and satellite telemetry, as well as conventional tagging, to determine patterns of movement and residency by sub-adult and adult sawfish. Over short time periods, movements appeared primarily tidal driven with some evidence that animals moved into shallow water during the ebbing or flooding tides. Adult sawfish sexually segregated seasonally with males found by mangrove-lined canals in the spring and females predominantly found in outer parts of the bay. Males migrated from canals starting in late May potentially as temperatures increased above 30°C. Some males and females migrated north during the summer, while others may have remained within deeper portions of Florida Bay. Male sawfish displayed site fidelity to Florida Bay as some individuals were recaptured 1–2 years after originally being tagged. We hypothesize that mating occurs in Florida Bay based on aggregations of mature animals coinciding with the proposed mating period, initial sexual segregation of adults followed by some evidence of females moving through areas where males show seasonal residency, and a high percentage of animals showing evidence of

  1. Ultrasound for critical care physicians: complication of a distant malignancy

    OpenAIRE

    Sante SC; Boivin M

    2016-01-01

    No abstract available. Article truncated after first page. An 82-year-old woman with prior medical history of stage IV colon cancer and chronic obstructive pulmonary disease presented to the medical intensive care unit with newly diagnosed community acquired pneumonia and acute kidney injury. The patient presented with acute onset of shortness of breath, nausea, generalized weakness, bilateral lower extremity swelling and decreased urine output. She was transferred for short term dialysis in ...

  2. Ultrasound for critical care physicians: a tempting dilemma

    OpenAIRE

    Marzouk I; Melendres L; Boivin M

    2014-01-01

    No abstract available. Article truncated after 150 words. A 46 year old woman presented with progressive severe hypoxemia and a chronic appearing pulmonary embolus on chest CT angiogram to the intensive care unit. The patient was hemodynamically stable, but had an oxygen saturation of 86% on a high-flow 100% oxygen mask. The patient had been previously investigated for interstitial lung disease over the past 2 year, this was felt to be due to non-specific interstitial pneumonitis. Her echocar...

  3. Survivorship care for older adults with cancer: U13 conference report.

    Science.gov (United States)

    Guerard, Emily J; Nightingale, Ginah; Bellizzi, Keith; Burhenn, Peggy; Rosko, Ashley; Artz, Andrew S; Korc-Grodzicki, Beatriz; Canin, Beverly; Dale, William; Ferrell, Betty

    2016-07-01

    Older adult cancer survivors currently account for almost 60% of all cancer survivors. The number of older cancer survivors will continue to increase as the population ages and as patients' live longer after a cancer diagnosis. As part of cancer center accreditation, the American College of Surgeons Commission on Cancer® (CoC) has placed great importance on survivorship care planning. While the CoC has set standards for general survivorship care, there is sparse evidence on how to best care for older adult cancer survivors. Concern exists among the medical community that survivorship care plans could increase paperwork without improving outcomes. Given the diverse and unique needs of older adult cancer survivors, the inter-professional team provides a structure and process for survivorship care built around the particular needs of older adults. The Cancer and Aging Research Group (CARG), in partnership with the NIA/NCI, held a U13 conference in May 2015 in part to discuss survivorship care for older adults with cancer. This report discusses four themes that emerged from one section of the conference: (1) survivorship care is a process that continually evolves to meet the needs of older adults; (2) older adult cancer survivors have unique needs and care plans should be tailored to meet these needs; (3) the inter-professional team is ideally suited to structure survivorship care of older adults; (4) patient advocacy must be encouraged throughout the cancer care continuum. As evidence based survivorship practices develop, the unique needs of older adults need to be given substantial attention.

  4. Critical cultural competence for culturally diverse workforces: toward equitable and peaceful health care.

    Science.gov (United States)

    Almutairi, Adel F; Rondney, Patricia

    2013-01-01

    In this article, we argue that attaining equity, and therefore peace in health care delivery, necessitates that nursing and other health care professions more carefully attend to the sociocultural context in which health care is delivered. That sociocultural context includes culturally diverse patients, families, and communities, as well as health care providers who are themselves culturally diverse. We draw on findings from Almutairi's doctoral research with health care providers in Saudi Arabia to argue for what he has identified as critical cultural competence for health care providers. In so doing, we explicate the complexity of cultural and linguistic issues and power relations induced by race, class, and gender that can contribute to vulnerabilities for health care providers and recipients alike. PMID:23907302

  5. Residential Segregation and Overweight/Obesity Among African-American Adults: A Critical Review

    OpenAIRE

    Corral, Irma; Landrine, Hope; Hall, Marla B.; Bess, Jukelia J.; Mills, Kevin R.; Jimmy T. Efird

    2015-01-01

    The relationship between residential segregation and overweight/obesity among African-American adults remains unclear. Elucidating that relationship is relevant to efforts to prevent and to reduce racial disparities in obesity. This article provides a critical review of the 11 empirical studies of segregation and overweight/obesity among African-American adults. Results revealed that most studies did not use a valid measure of segregation, many did not use a valid measure of overweight/obesit...

  6. Critical Issues in Foster Care: Lessons the Children's Ark Learned from Barbara and Nathan

    Science.gov (United States)

    Mann, Janet; Kretchmar, Molly D.; Worsham, Nancy L.

    2008-01-01

    Using an attachment theory framework, this article explores several critical issues in foster care as reflected in the case of Barbara and her 9-month-old son, Nathan. Barbara and Nathan participated in The Children's Ark, an innovative intervention for families in foster care that allowed mothers who had lost custody of their children to live,…

  7. Year in review 2005: Critical Care – Respirology: mechanical ventilation, infection, monitoring, and education

    OpenAIRE

    Haitsma, Jack J; Villar, Jesús; Slutsky, Arthur S.

    2006-01-01

    We summarize all original research in the field of respiratory intensive care medicine published in 2005 in Critical Care. Twenty-seven articles were grouped into the following categories and subcategories to facilitate rapid overview: mechanical ventilation (physiology, spontaneous breathing during mechanical ventilation, high frequency oscillatory ventilation, side effects of mechanical ventilation, sedation, and prone positioning); infection (pneumonia and sepsis); monitoring (ventilatory ...

  8. Two Case Studies Using Mock-Ups for Planning Adult and Neonatal Intensive Care Facilities

    Directory of Open Access Journals (Sweden)

    Sue Hignett

    2010-01-01

    Full Text Available This paper describes two case studies using a 5-step protocol to determine functional space requirements for cardiac and neonatal intensive care clinical activities. Functional space experiments were conducted to determine the spatial requirements (defined as the minimumsized rectangle to encompass the Link Analysis. The data were collected with multi-directional filming and analysed frame-by-frame to plot the movements between the nurses and other components in the space. The average clinical functional space for the adult critical care unit was 22.83m2 (excluding family and hygiene space and in-room storage. The average functional clinical space for neonatal intensive care unit was 13.5m2 (excluding circulation and storage. The use of the 5-step protocol is reviewed, with limitations in case study 1 addressed in case study 2. The findings from both case studies have been incorporated into government guidance and achieved knowledge transfer by being implemented in building design.

  9. Reconciliation of work and care among lone mothers of adults with intellectual disabilities: the role and limits of care capital.

    Science.gov (United States)

    Chou, Yueh-Ching; Kröger, Teppo

    2014-07-01

    In this study, the concept of social capital is applied to an exploration of Guanxi (social networking to create good relationships) among working lone mothers of adults with intellectual disabilities (ID) in Taiwan. Using in-depth interviews, this study explores the role of social capital, here referred to as 'care capital', in making it possible for working lone mothers to combine their roles as family carers and workers. Eleven divorced or widowed mothers combining their paid work with long-term care responsibilities were recruited from a survey or through NGOs and were interviewed at their home between October 2008 and July 2010. An interpretative phenomenological approach was adopted for data analysis. The findings revealed that the mothers' care capital was extremely limited and was lost, gained and lost again during their life-cycles of long-term care-giving. Guanxi, especially in relation to their employers, proved to be the sole source of care capital for these mothers, making reconciliation between work and care responsibilities possible. In the absence of formal or informal support, religion and the mother-child relationship seemed also to become a kind of care capital for these lone mothers, helping them to get by with their life-long care responsibilities. For formal social and healthcare services, not just in Taiwan but in every country, it is important to develop support for lone mothers of adults with ID who have long-term care responsibilities and low levels of care capital and thus face care poverty.

  10. Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition

    Directory of Open Access Journals (Sweden)

    Muntinga Maaike E

    2012-04-01

    Full Text Available Abstract Background Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling frail older adults. Methods/design In a 2-year stepped-wedge cluster randomised clinical trial with 6-monthly measurements, the chronic care model will be compared with usual care. The trial will be carried out among 35 primary care practices in two regions in the Netherlands. Per region, practices will be randomly allocated to four allocation arms designating the starting point of the intervention. Participants: 1200 community-dwelling older adults aged 65 or over and their primary informal caregivers. Primary care physicians will identify frail individuals based on a composite definition of frailty and a polypharmacy criterion. Final inclusion criterion: scoring 3 or more on a disability case-finding tool. Intervention: Every 6 months patients will receive a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Expert teams will manage and train practice nurses. Patients with complex care needs will be reviewed in interdisciplinary consultations. Evaluation: We will perform an effect evaluation, an economic evaluation, and a process evaluation. Primary outcome is quality of life as measured with the Short Form-12 questionnaire. Effect analyses will be based on the “intention-to-treat” principle, using multilevel regression analysis. Cost measurements will be administered continually during the study period. A cost-effectiveness analysis and cost-utility analysis will be conducted comparing mean total costs to functional

  11. The health and social consequences of an alcohol related admission to critical care: a qualitative study

    OpenAIRE

    McPeake, Joanne; Forrest, Ewan; Quasim, Tara; Kinsella, John; O'Neill, Anna

    2016-01-01

    Objective: To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design: In-depth, semistructured interviews with participants ( patients) 3–7 months post intensive care discharge. Setting: The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients ...

  12. Health and social consequences of an alcohol-related admission to critical care: a qualitative study

    OpenAIRE

    McPeake, Joanne; Forrest, Ewan; Quasim, Tara; Kinsella, John; O'Neill, Anna

    2016-01-01

    Objective To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design In-depth, semistructured interviews with participants (patients) 3–7 months post intensive care discharge. Setting The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocate...

  13. Communication of bed allocation decisions in a critical care unit and accountability for reasonableness

    Directory of Open Access Journals (Sweden)

    Swota Alissa H

    2005-10-01

    Full Text Available Abstract Background Communication may affect perceptions of fair process for intensive care unit bed allocation decisions through its impact on the publicity condition of accountability for reasonableness. Methods We performed a qualitative case study to describe participant perceptions of the communication of bed allocation decisions in an 18-bed university affiliated, medical-surgical critical care unit at Sunnybrook and Women's College Health Sciences Centre. Interviewed participants were 3 critical care physicians, 4 clinical fellows in critical care, 4 resource nurses, 4 "end-users" (physicians who commonly referred patients to the unit, and 3 members of the administrative staff. Median bed occupancy during the study period (Jan-April 2003 was 18/18; daily admissions and discharges (median were 3. We evaluated our description using the ethical framework "accountability for reasonableness" (A4R to identify opportunities for improvement. Results The critical care physician, resource nurse, critical care fellow and end-users (trauma team leader, surgeons, neurosurgeons, anesthesiologists functioned independently in unofficial "parallel tracks" of bed allocation decision-making; this conflicted with the official designation of the critical care physician as the sole authority. Communication between key decision-makers was indirect and could exclude those affected by the decisions; notably, family members. Participants perceived a lack of publicity for bed allocation rationales. Conclusion The publicity condition should be improved for critical care bed allocation decisions. Decision-making in the "parallel tracks" we describe might be unavoidable within usual constraints of time, urgency and demand. Formal guidelines for direct communication between key participants in such circumstances would help to improve the fairness of these decisions.

  14. Stress levels of critical care doctors in India: A national survey

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    Rahul Amte

    2015-01-01

    Full Text Available Background: Doctors working in critical care units are prone to higher stress due to various factors such as higher mortality and morbidity, demanding service conditions and need for higher knowledge and technical skill. Aim: The aim was to evaluate the stress level and the causative stressors in doctors working in critical care units in India. Materials and Methods: A two modality questionnaire-based cross-sectional survey was conducted. In manual mode, randomly selected delegates attending the annual congress of Indian Society of Critical Care Medicine filled the questionnaire. In the electronic mode, the questionnaires were E-mailed to critical care doctors. These questionnaires were based on General Health Questionnaire-12 (GHQ-12. Completely filled 242 responses were utilized for comparative and correlation analysis. Results: Prevalence of moderate to severe stress level was 40% with a mean score of 2 on GHQ-12 scale. Too much responsibility at times and managing VIP patients ranked as the top two stressors studied, while the difficult relationship with colleagues and sexual harassment were the least. Intensivists were spending longest hours in the Intensive Care Unit (ICU followed by pulmonologists and anesthetists. The mean number of ICU bed critical care doctors entrusted with was 13.2 ± 6.3. Substance abuse to relieve stress was reported as alcohol (21%, anxiolytic or antidepressants (18% and smoking (14%. Conclusion: Despite the higher workload, stress levels measured in our survey in Indian critical care doctors were lower compared to International data. Substantiation of this data through a wider study and broad-based measures to improve the quality of critical care units and quality of the lives of these doctors is the need of the hour.

  15. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness

    DEFF Research Database (Denmark)

    Jones, Christina; Bäckman, Carl; Capuzzo, Maurizia;

    2010-01-01

    Patients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness...

  16. Transitioning Adolescents and Young Adults With Sickle Cell Disease From Pediatric to Adult Health Care: Provider Perspectives.

    Science.gov (United States)

    Stollon, Natalie B; Paine, Christine W; Lucas, Matthew S; Brumley, Lauren D; Poole, Erika S; Peyton, Tamara; Grant, Anne W; Jan, Sophia; Trachtenberg, Symme; Zander, Miriam; Bonafide, Christopher P; Schwartz, Lisa A

    2015-11-01

    The transition from pediatric to adult health care is often challenging for adolescents and young adults with sickle cell disease (SCD). Our study aimed to identify (1) measures of success for the transition to adult health care; and (2) barriers and facilitators to this process. We interviewed 13 SCD experts and asked them about their experiences caring for adolescents and young adults with SCD. Our interview guide was developed based on Social-Ecological Model of Adolescent and Young Adult Readiness to Transition framework, and interviews were coded using the constant comparative method. Our results showed that transition success was measured by health care utilization, quality of life, and continuation on a stable disease trajectory. We also found that barriers to transition include negative experiences in the emergency department, sociodemographic factors, and adolescent skills. Facilitators include a positive relationship with the provider, family support, and developmental maturity. Success in SCD transition is primarily determined by the patients' quality of relationships with their parents and providers and their developmental maturity and skills. Understanding these concepts will aid in the development of future evidence-based transition care models.

  17. Financing Mental Health Care in Spain: Context and critical issues

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    L. Salvador-Carulla

    2006-03-01

    Full Text Available BACKGROUND: Financing and the way in which funds are then allocated are key issues in health policy. They can act as an incentive or barrier to system reform , can prioritise certain types or sectors of care and have long term consequences for the planning and delivery of services. The way in which these issues can impact on the funding of mental health services across Europe has been a key task of the Mental Health Economics European Network. (MHEEN This paper draws on information prepared for MHEEN and provides an analysis of the context and the main issues related to mental health financing in Spain. METHODS: A structured questionnaire developed by the MHEEN group was used to assess the pattern of financing, eligibility and coverage for mental healthcare. In Spain contacts were made with the Mental Health agencies of the 17 Autonomous Communities (ACs, and available mental health plans and annual reports were reviewed. A direct collaboration was set up with four ACs (Madrid, Navarre, Andalusia, Catalonia. RESULTS: In Spain, like many other European countries mental healthcare is an integral part of the general healthcare with universal coverage funded by taxation. Total health expenditure accounted for 7.7% of GDP in 2003 (public health expenditure was 5.6% of GDP. Although the actual percentage expended in mental care is not known and estimates are unreliable, approximately 5% of total health expenditure can be attributed to mental health. Moreover what is often overlooked is that many services have been shifted from the health to the social care sector as part of the reform process. Social care is discretionary, and provides only limited coverage. This level of expenditure also appears low by European standards, accounting for just 0.6% of GDP. COMMENTS: In spite of its policy implications, little is known about mental healthcare financing in Spain. Comparisons of expenditure for mental health across the ACs are problematic, making it

  18. Financing Mental Health Care in Spain: Context and critical issues

    OpenAIRE

    Salvador-Carulla, L.; Garrido, M.; McDaid, D; Haro, J. M.

    2006-01-01

    BACKGROUND: Financing and the way in which funds are then allocated are key issues in health policy. They can act as an incentive or barrier to system reform , can prioritise certain types or sectors of care and have long term consequences for the planning and delivery of services. The way in which these issues can impact on the funding of mental health services across Europe has been a key task of the Mental Health Economics European Network. (MHEEN) This paper draws on information prepared ...

  19. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

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    Sophie L W Spoorenberg

    Full Text Available Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs.Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach.Responses of participants concerned two focus areas: 1 Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2 Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system.The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  20. Extra Physiotherapy in Critical Care (EPICC) Trial Protocol: a randomised controlled trial of intensive versus standard physical rehabilitation therapy in the critically ill

    OpenAIRE

    Thomas, Kirsty; Wright, Stephen E.; Watson, Gillian; Baker, Catherine; Stafford, Victoria; Wade, Clare; Chadwick, Thomas J.; Mansfield, Leigh; Wilkinson, Jennifer; Shen, Jing; Deverill, Mark; Bonner, Stephen; Hugill, Keith; Howard, Philip; Henderson, Andrea

    2015-01-01

    Introduction Patients discharged from Critical Care suffer from excessive longer term morbidity and mortality. Physical and mental health measures of quality of life show a marked and immediate fall after admission to Critical Care with some recovery over time. However, physical function is still significantly reduced at 6 months. The National Institute for Health and Care Excellence clinical guideline on rehabilitation after critical illness, identified the need for high-quality randomised c...

  1. Coping strategies of relatives when an adult next-of-kin is recovering at home following critical illness.

    Science.gov (United States)

    Johansson, Ingrid; Fridlund, Bengt; Hildingh, Cathrine

    2004-10-01

    The trend within the Swedish healthcare system is to reduce the duration of hospital care. This means that a patient who is discharged to their home after critical illness is highly likely to be functionally impaired, and therefore, requires care-giving assistance from a family member. The aim of this study was to generate a theoretical model with regard to relatives' coping when faced with the situation of having an adult next-of-kin recovering at home after critical illness. The design incorporated grounded theory methodology. Four coping strategies exhibiting different characteristics were identified: volunteering, accepting, modulating and sacrificing. Factors determining the choice of coping strategy were the physical and psychological status of the relative, previous experience of ICU-care and the psychological status of the patient. The theoretical model described in this article can contribute to expanding healthcare professionals' understanding of the coping strategies of relatives during recovery, but also provide inspiration for social action to be taken. PMID:15450617

  2. Nurses’ Burnout in Oncology Hospital Critical Care Unit

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    Yeliz İrem Tunçel

    2014-08-01

    Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.

  3. Professional stress and health among critical care nurses in Serbia.

    Science.gov (United States)

    Milutinović, Dragana; Golubović, Boris; Brkić, Nina; Prokeš, Bela

    2012-06-01

    The aim of this study was to identify and analyse professional stressors, evaluate the level of stress in nurses in Intensive Care Units (ICU), and assess the correlation between the perception of stress and psychological and somatic symptoms or diseases shown by nurses. The research, designed as a cross-sectional study, was carried out in the Intensive Care Units (ICU), in health centres in Serbia. The sample population encompassed 1000 nurses. Expanded Nursing Stress Scale (ENSS) was used as the research instrument. ENSS revealed a valid metric characteristic within our sample population. Nurses from ICUs rated situations involving physical and psychological working environments as the most stressful ones, whereas situations related to social working environment were described as less stressful; however, the differences in the perception of stressfulness of these environments were minor. Socio-demographic determinants of the participants (age, marital status and education level) significantly affected the perception of stress at work. Significant differences in the perception of stressfulness of particular stress factors were observed among nurses with respect to psychological and somatic symptoms (such as headache, insomnia, fatigue, despair, lower back pain, mood swings etc.) and certain diseases (such as hypertension, myocardial infarction, stroke, diabetes mellitus etc). In view of permanent escalation of professional stressors, creating a supportive working environment is essential for positive health outcomes, prevention of job-related diseases and better protection of already ill nurses. PMID:22728799

  4. Long-term mortality after critical care: what is the starting point?

    OpenAIRE

    Ranzani, Otavio T.; Zampieri, Fernando G.; Park, Marcelo; Salluh, Jorge IF

    2013-01-01

    Mortality is still the most assessed outcome in the critically ill patient and is routinely used as the primary end-point in intervention trials, cohort studies, and benchmarking analysis. Despite this, interest in patient-centered prognosis after ICU discharge is increasing, and several studies report quality of life and long-term outcomes after critical illness. In a recent issue of Critical Care, Cuthbertson and colleagues reported interesting results from a cohort of 439 patients with sep...

  5. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults

    OpenAIRE

    Hodgson, Carol L; Stiller, Kathy; Needham, Dale M.; Tipping, Claire J; Harrold, Megan; Baldwin, Claire E; Bradley, Scott; Berney, Sue; Caruana, Lawrence R; Elliott, Doug; Green, Margot; Haines, Kimberley; Higgins, Alisa M; Kaukonen, Kirsi-Maija; Leditschke, Isabel Anne

    2014-01-01

    Introduction The aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients. Methods A systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients. Results Safety considerations were summarized in four categories: respiratory, cardiovascular, neurological and other. Consensus ...

  6. Strategies of organization and service for the critical-care laboratory.

    Science.gov (United States)

    Fleisher, M; Schwartz, M K

    1990-08-01

    Critical-care medicine requires rapidity of treatment decisions and clinical management. To meet the objectives of critical-care medicine, the critical-care laboratory must consider four major aspects of laboratory organization in addition to analytical responsibilities: specimen collection and delivery, training of technologists, selection of reliable instrumentation, and efficient data dissemination. One must also consider the advantages and disadvantages of centralization vs decentralization, the influence of such a laboratory on patient care and personnel needs, and the space required for optimal operation. Centralization may lead to workflow interruption and increased turnaround time (TAT); decentralization requires redundancy of instrumentation and staff but may shorten TAT. Minimal TAT is the hallmark of efficient laboratory service. We surveyed 55 laboratories in 33 hospitals and found that virtually all hospitals with 200 or more beds had a critical-care laboratory operating as a satellite of the main laboratory. We present data on actual TAT, although these were available in only eight of the 15 routine laboratories that provided emergency service and in eight of the 40 critical-care laboratories. In meeting the challenges of an increasing workload, a reduced clinical laboratory work force, and the need to reduce TAT, changes in traditional laboratory practice are mandatory. An increased reliance on whole-blood analysis, for example, should eliminate delays associated with sample preparation, reduce the potential hazards associated with centrifugation, and eliminate excess specimen handling.

  7. Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Vi Am Dinh

    2015-01-01

    Full Text Available Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS, standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM fellows. Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows’ attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course. Results. There was a significant improvement in CCM fellows’ written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after the course. Conclusions. Implementation of a 2-day critical care ultrasound course covering general CCUS and basic critical care echocardiography using a combination of didactics, live models, and ultrasound simulators is effective in improving critical care fellows’ proficiency and confidence with ultrasound use in both the short- and long-term settings.

  8. Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study.

    Science.gov (United States)

    Dinh, Vi Am; Giri, Paresh C; Rathinavel, Inimai; Nguyen, Emilie; Hecht, David; Dorotta, Ihab; Nguyen, H Bryant; Chrissian, Ara A

    2015-01-01

    Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS), standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM) fellows. Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows' attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course. Results. There was a significant improvement in CCM fellows' written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after the course. Conclusions. Implementation of a 2-day critical care ultrasound course covering general CCUS and basic critical care echocardiography using a combination of didactics, live models, and ultrasound simulators is effective in improving critical care fellows' proficiency and confidence with ultrasound use in both the short- and long-term settings. PMID:26346694

  9. Measuring health-related quality of life in adults with chronic conditions in primary care settings

    Science.gov (United States)

    Hand, Carri

    2016-01-01

    Abstract Objective To describe health-related quality of life (HRQOL) conceptual frameworks, critically review 3 commonly used HRQOL scales relevant to adults with chronic conditions in primary care settings, and make recommendations for using HRQOL scales in primary care practice. Data sources Information was accessed regarding HRQOL conceptual and theoretical approaches. A comprehensive search strategy identified 3 commonly used scales that met the review criteria and evidence regarding use of the scales in adults with chronic conditions in community settings. Scale selection Scales were selected if they were designed for clinical use; were easy to administer; were generic and broad in content areas; and contained some individualized items. Scales were critiqued according to content development, theoretical basis, psychometric properties, scoring, feasibility, the concepts being measured, and the number of items that measured an individualized concept. Synthesis Early HRQOL approaches focused on health and functional status while recent approaches incorporate individualized concepts such as the person’s own values and the environment. The abbreviated World Health Organization Quality of Life Scale (WHOQOL-BREF), the 36-Item Short Form Health Survey (SF-36), and the Duke Health Profile were critiqued. All address physical, mental, and social domains, while the WHOQOL-BREF also addresses environment. Psychometric evidence supports use of the SF-36 and WHOQOL-BREF with this population. The SF-36 has the most evidence of responsiveness but has some floor and ceiling effects, while the WHOQOL-BREF does not appear to have floor or ceiling effects but has limited evidence of responsiveness. The WHOQOL-BREF has the highest proportion of individualized items. Conclusion Measurement of HRQOL in adults with chronic conditions can support patient management and contribute to primary care service evaluation. Scales that are based on a broad definition of health and that

  10. Nurse care assesment at the end of life in intensive critical units

    Directory of Open Access Journals (Sweden)

    Mª Cristina Pascual Fernández

    2013-11-01

    Full Text Available To die nowadays is not the critical instant of our existence in occidental societies. Technological and scientific advances in health sciences have not been developed equally company and humanization in care. Nurses play an important and responsible role at end of life care, to provide patients and their families comfort cares in dying process. The main objective was to describe and analyze the professionals’ cares in Intensive Care Unit at the end of life process. An observational study was developed and 472 surveys to critical care nurses of six high complexity hospitals of Madrid Community were made. The questionnaire on the evaluation from the cares to the children that die in Pediatrics Intensive Care was applied. We have obtained that nurses said that most of the families remained with their patient in the moment of the death and needed support and empathy from the staff. As a conclusion we could say that the cares to the patients in Intensive Care Unit should be improved.

  11. Ultrasound for critical care physicians: complication of a distant malignancy

    Directory of Open Access Journals (Sweden)

    Sante SC

    2016-07-01

    Full Text Available No abstract available. Article truncated after first page. An 82-year-old woman with prior medical history of stage IV colon cancer and chronic obstructive pulmonary disease presented to the medical intensive care unit with newly diagnosed community acquired pneumonia and acute kidney injury. The patient presented with acute onset of shortness of breath, nausea, generalized weakness, bilateral lower extremity swelling and decreased urine output. She was transferred for short term dialysis in the setting of multiple electrolyte abnormalities, including hyperkalemia of 6.4 mmol/l, as well as a creatinine of 6.5 mg/dl. The following imaging of the right internal jugular vein was performed with ultrasound during preparation for placement of a temporary triple lumen hemodialysis catheter. Based on the above imaging what would be the best location to place the dialysis catheter? 1. Left internal jugular vein; 2. Right femoral vein; 3. Right internal jugular vein; 4. Right subclavian vein. ...

  12. Ultrasound for critical care physicians: shortness of breath

    Directory of Open Access Journals (Sweden)

    Douglas MJK

    2015-09-01

    Full Text Available Abstract not available. Article truncated after first page. An 85 year old woman with a history of congestive heart failure and diabetes presented to the emergency department with progressive shortness of breath. She had recently been discharged from another hospital where she had been admitted for several days for community acquired pneumonia. The patient was in respiratory distress on arrival with tachypnea, increased work of breathing, and hypoxia despite supplemental oxygen with a non-rebreather mask and she was subsequently intubated. ED point-of-care ultrasound was performed of the right hemithorax. What does Figure 1 demonstrate? 1. Intravascular volume depletion; 2. Normal lung aeration; 3. Numerous B-lines; 4. Pleural effusion and consolidation; 5. Pneumothorax.

  13. Technology and the lifeworld of critical care nursing.

    Science.gov (United States)

    Walters, A J

    1995-08-01

    Traditionally, nursing scholars have concerned themselves with philosophies of science. This perspective reflects the Platonic dominance of theory over practice. The consequence of this view is that technology is conceived as an applied science. Furthermore, technology is considered as a neutral instrument of science. The primacy of theory was challenged by the philosopher Martin Heidegger, who argued that the correct relationship between these two concepts was a technology-science one. This reconceptualization suggests that practice precedes theory. This paper examines the developing body of literature concerning the philosophy of technology. Specifically, the philosophies of Martin Heidegger, Don Ihde, Albert Borgmann and Langdon Winner are explored from a nursing perspective, and how they may offer nursing a way of conceptualizing the ever expanding technological environment of the intensive care unit is discussed. PMID:7593956

  14. Bridging the Gap between Human Resource Development and Adult Education: Part Two, the Critical Turn

    Science.gov (United States)

    Hatcher, Tim; Bowles, Tuere

    2014-01-01

    Human resource development (HRD) as a scholarly endeavor and as a practice is often criticized in the adult education (AE) literature and by AE scholars as manipulative and oppressive and, through training and other interventions, controlling workers for strictly economic ends (Baptiste, 2001; Cunningham, 2004; Schied, 2001; Welton, 1995). The…

  15. Editorial Commentary: Arthroscopic Hip Preservation Is Critical for Preserving Health and Function in Adolescents and Adults.

    Science.gov (United States)

    Martin, Hal David

    2016-09-01

    Hip health is a critical factor in preserving daily life activities and wellbeing for both adults and adolescents. There are several potential economic influences in developing arthroscopic hip techniques for the evaluation and treatment of hip pathology in patients of all ages. PMID:27594331

  16. Workforce Readiness: Changes in Critical Thinking Skills of Adult Learners in an Accelerated Undergraduate Degree Program

    Science.gov (United States)

    Slemp, Kathleen N.

    2012-01-01

    This mixed-method case study explored the change in critical thinking skills over the span of the adult student's accelerated lock-step cohort experience pursuing an organizational management and leadership degree completion program at a liberal arts institution in the Midwest. Three areas of research informed this study: workforce readiness,…

  17. "Media Mediators": Advocating an Alternate Paradigm for Critical Adult Education ICT Policy

    Science.gov (United States)

    Remtulla, Karim A.

    2010-01-01

    This article explores the efficacy of current education program approaches to prepare instructors to achieve critical thinking and active learning from their students by integrating ICTs with traditional adult education practices. An argument is put forward that the increasing presence and influence of ICTs in education necessitates a paradigmatic…

  18. Ultrasound for critical care physicians: a tempting dilemma

    Directory of Open Access Journals (Sweden)

    Marzouk I

    2014-09-01

    Full Text Available No abstract available. Article truncated after 150 words. A 46 year old woman presented with progressive severe hypoxemia and a chronic appearing pulmonary embolus on chest CT angiogram to the intensive care unit. The patient was hemodynamically stable, but had an oxygen saturation of 86% on a high-flow 100% oxygen mask. The patient had been previously investigated for interstitial lung disease over the past 2 year, this was felt to be due to non-specific interstitial pneumonitis. Her echocardiogram findings are as presented below (Figures 1 and 2. The patient had refractory hypoxemia despite trials of high flow oxygen and non-invasive positive pressure ventilation. She had mild symptoms at rest but experienced severe activity intolerance secondary to exertional dyspnea. Vitals including blood pressure remained stable and normal during admission and the patient had a pulsus paradoxus measurement of < 10 mmHg. She had previously had an echocardiogram 6 months before that revealed significant pulmonary hypertension. What would be the ...

  19. August 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Deangelis JL

    2016-08-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: The patient is a previously healthy, albeit anxious, 15-year-old girl seen by her primary care physician. She has had several months of general malaise and ongoing fatigue and an increased frequency in night terrors over the past few weeks. Her family attributes this to stress of school and her new job. She was noted to have lost 3 kg in the previous nine weeks. PMH, SH, and FH: Her PMH was unremarkable. She is a student and denies smoking, drinking or drug abuse. Her family history is noncontributory. Physical Examination: Vital signs: BP 100/60 mm Hg, P 90 beats/min and regular, R 16 breaths/min, T 100.8 ºF, BMI 15; Diffuse, non-tender lymphadenopathy through the submandibular and upper anterior cervical chains; Lungs: clear; Heart: regular rhythm without murmur: Abdomen: slightly rounded and firm. Which of the following are diagnostic considerations at this time? 1. Anorexia nervosa 2. ...

  20. Management of Acute Pancreatitis in Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Güniz Meyancı Köksal

    2010-12-01

    Full Text Available Pancreatitis is characterized by an inflammation occuring due to digestion of pancreatic self tissues and other organs after activation of digestive enzymes which are stable under normal conditions . For all the pancreatitis cases, the mortality rate is <%15. In the acute pancreatitis cases, the monitorization of the inspiration system, cardiovascular system and the metabolic status are needed. There is no primary therapy for the pancreatitis. All the therapy protocols are support therapy. The basic support therapy methods are: Liquid replacement, respiration support, pain management, pancreas secretion inhibition, metabolic support, intra-abdominal monitoring and decompression, nutrition, antibiotherapy, immunomodulation, coagulation mechanism monitoring. In the acute pancreatitis, the causes of early deaths are pancreatic shock and acute pulmonary thrombohemorrhage, within the first 7 days the causes of the 75% deaths are pulmonary shock and congestion and after 7 days the causes of the 77% are pancreas abscess, MOF (multiple organ failure, purulent peritonitis and erosive hemorrhage. (Journal of the Turkish Society of Intensive Care 2010; 8: 85-9

  1. Care of critically ill newborns in India. Legal and ethical issues.

    Science.gov (United States)

    Subramanian, K N; Paul, V K

    1995-06-01

    The nature of neonatal care in India is changing. While the quality of care will most likely improve as the economy grows, the eventual scope of change remains to be seen. Attitudinal and behavioral changes, in addition to better economic conditions, are needed to realize more appropriate interventions in neonatal care. Economic, cultural, religious, social, political, and other considerations may limit or affect neonatal care, especially for ELBW infants or infants with congenital malformations or brain injury. Various protections for critically ill newborns exist under Indian law and the Constitution of India. New laws are being enacted to enhance the level of protection conferred, including laws which ban amniocentesis for sex determination and define brain death in connection with the use of human organs for therapeutic purposes. The applicability of consumer protection laws to medical care is also being addressed. It is noted, however, that India lacks a multidisciplinary bioethics committee. An effort should be made to discuss the legal and ethical issues regarding the care of critically ill newborns, with discussions considering religious, cultural, traditional, and family values. Legal and ethical guidelines should be developed by institutions, medical councils, and society specific to newborn care, and medical, nursing, and other paramedical schools should include these issues as part of the required coursework. Physicians, nurses, philosophers, and attorneys with expertise in law and ethics should develop and teach these courses. Such measures over the long term will ensure that future health care providers are exposed to these issues, ideally with a view toward enhancing patient care.

  2. Modernisation as a professionalising strategy: the case of critical care in England.

    Science.gov (United States)

    Green, Judith; Durand, Mary Alison; Hutchings, Andrew; Black, Nick

    2011-09-01

    There has been broad agreement about how to characterise the processes of 'modernisation' of the public sector in welfare societies, but rather less consensus on the impact of this modernisation on professionals. This paper takes critical care in England as a case study to explore how professionals in one setting account for the changes associated with modernisation. In contrast to reports from other arenas, critical care professionals were positive about the processes and outcomes of 'modernisation' in general, and there was a surprising lack of nostalgia in their accounts of organisational changes. However, joking comments suggested considerable scepticism about the initiatives explicitly associated with the national organisation that was charged with 'modernising' critical care, the Modernisation Agency. We suggest that the relative optimism of staff is in part explained by historical and political contingencies which meant that critical care, as a relatively new clinical specialty, benefited in tangible ways from modernisation. Further, all staff groups were able to attribute gains, rather than losses, in autonomy and authority to the modernisation of critical care. Their accounts suggest that modernisation can be a professionalising strategy, with responses to change being neither resistant nor compliant, but sceptically strategic. PMID:21314690

  3. Modernisation as a professionalising strategy: the case of critical care in England.

    Science.gov (United States)

    Green, Judith; Durand, Mary Alison; Hutchings, Andrew; Black, Nick

    2011-09-01

    There has been broad agreement about how to characterise the processes of 'modernisation' of the public sector in welfare societies, but rather less consensus on the impact of this modernisation on professionals. This paper takes critical care in England as a case study to explore how professionals in one setting account for the changes associated with modernisation. In contrast to reports from other arenas, critical care professionals were positive about the processes and outcomes of 'modernisation' in general, and there was a surprising lack of nostalgia in their accounts of organisational changes. However, joking comments suggested considerable scepticism about the initiatives explicitly associated with the national organisation that was charged with 'modernising' critical care, the Modernisation Agency. We suggest that the relative optimism of staff is in part explained by historical and political contingencies which meant that critical care, as a relatively new clinical specialty, benefited in tangible ways from modernisation. Further, all staff groups were able to attribute gains, rather than losses, in autonomy and authority to the modernisation of critical care. Their accounts suggest that modernisation can be a professionalising strategy, with responses to change being neither resistant nor compliant, but sceptically strategic.

  4. Fatigue in Family Caregivers of Adult Intensive Care Unit Survivors

    Science.gov (United States)

    Choi, JiYeon; Tate, Judith A.; Hoffman, Leslie A.; Schulz, Richard; Ren, Dianxu; Donahoe, Michael P.; Given, Barbara A.; Sherwood, Paula R.

    2014-01-01

    Context Family caregivers are a vital resource in the recovery of intensive care unit (ICU) survivors. Of concern, the stress associated with this role can negatively affect caregiver health. Fatigue, an important health indicator, has been identified as a predictor of various illnesses, greater use of health services, and early mortality. Examining the impact of fatigue on caregivers’ physical health can assist in identifying critical time points and potential targets for intervention. Objectives To describe self-reported fatigue in caregivers of ICU survivors from patients’ ICU admission to ≤ two weeks, two- and four-months post-ICU discharge. Methods Patient-caregiver pairs were enrolled from a medical ICU. Caregiver fatigue was measured using the Short-Form-36 Health Survey Vitality subscale (SF-36 Vitality). Caregiver psychobehavioral stress responses included depressive symptoms, burden, health risk behaviors, and sleep quality. Patient data included self-reported physical symptoms and disposition (home vs. institution). Results Forty seven patient-caregiver pairs were initially enrolled. Clinically significant fatigue (SF-36 Vitality ≤ 45) was reported by 43% to 53% of caregivers across the time points and these caregivers reported worse scores in measures of depressive symptoms, burden, health risk behaviors and sleep quality, and patients’ symptom burden. In 26 caregivers with data for all time points (55% of the total sample), SF-36 Vitality scores showed trends of improvement when the patient returned home and greater impairment when institutionalization continued. Conclusion In caregivers of ICU survivors, fatigue is common and potentially linked with poor psychobehavioral responses. Worsening fatigue was associated with greater symptom distress and long-term patient institutionalization. PMID:24439845

  5. Is older adult care mediated by caregivers’ cultural stereotypes? The role of competence and warmth attribution

    Science.gov (United States)

    Fernández-Ballesteros, Rocío; Bustillos, Antonio; Santacreu, Marta; Schettini, Rocio; Díaz-Veiga, Pura; Huici, Carmen

    2016-01-01

    Purpose The purpose of this study is to examine, from the stereotype content model (SCM) perspective, the role of the competence and warmth stereotypes of older adults held by professional caregivers. Methods A quasi-experimental design, ex post facto with observational analyses, was used in this study. The cultural view on competence and warmth was assessed in 100 caregivers working in a set of six residential geriatric care units (three of them organized following a person-centered care approach and the other three providing standard geriatric care). In order to assess caregivers’ cultural stereotypical views, the SCM questionnaire was administered. To evaluate the role of caregivers’ cultural stereotypes in their professional performance as well as in older adult functioning, two observational scales from the Sistema de Evaluación de Residencias de Ancianos (assessment system for older adults residences)-RS (staff functioning and residents’ functioning) were applied. Results Caregivers’ cultural views of older adults (compared to young people) are characterized by low competence and high warmth, replicating the data obtained elsewhere from the SCM. Most importantly, the person-centered units predict better staff performance and better resident functioning than standard units. Moreover, cultural stereotyping of older adult competence moderates the effects of staff performance on resident functioning, in line with the findings of previous research. Conclusion Our results underline the influence of caregivers’ cultural stereotypes on the type of care, as well as on their professional behaviors and on older adult functioning. Caregivers’ cultural stereotypes could be considered as a central issue in older adult care since they mediate the triangle of care: caregivers/older adults/type of care; therefore, much more attention should be paid to this psychosocial care component. PMID:27217736

  6. In Sickness and in Health: Health Care Experiences of Korean Immigrant Older Adults

    OpenAIRE

    Juhn, Erica

    2012-01-01

    The purpose of this study was to document the health care experiences of Korean immigrant older adults, 65 years of age or older, living in Los Angeles County, who have health care access through Medicare and/or Medi-Cal, access to a large Korean ethnic enclave, and a diverse social support network. Twelve Korean immigrant older adults were recruited through word-of-mouth via community contacts. Semi-structured qualitative interviews were conducted with individual seniors, with the help of ...

  7. Use of and interest in alternative therapies among adult primary care clinicians and adult members in a large health maintenance organization.

    Science.gov (United States)

    Gordon, N P; Sobel, D S; Tarazona, E Z

    1998-09-01

    During spring 1996, random samples of adult primary care physicians, obstetrics-gynecology physicians and nurse practitioners, and adult members of a large northern California group practice model health maintenance organization (HMO) were surveyed by mail to assess the use of alternative therapies and the extent of interest in having them incorporated into HMO-delivered care. Sixty-one percent (n = 624) of adult primary care physicians, 70% (n = 157) of obstetrics-gynecology clinicians, and 50% (2 surveys, n = 1,507 and n = 17,735) of adult HMO members responded. During the previous 12 months, 25% of adults reported using and nearly 90% of adult primary care physicians and obstetrics-gynecology clinicians reported recommending at least 1 alternative therapy, primarily for pain management. Chiropractic, acupuncture, massage, and behavioral medicine techniques such as meditation and relaxation training were most often cited. Obstetrics-gynecology clinicians used herbal and homeopathic medicines more often than adult primary care physicians, primarily for menopause and premenstrual syndrome. Two thirds of adult primary care physicians and three fourths of obstetrics-gynecology clinicians were at least moderately interested in using alternative therapies with patients, and nearly 70% of young and middle-aged adult and half of senior adult members were interested in having alternative therapies incorporated into their health care. Adult primary care physicians and members were more interested in having the HMO cover manipulative and behavioral medicine therapies than homeopathic or herbal medicines. PMID:9771154

  8. Challenges to the provision of emergency services and critical care in resource-constrained settings.

    Science.gov (United States)

    Stafford, Renae E; Morrison, Catherine A; Godfrey, Godwin; Mahalu, William

    2014-09-01

    The practice of intensive care unit (ICU) care in Sub-Saharan Africa is challenging and can have a significant impact on the lives of people in the region. Sub-Saharan Africa bears a disproportionate global burden of disease compared with the rest of the world. Inadequate emergency care services and transportation infrastructure; long lead times to hospital admission, evaluation, treatment and transfer to ICU; inadequate ICU and hospital infrastructure and, unreliable consumable and medical equipment supply chains all present significant challenges to the provision of ICU care in Sub-Saharan Africa. These challenges, coupled with an inadequate supply of trained healthcare workers and biomedical technicians and a lack of formal ICU-related research in Sub-Saharan Africa, would seem to be insurmountable. However, ICU care is being provided in district and regional hospitals throughout the region. We describe some of the challenges to the provision of emergency services and critical care in Tanzania. PMID:25667183

  9. The Perceived Needs and Availability of Eye Care Services for Older Adults in Long-term Care Facilities

    Science.gov (United States)

    Kergoat, Hélène; Boisjoly, Hélène; Freeman, Ellen E.; Monette, Johanne; Roy, Sylvie; Kergoat, Marie-Jeanne

    2014-01-01

    Background The objective was to evaluate the eye care services offered to older residents living in long-term care facilities (LTCFs). Methods A questionnaire targeting residents aged ≥65 years was sent to all LTCFs in Quebec. Questions related to the institution’s characteristics, demographic data related to residents, oculovisual health of residents and barriers to eye care, eye care services offered within and outside the institution, and degree of satisfaction regarding the eye care services offered to residents. Results 196/428 (45.8%) LTCFs completed the questionnaire. Participating LTCFs had an average of 97.0 ± 5.1 residents with a mean age of 82.8 ± 3.0 yrs and 69% women. Eye care services were mostly offered outside the institution, on a “per request” basis. The main barriers to eye care were the perception that residents could not cooperate and the lack of eye care professionals. Most LTCFs were satisfied with the eye care services offered to residents. Conclusions The fact that the LTCFs were satisfied with the eye care services offered to their residents, although it was neither provided on a regular basis nor to all residents, suggests that eye care professionals should take a proactive educational role for improving services to older institutionalized adults. PMID:25232370

  10. Nurses' Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai.

    Directory of Open Access Journals (Sweden)

    Ying Wang

    Full Text Available To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses' job satisfaction.China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses' working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses' job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area.A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests.The average overall IWS (part B score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494.Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved.

  11. Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death.

    OpenAIRE

    Peter Hodkinson; Andrew Argent; Lee Wallis; Steve Reid; Rafael Perera; Sian Harrison; Matthew Thompson; Mike English; Ian Maconochie; Alison Ward

    2016-01-01

    Purpose Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. Methods A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency dep...

  12. Quality Outcomes in Group Home Dementia Care for Adults with Intellectual Disabilities

    Science.gov (United States)

    Janicki, M. P.

    2011-01-01

    Background: Dementia, as a public health challenge, is a phenomenon vexing many care organisations providing specialised residential and family supports for older adults with intellectual disabilities. With increasing survivorship to ages when risk is greatest, expectations are that many more adults in service will present with cognitive decline…

  13. Making Work Fit Care: Reconciliation Strategies Used by Working Mothers of Adults with Intellectual Disabilities

    Science.gov (United States)

    Chou, Yueh-Ching; Fu, Li-yeh; Chang, Heng-Hao

    2013-01-01

    Background: This study explored the experiences of working mothers with an adult child with intellectual disabilities to understand how they reconcile paid work and care responsibilities. Methods: Fifteen working mothers in Taiwan with an adult child with intellectual disabilities were interviewed, and an interpretative phenomenological approach…

  14. Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods.

    Science.gov (United States)

    Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck

    2015-04-01

    This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

  15. The influence of gender on conflicts of interest in the allocation of limited critical care resources: justice versus care.

    Science.gov (United States)

    Self, D J; Olivarez, M

    1993-03-01

    After noting that the principle of autonomy has been inadequate for the resolution of many of the complex and difficult moral dilemmas involving conflicts of interest in the allocation of limited critical care resources, this paper analyzes the concepts of justice and care as alternative solutions to moral problems and applies them to the issue of repeat organ transplants to a single recipient. These concepts are found to be the basis of the notions of moral reasoning and moral orientation, respectively, which serve in moral development theory as two fundamentally different ways to approach moral problem solving. Following an elaboration of moral reasoning as found in Kohlberg's cognitive moral development theory, the influence of gender on moral reasoning is investigated. The empirical data show that women (mean Defining Issues Test score, 47.18) score significantly higher (P justice for resolving moral dilemmas. Following an elaboration of moral orientation as found in Gilligan's moral theory of the ethics of care, the influence of gender on moral orientation is investigated. The empirical data show that women use the concept of care significantly more often (P justice in the resolution of moral dilemmas, such as the conflicts of interest in the allocation of limited critical care resources, but that if women do use, or are required by the social system to use, justice in the resolution of moral dilemmas, they do a better job of it than men.

  16. Volatile Anesthetics. Is a New Player Emerging in Critical Care Sedation?

    Science.gov (United States)

    Jerath, Angela; Parotto, Matteo; Wasowicz, Marcin; Ferguson, Niall D

    2016-06-01

    Volatile anesthetic agent use in the intensive care unit, aided by technological advances, has become more accessible to critical care physicians. With increasing concern over adverse patient consequences associated with our current sedation practice, there is growing interest to find non-benzodiazepine-based alternative sedatives. Research has demonstrated that volatile-based sedation may provide superior awakening and extubation times in comparison with current intravenous sedation agents (propofol and benzodiazepines). Volatile agents may possess important end-organ protective properties mediated via cytoprotective and antiinflammatory mechanisms. However, like all sedatives, volatile agents are capable of deeply sedating patients, which can have respiratory depressant effects and reduce patient mobility. This review seeks to critically appraise current volatile use in critical care medicine including current research, technical consideration of their use, contraindications, areas of controversy, and proposed future research topics. PMID:27002466

  17. Cardiac critical care in resource-limited environments: lessons from Tanzania.

    Science.gov (United States)

    Chillo, Pilly; Humphrey, Stephen H; Meda, John; Kerry, Vanessa B

    2014-09-01

    The concept of cardiac critical care is emerging as a tool in the management of cardiovascular diseases in many Sub-Saharan African countries. The region is undergoing significant epidemiological transition. There remains a significant burden of infectious and nutritional disease, but cardiovascular disease, notably hypertension and coronary artery disease, as well as other noncommunicable diseases (NCD) are emerging rapidly, placing a double burden on existing healthcare systems. Within this complex, heterogeneous, and changing epidemiologic setting, efforts to diagnose and treat cardiovascular diseases have increased. As more patients are diagnosed with acute cardiac conditions, the number requiring management in a cardiac critical care unit is also increasing. In this review, using the Tanzanian experience, we attempt to chronicle the appearance of cardiac critical care services and the many challenges to their implementation in a resource-limited environment. PMID:25667182

  18. Volatile Anesthetics. Is a New Player Emerging in Critical Care Sedation?

    Science.gov (United States)

    Jerath, Angela; Parotto, Matteo; Wasowicz, Marcin; Ferguson, Niall D

    2016-06-01

    Volatile anesthetic agent use in the intensive care unit, aided by technological advances, has become more accessible to critical care physicians. With increasing concern over adverse patient consequences associated with our current sedation practice, there is growing interest to find non-benzodiazepine-based alternative sedatives. Research has demonstrated that volatile-based sedation may provide superior awakening and extubation times in comparison with current intravenous sedation agents (propofol and benzodiazepines). Volatile agents may possess important end-organ protective properties mediated via cytoprotective and antiinflammatory mechanisms. However, like all sedatives, volatile agents are capable of deeply sedating patients, which can have respiratory depressant effects and reduce patient mobility. This review seeks to critically appraise current volatile use in critical care medicine including current research, technical consideration of their use, contraindications, areas of controversy, and proposed future research topics.

  19. Severe imported falciparum malaria: a cohort study in 400 critically ill adults.

    Directory of Open Access Journals (Sweden)

    Fabrice Bruneel

    Full Text Available BACKGROUND: Large studies on severe imported malaria in non-endemic industrialized countries are lacking. We sought to describe the clinical spectrum of severe imported malaria in French adults and to identify risk factors for mortality at admission to the intensive care unit. METHODOLOGY AND PRINCIPAL FINDINGS: Retrospective review of severe Plasmodium falciparum malaria episodes according to the 2000 World Health Organization definition and requiring admission to the intensive care unit. Data were collected from medical charts using standardised case-report forms, in 45 French intensive care units in 2000-2006. Risk factors for in-hospital mortality were identified by univariate and multivariate analyses. Data from 400 adults admitted to the intensive care unit were analysed, representing the largest series of severe imported malaria to date. Median age was 45 years; 60% of patients were white, 96% acquired the disease in sub-Saharan Africa, and 65% had not taken antimalarial chemoprophylaxis. Curative quinine treatment was used in 97% of patients. Intensive care unit mortality was 10.5% (42 deaths. By multivariate analysis, three variables at intensive care unit admission were independently associated with hospital death: older age (per 10-year increment, odds ratio [OR], 1.72; 95% confidence interval [95%CI], 1.28-2.32; P = 0.0004, Glasgow Coma Scale score (per 1-point decrease, OR, 1.32; 95%CI, 1.20-1.45; P<0.0001, and higher parasitemia (per 5% increment, OR, 1.41; 95%CI, 1.22-1.62; P<0.0001. CONCLUSIONS AND SIGNIFICANCE: In a large population of adults treated in a non-endemic industrialized country, severe malaria still carried a high mortality rate. Our data, including predictors of death, can probably be generalized to other non-endemic countries where high-quality healthcare is available.

  20. Telemedicine: an enhanced emergency care program for older adults

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2014-07-01

    Full Text Available Paul Y Takahashi,1 Anupam Chandra,1 Frederick North,1 Jennifer L Pecina,2 Benjavan Upatising,3 Gregory J Hanson11Mayo Clinic Division of Primary Care Internal Medicine, 2Mayo Clinic Department of Family Medicine, Rochester, MN, USA; 3Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USAAbstract: Recent changes and consolidations in health care systems have resulted in an increase in new health care delivery models. Telemedicine holds great promise as one of these models. There is a great potential for new patient evaluation and treatment models in emergency care (EC, especially when patients are miles away from a medical team. Evaluations can be performed in a patient's home, a nursing care facility, and in hospitals that focus on advanced subspecialty care. Due to rapid developments in this area, current care models are constantly being evaluated and modified. This review article outlines current telemedicine models for EC and summarizes their potential benefits to patients and the health care system. The review examines the role that the telephone, a fundamental tool of telemedicine, plays in these new models. The review also examines evidence of improved health care outcomes by highlighting the role of telemedicine in reducing hospitalizations. The patient is the primary focus; as a result, this review also examined patient experiences and satisfaction levels regarding telemedicine health care teams. The authors support these technological advances and their potential for information transfer. Health care providers need to continue developing these models by making use of increasing amounts of information. One of the main implementation barriers of these new models in the US and other countries is the issue of payment and reimbursement. Despite this, advancements in EC telemedicine continue.Keywords: telemedicine, emergency care, geriatric, patient evaluation models

  1. Identifying Care Coordination Interventions Provided to Community-Dwelling Older Adults Using Electronic Health Records.

    Science.gov (United States)

    Kim, Tae Youn; Marek, Karen D; Coenen, Amy

    2016-07-01

    Although care coordination is a popular intervention, there is no standard method of delivery. Also little is known about who benefits most, or characteristics that predict the amount of care coordination needed, especially with chronically ill older adults. The purpose of this study was to identify types and amount of nurse care coordination interventions provided to 231 chronically ill older adults who participated in a 12-month home care medication management program in the Midwest. For each participant, the nurse care coordinator spent an average of 134 min/mo providing in-person home care, 48 min/mo of travel, and 18 min/mo of indirect care occurring outside the home visit. This accounted for 67.2%, 23.8%, and 9.0% of nursing time, respectively, for home visits, travel, and indirect care. Four of 11 nursing interventions focused on medication management were provided to all participants. Seven of the 11 main interventions were individualized according to each person's special needs. Wide variations were observed in time provided with in-person home care and communications with multiple stakeholders. Study findings indicate the importance of individualizing interventions and the variability in the amount of nursing time needed to provide care coordination to chronically ill older adults.

  2. Identifying Care Coordination Interventions Provided to Community-Dwelling Older Adults Using Electronic Health Records.

    Science.gov (United States)

    Kim, Tae Youn; Marek, Karen D; Coenen, Amy

    2016-07-01

    Although care coordination is a popular intervention, there is no standard method of delivery. Also little is known about who benefits most, or characteristics that predict the amount of care coordination needed, especially with chronically ill older adults. The purpose of this study was to identify types and amount of nurse care coordination interventions provided to 231 chronically ill older adults who participated in a 12-month home care medication management program in the Midwest. For each participant, the nurse care coordinator spent an average of 134 min/mo providing in-person home care, 48 min/mo of travel, and 18 min/mo of indirect care occurring outside the home visit. This accounted for 67.2%, 23.8%, and 9.0% of nursing time, respectively, for home visits, travel, and indirect care. Four of 11 nursing interventions focused on medication management were provided to all participants. Seven of the 11 main interventions were individualized according to each person's special needs. Wide variations were observed in time provided with in-person home care and communications with multiple stakeholders. Study findings indicate the importance of individualizing interventions and the variability in the amount of nursing time needed to provide care coordination to chronically ill older adults. PMID:26985762

  3. Individual and contextual-level factors associated with continuity of care for adults with schizophrenia.

    Science.gov (United States)

    Fontanella, Cynthia A; Guada, Joseph; Phillips, Gary; Ranbom, Lorin; Fortney, John C

    2014-09-01

    This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18-64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care.

  4. Fostering critical thinking skills: a strategy for enhancing evidence based wellness care

    OpenAIRE

    Jamison Jennifer R

    2005-01-01

    Abstract Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of "wellness coaches". Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of inter...

  5. Relationship of anxiety and burnout with extrasystoles in critical care nurses in Turkey

    OpenAIRE

    Denat, Yildiz; Gokce, Serap; Gungor, Hasan; Zencir, Cemil; AKGULLU, Cagdas

    2016-01-01

    Objective: To determine the relationship between levels of anxiety and burnout and prevalence of atrial extrasystoles (AESs) and ventricular extrasystoles (VESs) among critical care nurses. Methods: The sample of study included 51 nurses who worked in the intensive care units of a university hospital located in western Turkey. Beck’s Anxiety Inventory and the Maslach Burnout Inventory were used in the study. Results: The mean emotional exhaustion score of the nurses was 14.68±6.10, the mean p...

  6. Mead Johnson Critical Care Symposium for the Practising Surgeon. 4. Abdominal crisis in the intensive care unit.

    Science.gov (United States)

    Gregor, P; Prodger, J D

    1988-09-01

    Abdominal crises are common in critically ill patients who are admitted to the intensive care unit for problems unrelated to the abdomen. General surgeons may be asked to assess these patients for such reasons as pain, distension, possible sepsis, radiologic or laboratory abnormalities. Since many of the diagnostic signs and symptoms of acute abdomen are blunted or absent in critically ill patients who may be comatose or have been given analgesics or steroids, frequent thorough physical examination and close cooperation with the service admitting the patient are necessary to ensure early diagnosis and aggressive treatment of the abdominal crisis. PMID:3046730

  7. Continued transmission of Pseudomonas aeruginosa from a wash hand basin tap in a critical care unit.

    Science.gov (United States)

    Garvey, M I; Bradley, C W; Tracey, J; Oppenheim, B

    2016-09-01

    Pseudomonas aeruginosa is an important nosocomial pathogen, colonizing hospital water supplies including taps and sinks. We report a cluster of P. aeruginosa acquisitions during a period of five months from tap water to patients occupying the same burns single room in a critical care unit. Pseudomonas aeruginosa cultured from clinical isolates from four different patients was indistinguishable from water strains by pulsed-field gel electrophoresis. Water outlets in critical care may be a source of P. aeruginosa despite following the national guidance, and updated guidance and improved control measures are needed to reduce the risks of transmission to patients. PMID:27249962

  8. Critical interactionism: an upstream-downstream approach to health care reform.

    Science.gov (United States)

    Martins, Diane Cocozza; Burbank, Patricia M

    2011-01-01

    Currently, per capita health care expenditures in the United States are more than 20% higher than any other country in the world and more than twice the average expenditure for European countries, yet the United States ranks 37th in life expectancy. Clearly, the health care system is not succeeding in improving the health of the US population with its focus on illness care for individuals. A new theoretical approach, critical interactionism, combines symbolic interactionism and critical social theory to provide a guide for addressing health care problems from both an upstream and downstream approach. Concepts of meaning from symbolic interactionism and emancipation from critical perspective move across system levels to inform and reform health care for individuals, organizations, and societies. This provides a powerful approach for health care reform, moving back and forth between the micro and macro levels. Areas of application to nursing practice with several examples (patients with obesity; patients who are lesbian, gay, bisexual, and transgender; workplace bullying and errors), nursing education, and research are also discussed. PMID:22067231

  9. Critical appraisal skills training for health care professionals: a randomized controlled trial [ISRCTN46272378

    OpenAIRE

    Ewings Paul E; Reeves Barnaby C; Taylor Rod S; Taylor Rebecca J

    2004-01-01

    Abstract Introduction Critical appraisal skills are believed to play a central role in an evidence-based approach to health practice. The aim of this study was to evaluate the effectiveness and costs of a critical appraisal skills educational intervention aimed at health care professionals. Methods This prospective controlled trial randomized 145 self-selected general practitioners, hospital physicians, professions allied to medicine, and healthcare managers/administrators from the South West...

  10. International recommendations on competency in critical care ultrasound: pertinence to Australia and New Zealand.

    Science.gov (United States)

    McLean, Anthony S

    2011-03-01

    The use of echocardiography and other applications of ultrasound in the management of critically ill patients is becoming mainstream. With increased accessibility to equipment, the main challenges are in providing training and drawing up an outline of what levels of competency should be achieved. An international body of experienced critical care physician sonographers has reached consensus on guidelines in training and on two levels of competency - basic and advanced. Formal structures to aid the physician have been developed in Australia and New Zealand.

  11. The Influence of Adult Attachment on Patient Self-Management in Primary Care - The Need for a Personalized Approach and Patient-Centred Care

    OpenAIRE

    Katja Brenk-Franz; Bernhard Strauss; Fabian Tiesler; Christian Fleischhauer; Paul Ciechanowski; Nico Schneider; Jochen Gensichen

    2015-01-01

    Objective Self-management strategies are essential elements of evidence-based treatment in patients with chronic conditions in primary care. Our objective was to analyse different self-management skills and behaviours and their association to adult attachment in primary care patients with multiple chronic conditions. Methods In the apricare study (Adult Attachment in Primary Care) we used a prospective longitudinal design to examine the association between adult attachment and self-management...

  12. Primary Care of Adult Women: Common Dermatologic Conditions.

    Science.gov (United States)

    Ruiz de Luzuriaga, Arlene M; Mhlaba, Julie; Roman, Carly

    2016-06-01

    Dermatologic disease often presents in the primary care setting. Therefore, it is important for the primary care provider to be familiar with the presentation, diagnosis, and treatment of common skin conditions. This article provides an overview of acne, rosacea, melasma, vitiligo, alopecia, nonmelanoma, and melanoma skin cancer, dermatitis, and lichen sclerosus. PMID:27212088

  13. Psychiatric Nursing Care for Adult Survivors of Child

    NARCIS (Netherlands)

    Zalm, Yvonne van der; Nugteren, Willem; Hafsteinsdóttir, Thóra van der; Venne, Cokky van der; Kool, Nienke; Meijel, Berno van

    2014-01-01

    PURPOSE: To determine what is known from the literature about nursing care of psychiatric patients with a history of child maltreatment. CONCLUSIONS: Psychiatric nurses underline the importance of a routine inquiry of child abuse on admission of patients to psychiatric care, but are reluctant to as

  14. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2013-07-26

    ... June 30, 2013, on July 24, 2012, in the Federal Register at 77 FR 43229. Adjusted Payments The... related notice published at 48 FR 29114, June 24, 1983.) This notice has been determined to be not... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  15. Incidence of diabetes mellitus type 2 complications among Saudi adult patients at primary health care center

    OpenAIRE

    Alsenany, Samira; Al Saif, Amer

    2015-01-01

    [Purpose] This study analyzed type 2 diabetes and its role in complications among adult Saudi patients. [Subjects] Patients attending four primary health care centers in Jeddah were enrolled. [Methods] A cross-sectional design study among Saudi patients attending Ministry of Health primary health care centers in Jeddah was selected for use by the Primary Health Care administration. Patients were interviewed with structured questionnaires to determine the presence of diabetes and risk factors ...

  16. Assessing and developing critical-thinking skills in the intensive care unit.

    Science.gov (United States)

    Swinny, Betsy

    2010-01-01

    A lot of resources are spent on the development of new staff in the intensive care unit (ICU). These resources are necessary because the environment in the ICU is complex and the patients are critically ill. Nurses need an advanced knowledge base, the ability to accurately define and change priorities rapidly, good communication and teamwork skills, and the ability to work in a stressful environment in order to succeed and give their patients quality care. Critical thinking helps the nurse to navigate the complex and stressful environment of the ICU. Critical thinking includes more than just nursing knowledge. It includes the ability to think through complex, multifaceted problems to anticipate needs, recognize potential and actual complications, and to expertly communicate with the team. A nurse who is able to think critically will give better patient care. Various strategies can be used to develop critical thinking in ICU nurses. Nurse leaders are encouraged to support the development of critical-thinking skills in less experienced staff with the goal of improving the nurse's ability to work in the ICU and improving patient outcomes.

  17. End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine.

    Science.gov (United States)

    Myburgh, John; Abillama, Fayez; Chiumello, Davide; Dobb, Geoff; Jacobe, Stephen; Kleinpell, Ruth; Koh, Younsuk; Martin, Claudio; Michalsen, Andej; Pelosi, Paolo; Torra, Lluis Blanch; Vincent, Jean-Louis; Yeager, Susan; Zimmerman, Janice

    2016-08-01

    End-of-life care in the intensive care unit (ICU) was identified as an objective in a series of Task Forces developed by the World Federation of Societies of Intensive and Critical Care Medicine Council in 2014. The objective was to develop a generic statement about current knowledge and to identify challenges relevant to the global community that may inform regional and local initiatives. An updated summary of published statements on end-of-life care in the ICU from national Societies is presented, highlighting commonalities and differences within and between international regions. The complexity of end-of-life care in the ICU, particularly relating to withholding and withdrawing life-sustaining treatment while ensuring the alleviation of suffering, within different ethical and cultural environments is recognized. Although no single statement can therefore be regarded as a criterion standard applicable to all countries and societies, the World Federation of Societies of Intensive and Critical Care Medicine endorses and encourages the role of Member Societies to lead the debate regarding end-of-life care in the ICU within each country and to take a leading role in developing national guidelines and recommendations within each country. PMID:27288625

  18. Model of Care for Adolescents and Young Adults with Cancer: The Youth Project in Milan.

    Science.gov (United States)

    Magni, Chiara; Veneroni, Laura; Silva, Matteo; Casanova, Michela; Chiaravalli, Stefano; Massimino, Maura; Clerici, Carlo Alfredo; Ferrari, Andrea

    2016-01-01

    Adolescents and young adults (AYA) with cancer form a particular group of patients with unique characteristics, who inhabit a so-called "no man's land" between pediatric and adult services. In the last 10 years, the scientific oncology community has started to pay attention to these patients, implementing dedicated programs. A standardized model of care directed toward patients in this age range has yet to be developed and neither the pediatric nor the adult oncologic systems perfectly fit these patients' needs. The Youth Project of the Istituto Nazionale Tumori in Milan, dedicated to AYA with pediatric-type solid tumors, can be seen as a model of care for AYA patients, with its heterogeneous multidisciplinary staff and close cooperation with adult medical oncologists and surgeons. Further progress in the care of AYA cancer patients is still needed to improve their outcomes. PMID:27606308

  19. Bi-parental care contributes to sexually dimorphic neural cell genesis in the adult mammalian brain.

    Directory of Open Access Journals (Sweden)

    Gloria K Mak

    Full Text Available Early life events can modulate brain development to produce persistent physiological and behavioural phenotypes that are transmissible across generations. However, whether neural precursor cells are altered by early life events, to produce persistent and transmissible behavioural changes, is unknown. Here, we show that bi-parental care, in early life, increases neural cell genesis in the adult rodent brain in a sexually dimorphic manner. Bi-parentally raised male mice display enhanced adult dentate gyrus neurogenesis, which improves hippocampal neurogenesis-dependent learning and memory. Female mice display enhanced adult white matter oligodendrocyte production, which increases proficiency in bilateral motor coordination and preference for social investigation. Surprisingly, single parent-raised male and female offspring, whose fathers and mothers received bi-parental care, respectively, display a similar enhancement in adult neural cell genesis and phenotypic behaviour. Therefore, neural plasticity and behavioural effects due to bi-parental care persist throughout life and are transmitted to the next generation.

  20. Model of Care for Adolescents and Young Adults with Cancer: The Youth Project in Milan

    Science.gov (United States)

    Magni, Chiara; Veneroni, Laura; Silva, Matteo; Casanova, Michela; Chiaravalli, Stefano; Massimino, Maura; Clerici, Carlo Alfredo; Ferrari, Andrea

    2016-01-01

    Adolescents and young adults (AYA) with cancer form a particular group of patients with unique characteristics, who inhabit a so-called “no man’s land” between pediatric and adult services. In the last 10 years, the scientific oncology community has started to pay attention to these patients, implementing dedicated programs. A standardized model of care directed toward patients in this age range has yet to be developed and neither the pediatric nor the adult oncologic systems perfectly fit these patients’ needs. The Youth Project of the Istituto Nazionale Tumori in Milan, dedicated to AYA with pediatric-type solid tumors, can be seen as a model of care for AYA patients, with its heterogeneous multidisciplinary staff and close cooperation with adult medical oncologists and surgeons. Further progress in the care of AYA cancer patients is still needed to improve their outcomes. PMID:27606308

  1. Critical pathways for the management of preeclampsia and severe preeclampsia in institutionalised health care settings

    Directory of Open Access Journals (Sweden)

    Daftari Ashi

    2003-10-01

    Full Text Available Abstract Background Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. Methods Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a Definition of the conceptual framework; b Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c Structural development. Results The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. Conclusion Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and

  2. Patient Safety in Critical Care Unit: Development of a Nursing Quality Indicator System.

    Science.gov (United States)

    Lima, Camila S P; Barbosa, Sayonara F F

    2015-01-01

    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

  3. Awareness of bispectral index monitoring system among the critical care nursing personnel in a tertiary care hospital of India

    Directory of Open Access Journals (Sweden)

    Shikha Thakur

    2011-01-01

    Full Text Available Background: Bispectral index monitoring system (BIS is one of the several systems used to measure the effects of anaesthetic and sedative drugs on the brain and to track changes in the patient′s level of sedation and hypnosis. BIS monitoring provides information clinically relevant to the adjustment of dosages of sedating medication. It can help the nursing personnel in preventing under- and over sedation among intensive care unit (ICU patients. Objective: The present study was conducted to assess the knowledge of nursing personnel working in the ICU regarding BIS. Methods: Fifty-four subjects participated in the study. A structured questionnaire was developed to assess the knowledge of the nursing personnel regarding BIS. Focus group discussions were held among the nursing personnel to know their views regarding BIS. Results: Mean age (years of the subjects was 30.7΁7.19 (21-47 years, with a female preponderance. Although the use of BIS in ICU is not common, majority (94.44% were aware of BIS and its purpose. 79.62% of the subjects knew about its implication in patient care. The mean knowledge score of the subjects was 11.87΁2.43 (maximum score being 15. Conclusion: There exists an awareness among the critical care nursing staff in our institution regarding BIS and its clinical implications. Its use in the critical care setting may benefit the patients in terms of providing optimal sedation.

  4. Food Insecurity and Health Care Utilization Among Older Adults in the United States.

    Science.gov (United States)

    Bhargava, Vibha; Lee, Jung Sun

    2016-01-01

    This study examined the relationships between food insecurity and utilization of four health services among older Americans: office visits, inpatient hospital nights, emergency department visits, and home health care. Nationally representative data from the 2011 and 2012 National Health Interview Survey were used (N = 13,589). Nearly 83.0% of the sample had two or more office visits, 17.0% reported at least one hospital night, 23.0% had at least one emergency room visit, and 8.1% used home health care during the past 12 months. Adjusting for confounders, food-insecure older adults had higher odds of using more office visits, inpatient hospital nights, and emergency department visits than food-secure older adults, but similar odds of home health care utilization. The findings of this study suggest that programs and policies aimed at reducing food insecurity among older adults may have a potential to reduce utilization of health care services.

  5. The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan.

    Science.gov (United States)

    Tian, Wei-Hua

    2016-07-01

    The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals' utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program. PMID:27287671

  6. Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study.

    Science.gov (United States)

    Marrast, Lyndonna; Himmelstein, David U; Woolhandler, Steffie

    2016-10-01

    Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children's and young adults' receipt of mental health and substance abuse care using nationally representative data from the 2006-2012 Medical Expenditure Panel Surveys. Blacks' and Hispanics' visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care. PMID:27520100

  7. Relationship of anxiety and burnout with extrasystoles in critical care nurses in Turkey

    Science.gov (United States)

    Denat, Yildiz; Gokce, Serap; Gungor, Hasan; Zencir, Cemil; Akgullu, Cagdas

    2016-01-01

    Objective: To determine the relationship between levels of anxiety and burnout and prevalence of atrial extrasystoles (AESs) and ventricular extrasystoles (VESs) among critical care nurses. Methods: The sample of study included 51 nurses who worked in the intensive care units of a university hospital located in western Turkey. Beck’s Anxiety Inventory and the Maslach Burnout Inventory were used in the study. Results: The mean emotional exhaustion score of the nurses was 14.68±6.10, the mean personal accomplishment score was 19.19±7.08, the mean depersonalization score was 5.31±3.84 and the mean anxiety score was 12.37±11.12. The rates of VESs and AESs detected in the critical care nurses were 21.6% and 35.3%, respectively. No relationship was found between levels of anxiety and burnout and the prevalence of AESs and VESs among the critical care nurses. A positive correlation was found between personal accomplishment scores and numbers of VESs (r= 0.693, p=0.001) and AESs (r= 0.700, p= 0.001). Conclusion: In the present study, there were low mean scores of burnout and anxiety among nurses working in intensive care units. No relationship was found between levels of anxiety and burnout and the prevalence of AESs and VESs among nurses who work in intensive care units. It was found that the people feeling more personal accomplishment have more VES or AES. The prevalence of AESs and VESs among the critical care nurses suffering from burnout and anxiety may be studied in the future studies. PMID:27022374

  8. Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients

    DEFF Research Database (Denmark)

    Claudius, Casper; Perner, Anders; Møller, Morten Hylander

    2015-01-01

    BACKGROUND: Nebulised dornase alfa is used off-label in critically ill patients. We aimed to assess the benefits and harms of nebulised dornase alfa versus placebo, no prophylaxis, or hypertonic saline on patient-important outcome measures in adult critically ill patients. METHODS: We performed...... a systematic review with meta-analysis and trial sequential analysis (TSA) using the Cochrane Collaboration methodology. Eligible trials were randomised clinical trials comparing nebulised dornase alfa with placebo, no prophylaxis, or hypertonic saline. The predefined outcome measures were all-cause mortality...

  9. Standard instruction versus simulation: Educating registered nurses in the early recognition of patient deterioration in paediatric critical care.

    Science.gov (United States)

    O'Leary, Jessica; Nash, Robyn; Lewis, Peter

    2016-01-01

    Identifying and stabilising deterioration in a child with significant clinical compromise is both a challenging and necessary role of the paediatric critical care nurse. Within adult critical care research, high fidelity patient simulation (HFPS) has been shown to positively impact learner outcomes regarding identification and management of a deteriorating patient; however, there is a paucity of evidence examining the use of HFPS in paediatric nursing education. The aim of this study was to investigate the effect of HFPS on nurses' self-efficacy and knowledge for recognising and managing paediatric deterioration. Further, participants' perceptions of the learning experiences specific to the identification and management of a deteriorating child were also explored. Registered nurses working in a tertiary-referral paediatric critical care unit were recruited for this quasi-experimental study. Using a pre-test/post-test control-group design, participants were assigned to one of two learning experiences: HFPS or standard instruction. Following the learning experience, nurses were also invited to participate in semi-structured interviews. 30 nurses participated in the study (control n=15, experiment n=15). Participants in the HFPS intervention were most likely to demonstrate an increase in both perceived self-efficacy (p=experiment group compared to the control. HFPS also yielded higher follow-up knowledge scores (p=0.01) compared to standard instruction. Ten nurses participated in semi-structured interviews. Thematic analysis of the interview data identified four themes: self-awareness, hands-on learning, teamwork, and maximising learning. The results of this study suggest that HFPS can positively influence nurses' self-efficacy and knowledge test scores specific to the recognition and management of paediatric deterioration. PMID:26249644

  10. Clinicians' perceptions of rationales for rehabilitative exercise in a critical care setting: A cross-sectional study

    OpenAIRE

    Nickels, M.; Aitken, L. M.; Walsham, J.; L. Watson; McPhail, S.

    2016-01-01

    Australian College of Critical Care Nurses Ltd. Background: Rehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings. Objective: To identify which rationales for rehabilitative exercise interventions were perceived by ICU clinicians to be important and determine whether perceptions were consistent acr...

  11. Is older adult care mediated by caregivers' cultural stereotypes? The role of competence and warmth attribution

    Directory of Open Access Journals (Sweden)

    Fernández-Ballesteros R

    2016-05-01

    Full Text Available Rocío Fernández-Ballesteros,1 Antonio Bustillos,2 Marta Santacreu,1,3 Rocio Schettini,1 Pura Díaz-Veiga,4 Carmen Huici2 1Clinical and Health Psychology, Universidad Autónoma de Madrid (UAM, 2Social Psychology, Universidad Nacional de Educación a Distancia (UNED, 3Psychology Department, Universidad Europea de Madrid (UEM, 4Matia Instituto Gerontológico, Madrid, Spain Purpose: The purpose of this study is to examine, from the stereotype content model (SCM perspective, the role of the competence and warmth stereotypes of older adults held by professional caregivers.Methods: A quasi-experimental design, ex post facto with observational analyses, was used in this study. The cultural view on competence and warmth was assessed in 100 caregivers working in a set of six residential geriatric care units (three of them organized following a person-centered care approach and the other three providing standard geriatric care. In order to assess caregivers’ cultural stereotypical views, the SCM questionnaire was administered. To evaluate the role of caregivers’ cultural stereotypes in their professional performance as well as in older adult functioning, two observational scales from the Sistema de Evaluación de Residencias de Ancianos (assessment system for older adults residences-RS (staff functioning and residents’ functioning were applied.Results: Caregivers’ cultural views of older adults (compared to young people are characterized by low competence and high warmth, replicating the data obtained elsewhere from the SCM. Most importantly, the person-centered units predict better staff performance and better resident functioning than standard units. Moreover, cultural stereotyping of older adult competence moderates the effects of staff performance on resident functioning, in line with the findings of previous research.Conclusion: Our results underline the influence of caregivers’ cultural stereotypes on the type of care, as well as on their

  12. Satisfaction survey on the critical care response team services in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Saad Al Qahtani

    2011-03-01

    Full Text Available Saad Al Qahtani1,21Intensive Care Department, Critical Care Response Team, King Abdulaziz Medical City (KAMC, National Guard Health Affairs, 2King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Kingdom of Saudi ArabiaIntroduction: Patient care and safety is the main goal and mission of any health care provider. We surveyed nurses in the wards and obtained their feedback about the quality of care delivered by the Critical Care Response Team (CCRT.Methods: Our hospital has 900 beds. A self-administered survey was given onsite to all ward nurses. Survey items were identified, discussed, reviewed, piloted, and finalized over a 3-month period in a focus group discussion format during three CCRT core group meetings. Responses were anonymous and collected by the nurses onsite.Results: The total number of returned and analyzed surveys was 274 (98.6%. Ninety-seven percent agreed that CCRT staff arrived in a timely manner. Ninety-four percent reported that CCRT staff helped in managing sick patients and ~70% reported that it strengthened team dynamics. Only 50% of the nurses felt CCRT staff improved competence at the bedside. The overall satisfaction was 100%; none of the nurses were dissatisfied with the team.Conclusion: The CCRT helped manage sick patients in the wards. However, CRRT staff should remember to involve and communicate with the team initiator and the patient’s physician to optimize patient health care.Keywords: rapid response team, medical emergency team, critical care response team, satisfaction

  13. Residential segregation and overweight/obesity among African-American adults: A critical review

    Directory of Open Access Journals (Sweden)

    Irma eCorral

    2015-07-01

    Full Text Available The relationship between residential segregation and overweight/obesity among African-American adults remains unclear. Elucidating that relationship is relevant to efforts to prevent and to reduce racial disparities in obesity. This article provides a critical review of the 11 empirical studies of segregation and overweight/obesity among African-American adults. Results revealed that most studies did not use a valid measure of segregation, many did not use a valid measure of overweight/obesity, and many did not control for neighborhood poverty. Only four (36% of the studies used valid measures of both segregation and overweight/obesity and also controlled for area-poverty. Those four studies suggest that segregation contributes to overweight and obesity among African-American adults, but that conclusion cannot be drawn with any certainty in light of the considerable methodological problems in this area of research. Suggestions for improving research on this topic are provided.

  14. Residential Segregation and Overweight/Obesity Among African-American Adults: A Critical Review.

    Science.gov (United States)

    Corral, Irma; Landrine, Hope; Hall, Marla B; Bess, Jukelia J; Mills, Kevin R; Efird, Jimmy T

    2015-01-01

    The relationship between residential segregation and overweight/obesity among African-American adults remains unclear. Elucidating that relationship is relevant to efforts to prevent and to reduce racial disparities in obesity. This article provides a critical review of the 11 empirical studies of segregation and overweight/obesity among African-American adults. Results revealed that most studies did not use a valid measure of segregation, many did not use a valid measure of overweight/obesity, and many did not control for neighborhood poverty. Only four (36% of the) studies used valid measures of both segregation and overweight/obesity and also controlled for area-poverty. Those four studies suggest that segregation contributes to overweight and obesity among African-American adults, but that conclusion cannot be drawn with certainty in light of the considerable methodologic problems in this area of research. Suggestions for improving research on this topic are provided. PMID:26191522

  15. Critical Criminological Understandings of Adult Pornography and Woman Abuse: New Progressive Directions in Research and Theory

    Directory of Open Access Journals (Sweden)

    Walter DeKeseredy

    2015-12-01

    Full Text Available There is a small, but growing, social scientific literature on the racist and violent nature of contemporary adult pornography. However, considerably more empirical and theoretical work needs to be done to advance a critical criminological understanding of how such hurtful sexual media contribute to various forms of woman abuse in intimate relationships. The main objective of this article is to briefly review the relevant literature and to suggest a few new progressive empirical and theoretical directions.

  16. Medication error in anaesthesia and critical care: A cause for concern

    Directory of Open Access Journals (Sweden)

    Dilip Kothari

    2010-01-01

    Full Text Available Medication error is a major cause of morbidity and mortality in medical profession, and anaesthesia and critical care are no exception to it. Man, medicine, machine and modus operandi are the main contributory factors to it. In this review, incidence, types, risk factors and preventive measures of the medication errors are discussed in detail.

  17. Measuring Person-Centered Care: A Critical Comparative Review of Published Tools

    Science.gov (United States)

    Edvardsson, David; Innes, Anthea

    2010-01-01

    Purpose of the study: To present a critical comparative review of published tools measuring the person-centeredness of care for older people and people with dementia. Design and Methods: Included tools were identified by searches of PubMed, Cinahl, the Bradford Dementia Group database, and authors' files. The terms "Person-centered,"…

  18. A perspective on Serum Lactic acid, Lactic Acidosis in a Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Agela A.Elbadri

    2013-06-01

    Full Text Available Breast cancer is one of the major surgical problems encountered in Libya. Lactic acidosis is a universal complication in breast cancer patients and can be considered a possible prognostic marker. Therefore, it will be beneficial to correctly understand and review the biochemistry underlying lactic acidosis and its possible significance as a prognostic marker in critical care patients, including breast cancer.

  19. A novel technique of differential lung ventilation in the critical care setting

    Directory of Open Access Journals (Sweden)

    Kuwagata Yasuyuki

    2011-05-01

    Full Text Available Abstract Background Differential lung ventilation (DLV is used to salvage ventilatory support in severe unilateral lung disease in the critical care setting. However, DLV with a double-lumen tube is associated with serious complications such as tube displacement during ventilatory management. Thus, long-term ventilatory management with this method may be associated with high risk of respiratory incidents in the critical care setting. Findings We devised a novel DLV technique using two single-lumen tubes and applied it to five patients, two with severe unilateral pneumonia and three with thoracic trauma, in a critical care setting. In this novel technique, we perform the usual tracheotomy and insert two single-lumen tubes under bronchoscopic guidance into the main bronchus of each lung. We tie the two single-lumen tubes together and suture them directly to the skin. The described technique was successfully performed in all five patients. Pulmonary oxygenation improved rapidly after DLV induction in all cases, and the three patients with thoracic trauma were managed by DLV without undergoing surgery. Tube displacement was not observed during DLV management. No airway complications occured in either the acute or late phase regardless of the length of DLV management (range 2-23 days. Conclusions This novel DLV technique appears to be efficacious and safe in the critical care setting.

  20. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    Science.gov (United States)

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  1. Adaptation of the Critical Care Family Need Inventory to the Turkish population and its psychometric properties.

    Science.gov (United States)

    Büyükçoban, Sibel; Çiçeklioğlu, Meltem; Demiral Yılmaz, Nilüfer; Civaner, M Murat

    2015-01-01

    In the complex environment of intensive care units, needs of patients' relatives might be seen as the lowest priority. On the other hand, because of their patients' critical and often uncertain conditions, stress levels of relatives are quite high. This study aims to adapt the Critical Care Family Need Inventory, which assesses the needs of patients' relatives, for use with the Turkish-speaking population and to assess psychometric properties of the resulting inventory. The study was conducted in a state hospital with the participation of 191 critical care patient relatives. Content validity was assessed by expert opinions, and construct validity was examined by exploratory factor analysis (EFA). Cronbach's alpha coefficient was used to determine internal consistency. The translated inventory has a content validity ratio higher than the minimum acceptable level. Its construct validity was established by the EFA. Cronbach's alpha coefficient for the entire scale was 0.93 and higher than 0.80 for subscales, thus demonstrating the translated version's reliability. The Turkish adaptation appropriately reflects all dimensions of needs in the original CCFNI, and its psychometric properties were acceptable. The revised tool could be useful for helping critical care healthcare workers provide services in a holistic approach and for policymakers to improve quality of service. PMID:26357593

  2. Making Sense of Varying Standards of Care: The Experiences of Staff Working in Residential Care Environments for Adults with Learning Disabilities

    Science.gov (United States)

    Hutchison, Andrew; Kroese, Biza Stenfert

    2016-01-01

    Research evidence reveals that adults with learning disabilities who live in residential care facilities are being exposed to considerable variation in the standards of care they receive. High profile cases of substandard care have also raised concerns regarding the appropriateness of existing care provisions and practices. While attempts have…

  3. Psychiatric Nursing Care for Adult Survivors of Child

    OpenAIRE

    Zalm, Yvonne van der; Nugteren, Willem; Hafsteinsdóttir, Thóra van der; Venne, Cokky van der; Kool, Nienke; van Meijel, Berno

    2014-01-01

    PURPOSE: To determine what is known from the literature about nursing care of psychiatric patients with a history of child maltreatment. CONCLUSIONS: Psychiatric nurses underline the importance of a routine inquiry of child abuse on admission of patients to psychiatric care, but are reluctant to ask about child abuse. They often feel insufficiently competent to respond effectively to patients with a history of child maltreatment. PRACTICE IMPLICATIONS: Psychiatric nurses need training in how ...

  4. The research agenda in ICU telemedicine: a statement from the Critical Care Societies Collaborative.

    Science.gov (United States)

    Kahn, Jeremy M; Hill, Nicholas S; Lilly, Craig M; Angus, Derek C; Jacobi, Judith; Rubenfeld, Gordon D; Rothschild, Jeffrey M; Sales, Anne E; Scales, Damon C; Mathers, James A L

    2011-07-01

    ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework should consider the multidisciplinary nature of ICU care and describe the specific program goals. Key topic areas to be addressed include the effect of ICU telemedicine on the structure, process, and outcome of critical care delivery. Ideally, future research should attempt to address causation instead of simply associations and elucidate the mechanism of action in order to determine exactly how ICU telemedicine achieves its effects. ICU telemedicine has significant potential to improve critical care delivery, but high-quality research is needed to best inform its use. We propose an agenda to advance the science of ICU telemedicine and generate research with the greatest potential to improve patient care.

  5. A journey of critical consciousness: an educational strategy for health care leaders.

    Science.gov (United States)

    Getzlaf, Beverley A; Osborne, Margaret

    2010-01-01

    Healthcare leaders who develop a critical perspective of the relationship between culture and health; value respect for differences, inclusiveness, equity, and social justice; and use their power to enact these values in their spheres of influence, both professionally and personally, are better able to improve care for a diversity of clients. Graduate students can be assisted to develop such a critical perspective through a course designed as a journey of critical consciousness. We describe this journey that takes students through phases of awareness, reflection, and action in which they come to understand the concepts of critical theory and discourse analysis and begin to use these to create changes in their work settings in the direction of equity and social justice. We suggest broader implications for programs and invite readers to begin their own journeys of critical consciousness.

  6. [Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care].

    Science.gov (United States)

    Ulke, Christine; Klein, Annette M; von Klitzing, Kai

    2014-01-01

    Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care. The aim of this study was to evaluate the effects of several ward interventions (transition to an open ward concept, individualized treatment plans, tiered crisis-management, staff training, quality control) on repeated critical incidents, non-restrictive and restrictive measures. The outcome variables were compared in two time periods, 2007 and 2011. The study included 74 critical incident reports of 51 child and adolescent inpatients that had at least one hospital stay and one critical incident in the selected time periods. Aggressive, self-harming, and absconding incidents were included. The quantitative results suggest that ward interventions can contribute to a reduction of repeated critical incidents and restrictive measures. The qualitative evaluation suggests a cultural change of crisis management.

  7. Eluding meaninglessness: a note to self in regard to Camus, critical care, and the absurd.

    Science.gov (United States)

    Papadimos, Thomas John

    2014-01-01

    Here I present a medical narrative, as a catharsis, regarding Albert Camus’s The Myth of Sisyphus in an attempt to elude meaninglessness in my difficult everyday practice of critical care medicine. It is well documented that physicians who practice critical care medicine are subject to burnout. The sense of despair that occasionally overwhelms me prompted my rereading of Camus’s classic text and caused me to recount his arguments that life is meaningless unless one is willing to take a leap of faith to the divine or, alternately, to commit suicide. This set up the examination of his third alternative, acceptance of a life without prima facie evidence of purpose and meaning, a view that may truly have some bearing on my professional life in the intensive care unit.

  8. Prediction of chronic critical illness in a general intensive care unit

    Directory of Open Access Journals (Sweden)

    Sérgio H. Loss

    2013-06-01

    Full Text Available OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI, and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

  9. Developing professional attributes in critical care nurses using Team-Based Learning.

    Science.gov (United States)

    Currey, Judy; Eustace, Paula; Oldland, Elizabeth; Glanville, David; Story, Ian

    2015-05-01

    Australian nurses prepare for specialty practice by undertaking postgraduate theoretical and clinical education in partnership models between universities and hospitals. In our global healthcare system, nurses require advanced critical thinking and strong communication skills to provide safe, high quality patient care. Yet, few education programs focus on developing these skills. Team-Based Learning (TBL) is a specific educational strategy that encourages and rewards students to think critically and solve clinical problems individually and in teams. The aim of this study was to investigate critical care nursing students' perceptions and experiences of TBL after it was introduced into the second half of their postgraduate specialty course. Following Ethics Committee approval, thirty-two students were invited to participate in an extended response questionnaire on their perceptions of TBL as part of a larger study. Data were analyzed thematically. Postgraduate students perceived their professional growth was accelerated due to the skills and knowledge acquired through TBL. Four themes underpinned the development and accelerated acquisition of specialty nurse attributes due to TBL: Engagement, Learning Effectiveness, Critical Thinking, and Motivation to Participate. Team-Based Learning offered deep and satisfying learning experiences for students. The early acquisition of advanced critical thinking, teamwork and communication skills, and specialty practice knowledge empowered nurses to provide safe patient care with confidence.

  10. Mixed care networks of community-dwelling older adults with physical health impairments in the Netherlands.

    Science.gov (United States)

    Broese van Groenou, Marjolein; Jacobs, Marianne; Zwart-Olde, Ilse; Deeg, Dorly J H

    2016-01-01

    As part of long-term care reforms, home-care organisations in the Netherlands are required to strengthen the linkage between formal and informal caregivers of home-dwelling older adults. Information on the variety in mixed care networks may help home-care organisations to develop network type-dependent strategies to connect with informal caregivers. This study first explores how structural (size, composition) and functional features (contact and task overlap between formal and informal caregivers) contribute to different types of mixed care networks. Second, it examines to what degree these network types are associated with the care recipients' characteristics. Through home-care organisations in Amsterdam, the Netherlands, we selected 74 frail home-dwelling clients who were receiving care in 2011-2012 from both informal and formal caregivers. The care networks of these older adults were identified by listing all persons providing help with five different types of tasks. This resulted in care networks comprising an average of 9.7 caregivers, of whom 67% were formal caregivers. On average, there was contact between caregivers within 34% of the formal-informal dyads, and both caregivers carried out at least one similar type of task in 29% of these dyads. A principal component analysis of size, composition, contact and task overlap showed two distinct network dimensions from which four network types were constructed: a small mixed care network, a small formal network, a large mixed network and a large formal network. Bivariate analyses showed that the care recipients' activities of daily living level, memory problems, social network, perceived control of care and level of mastery differed significantly between these four types. The results imply that different network types require different actions from formal home-care organisations, such as mobilising the social network in small formal networks, decreasing task differentiation in large formal networks and assigning

  11. Transitioning the young adult with congenital heart disease for life-long medical care.

    Science.gov (United States)

    Fernandes, Susan M; Landzberg, Michael J

    2004-12-01

    Guidelines for the successful orchestration of transitioning of the adolescent and young and older adult patient with congenital heart disease to a health care system appropriate for their long-term congenital heart disease care and counseling appear necessary to improve patient and family confidence, education, therapy, life quality, and survival outcomes. Schema for care organization and delivery for adult patients with congenital heart disease remain primitive and largely unimplemented. The presence of a strong central care oversight organization and the establishment of a multi-institutional database to assist in assessment of care outcomes and guidelines appears requisite to these needs and for the establishment of transitioning guidelines for these patients as they assume a greater and deeper shared control of their futures with their caregivers.

  12. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    Directory of Open Access Journals (Sweden)

    Michael Mazzeffi

    2015-01-01

    Full Text Available Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

  13. Care of critically ill newborns in India. Legal and ethical issues.

    Science.gov (United States)

    Subramanian, K N; Paul, V K

    1995-06-01

    The nature of neonatal care in India is changing. While the quality of care will most likely improve as the economy grows, the eventual scope of change remains to be seen. Attitudinal and behavioral changes, in addition to better economic conditions, are needed to realize more appropriate interventions in neonatal care. Economic, cultural, religious, social, political, and other considerations may limit or affect neonatal care, especially for ELBW infants or infants with congenital malformations or brain injury. Various protections for critically ill newborns exist under Indian law and the Constitution of India. New laws are being enacted to enhance the level of protection conferred, including laws which ban amniocentesis for sex determination and define brain death in connection with the use of human organs for therapeutic purposes. The applicability of consumer protection laws to medical care is also being addressed. It is noted, however, that India lacks a multidisciplinary bioethics committee. An effort should be made to discuss the legal and ethical issues regarding the care of critically ill newborns, with discussions considering religious, cultural, traditional, and family values. Legal and ethical guidelines should be developed by institutions, medical councils, and society specific to newborn care, and medical, nursing, and other paramedical schools should include these issues as part of the required coursework. Physicians, nurses, philosophers, and attorneys with expertise in law and ethics should develop and teach these courses. Such measures over the long term will ensure that future health care providers are exposed to these issues, ideally with a view toward enhancing patient care. PMID:7636406

  14. Deciding intensive care unit-admission for critically ill cancer patients

    Directory of Open Access Journals (Sweden)

    Thiery Guillaume

    2007-01-01

    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.

  15. Dignity in health-care: a critical exploration using feminism and theories of recognition.

    Science.gov (United States)

    Aranda, Kay; Jones, Andrea

    2010-09-01

    Growing concerns over undignified health-care has meant the concept of dignity is currently much discussed in the British National Health Service. This has led to a number of policies attempting to reinstate dignity as a core ethical value governing nursing practice and health-care provision. Yet these initiatives continue to draw upon a concept of dignity which remains reliant upon a depoliticised, ahistorical and decontexualised subject. In this paper, we argue the need to revise the dignity debate through the lens of feminism and theories of recognition. Postmodern feminist theories provide major challenges to what remain dominant liberal approaches as they pay attention to the contingent, reflexive, and affective aspects of care work. Theories of recognition provide a further critical resource for understanding how moral obligations and responsibilities towards others and our public and private responses to difference arise. This re-situates dignity as a highly contested and politicised concept involving complex moral deliberations and diverse political claims of recognition. The dignity debate is thus moved beyond simplistic rational injunctions to care, or to care more, and towards critical discussions of complex politicised, moral practices infused with power that involve the recognition of difference in health-care. PMID:20712663

  16. Dignity in health-care: a critical exploration using feminism and theories of recognition.

    Science.gov (United States)

    Aranda, Kay; Jones, Andrea

    2010-09-01

    Growing concerns over undignified health-care has meant the concept of dignity is currently much discussed in the British National Health Service. This has led to a number of policies attempting to reinstate dignity as a core ethical value governing nursing practice and health-care provision. Yet these initiatives continue to draw upon a concept of dignity which remains reliant upon a depoliticised, ahistorical and decontexualised subject. In this paper, we argue the need to revise the dignity debate through the lens of feminism and theories of recognition. Postmodern feminist theories provide major challenges to what remain dominant liberal approaches as they pay attention to the contingent, reflexive, and affective aspects of care work. Theories of recognition provide a further critical resource for understanding how moral obligations and responsibilities towards others and our public and private responses to difference arise. This re-situates dignity as a highly contested and politicised concept involving complex moral deliberations and diverse political claims of recognition. The dignity debate is thus moved beyond simplistic rational injunctions to care, or to care more, and towards critical discussions of complex politicised, moral practices infused with power that involve the recognition of difference in health-care.

  17. Mental health system historians: adults with schizophrenia describe changes in community mental health care over time.

    Science.gov (United States)

    Stein, Catherine H; Leith, Jaclyn E; Osborn, Lawrence A; Greenberg, Sarah; Petrowski, Catherine E; Jesse, Samantha; Kraus, Shane W; May, Michael C

    2015-03-01

    This qualitative study examined changes in community mental health care as described by adults diagnosed with schizophrenia with long-term involvement in the mental health system to situate their experiences within the context of mental health reform movements in the United States. A sample of 14 adults with schizophrenia who had been consumers of mental health services from 12 to 40 years completed interviews about their hospital and outpatient experiences over time and factors that contributed most to their mental health. Overall, adults noted gradual changes in mental health care over time that included higher quality of care, more humane treatment, increased partnership with providers, shorter hospital stays, and better conditions in inpatient settings. Regardless of the mental health reform era in which they were hospitalized, participants described negative hospitalization experiences resulting in considerable personal distress, powerlessness, and trauma. Adults with less than 27 years involvement in the system reported relationships with friends and family as most important to their mental health, while adults with more than 27 years involvement reported mental health services and relationships with professionals as the most important factors in their mental health. The sample did not differ in self-reported use of services during their initial and most recent hospitalization experiences, but differences were found in participants' reported use of outpatient services over time. Findings underscore the importance of the lived experience of adults with schizophrenia in grounding current discourse on mental health care reform.

  18. Clinical care of adult Turner syndrome--new aspects

    DEFF Research Database (Denmark)

    Trolle, Christian; Mortensen, Kristian Havmand; Hjerrild, Britta E;

    2012-01-01

    Turner syndrome (TS) is characterized by numerous medical challenges during adolescence and adulthood. Puberty has to be induced in most cases, and female sex hormone replacement therapy (HRT) should continue during adult years. These issues are normally dealt with by the paediatrician, but once...

  19. Income Inequities in Health Care Utilization among Adults Aged 50 and Older.

    Science.gov (United States)

    Penning, Margaret J; Zheng, Chi

    2016-03-01

    Equitable access to and utilization of health services is a primary goal for many health care systems, particularly in countries with universal publicly funded systems. Despite concerns regarding potentially adverse implications of the 1990s' health care policy and other reforms, whether and how income inequalities in service utilization changed remains unclear. This study addressed the impact of income on physician and hospital utilization from 1992-2002 among adults aged 50 and older in British Columbia. Those with lower incomes were found less likely to access general practitioner and specialist services but more likely to access hospital services. Income-related disparities in physician care increased over time; hospital care declined. Volume of GP and hospital care was inversely associated with income; these differences increased regarding GP services only. Findings of declines in hospital-care access, accompanied by increasing income-related disparities in physician-services access, show that inequities are increasing within Canada's health care system. PMID:26757886

  20. Epidemiology of fungal infections in critical care setting of a tertiary care teaching hospital in North India: a prospective surveillance study

    OpenAIRE

    Tirath Singh; Anil Kumar Kashyap; Gautam Ahluwalia; Deepinder Chinna; Sandeep Singh Sidhu

    2014-01-01

    Background: During recent years, fungal infections have risen exponentially and are a cause of significant morbidity and mortality in hospitalized patients, especially in the critical care setting. There is paucity of data from India on fungal pathogens. Methods: We prospectively studied patients admitted to medical and surgical critical care section of a tertiary care institute in northern India. The clinical samples of patients were processed in Department of Microbiology for isolatio...

  1. Patients' Perceptions of Nurses' Behaviour That Influence Patient Participation in Nursing Care: A Critical Incident Study

    Directory of Open Access Journals (Sweden)

    Inga E. Larsson

    2011-01-01

    Full Text Available Patient participation is an important basis for nursing care and medical treatment and is a legal right in many Western countries. Studies have established that patients consider participation to be both obvious and important, but there are also findings showing the opposite and patients often prefer a passive recipient role. Knowledge of what may influence patients' participation is thus of great importance. The aim was to identify incidents and nurses' behaviours that influence patients' participation in nursing care based on patients' experiences from inpatient somatic care. The Critical Incident Technique (CIT was employed. Interviews were performed with patients (=17, recruited from somatic inpatient care at an internal medical clinic in West Sweden. This study provided a picture of incidents, nurses' behaviours that stimulate or inhibit patients' participation, and patient reactions on nurses' behaviours. Incidents took place during medical ward round, nursing ward round, information session, nursing documentation, drug administration, and meal.

  2. Therapeutic effect of insulin in reduction of critical illness polyneuropathy and Myopathy in pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    nemat BILAN

    2012-09-01

    . 1984 Nov;47(11:1223-31.Vondracek P, Bednarik J. Critical and electrophysiological findings and long-term outcomes in pediatric patients with critical illness polyneuropathy. Eur J Pediatr Neurol 2006 Jul;10(4:176-81.Witt NJ, Zochodne DW, Bolton CF, Grand’Maison F, Wells G, Young GB et al. Peripheral nerve functionin sepsis and multiple organ failure. Chest 1991 Jan;99(1:176-84.5. Marino PL. The ICU book. 2nd ed. Philadelphia:Lippincott Williams and Wilkins; 1998. p. 800-1.Hermans G, De Jonghe B, Bruyninckx F, Van den BergheG. Clinical review: Critical illness polyneuropathy and myopathy. Crit Care 2008;12(6: 238.Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta analysis.JAMA 2008 Aug;300(8:933-44.8. Griesdale DE, de Souza RJ, van Dam RM, Heyland DK,Cook DJ, Malhotra A et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 2009 Apr;180(8:821-7.Mraovic B. Continuous glucose monitoring during intensive insulin therapy. J iabetes Sci Technol 2009 Jul;3(4:960-3.De Jonghe B, Bastuji-Garin S, Sharshar T, Outina,H, Brochard L. Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 2004 Jun;30(6:1117-21.Garnacho-Mantero J, Amaya-Villar R, García-Garmendía JL, Madrazo-Osuna J, Ortiz-Leyba C. Effects of criticallillness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. CritCare Med 2005 Feb;33(2:349-54.

  3. Using function-focused care to increase physical activity among older adults.

    Science.gov (United States)

    Resnick, Barbara; Galik, Elizabeth

    2013-01-01

    Despite the known benefits of physical activity for older adults, adherence to regular physical activity recommendations is poor. Less than half of adults in this country meet physical activity recommendations with reasons for lack of adherence including such things as access, motivation, pain, fear, comorbidities, among others. To overcome these challenges, function-focused care was developed. Function-focused care is a philosophy of care that focuses on evaluating the older adult's underlying capability with regard to function and physical activity and helping him or her optimize and maintain physical function and ability and continually increase time spent in physical activity. Examples of function-focused care include such things as using verbal cues during bathing, so the older individual performs the tasks rather than the caregiver bathing the individual; walking a resident or patient to the bathroom rather than using a urinal, or taking a resident to an exercise class. There are now over 20 studies supporting the benefits of function-focused care approaches across all settings and different types of patient groups (i.e, those with mild versus moderate-to-severe cognitive impairment). The approaches for implementation of function-focused care have also been well supported and have moved beyond establishing effectiveness to considering dissemination and implementation of this approach into real world clinical settings. The process of dissemination and implementation has likewise been articulated and supported, and ongoing work needs to continue in this venue across all care settings. PMID:24894140

  4. Appropriateness of cardiovascular care in elderly adult cancer survivors.

    Science.gov (United States)

    Cheung, Winson Y; Levin, Raisa; Setoguchi, Soko

    2013-01-01

    Research suggests that the quality of non-cancer-related care among cancer survivors (CS) is suboptimal. Secondary disease prevention is an important component of survivorship care that has not been previously evaluated. Our aims were (1) to assess the utilization of and adherence to medications and treatments for the secondary prevention of myocardial infarction (MI) in CS versus non-cancer patients (NCP) and (2) to compare temporal trends in cardiovascular care between these two patient cohorts. Linking data from Medicare, pharmacy assistance programs, and cancer registries, we calculated the percentage of individuals receiving preventive medications (statins, β-blockers, angiotensin-converting enzyme inhibitors) and revascularization interventions (angioplasty, stent, bypass surgery) within 90 days after acute MI in CS and propensity score-matched NCP. We assessed trends over time and determined predictors of appropriate preventive care using modified Poisson regression. We identified 1,119 CS and 7,886 NCP. Compared to NCP, more survivors received statins (38 vs. 31 %) and β-blockers (67 vs. 59 %), but fewer underwent bypass surgery (1.5 vs. 2.8 %) after MI. From 1997 to 2004, both survivors and NCP were increasingly prescribed medications to prevent future coronary events. Over the same time period, receipt of bypass surgery was significantly lower among survivors. Co-morbidities, such as depression and lung disease, and demographic factors, such as advanced age and female, were associated with underuse of preventive care among survivors when compared to NCP. Use of preventive medications and procedures has generally improved, but uptake of bypass surgery among CS still lags behind NCP.

  5. Factors influencing dental care access in Jordanian adults

    OpenAIRE

    Obeidat, Suhair Ref’at; Alsa’di, Amani Ghassan; Taani, Dafi Sultan

    2014-01-01

    Background The aims of this study are to assess the influences of demographic and personal factors on Jordanian adults’ abilities to use dental services and the barriers to regular attendance. Methods A self-administered questionnaire was distributed to a sample of 650 Jordanian adults attending King Abdullah University Hospital (KAUH) (n = 200), Jordan University of Science and Technology–Dental Health Teaching Center (JUST–DHTC) (n = 150), Yarmouk University Health Clinics (YUHC) (n = 150),...

  6. Management of adults with paediatric-onset chronic liver disease: strategic issues for transition care.

    Science.gov (United States)

    Vajro, Pietro; Ferrante, Lorenza; Lenta, Selvaggia; Mandato, Claudia; Persico, Marcello

    2014-04-01

    Advances in the management of children with chronic liver disease have enabled many to survive into adulthood with or without their native livers, so that the most common of these conditions are becoming increasingly common in adult hepatology practice. Because the aetiologies of chronic liver disease in children may vary significantly from those in adulthood, adults with paediatric-onset chronic liver disease may often present with clinical manifestations unfamiliar to their adulthood physician. Transition of medical care to adult practice requires that the adulthood medical staff (primary physicians and subspecialists) have a comprehensive knowledge of childhood liver disease and their implications, and of the differences in caring for these patients. Pending still unavailable Scientific Society guidelines, this article examines causes, presentation modes, evaluation, management, and complications of the main paediatric-onset chronic liver diseases, and discusses key issues to aid in planning a program of transition from paediatric to adult patients.

  7. Motivational interviewing for older adults in primary care: a systematic review.

    Science.gov (United States)

    Purath, Janet; Keck, Annmarie; Fitzgerald, Cynthia E

    2014-01-01

    Chronic disease is now the leading cause of death and disability in United States. Many chronic illnesses experienced by older adults can be prevented or managed through behavior change, making patient counseling an essential component of disease prevention and management. Motivational Interviewing (MI), a type of conversational method, has been effective in eliciting health behavior changes in people in a variety of settings and may also be a useful tool to help older adults change. This review of the literature analyzes current research and describes potential biases of MI interventions that have been conducted in primary care settings with older adults. MI shows promise as a technique to elicit health behavior change among older adults. However, further study with this population is needed to evaluate efficacy of MI interventions in primary care settings.

  8. Knowledge of Critical Care Provider on Prevention of Ventilator Associated Pneumonia

    Directory of Open Access Journals (Sweden)

    Passang Chiki Sherpa

    2014-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP continues to be an important cause of morbidity and mortality in ventilated patient. Prevention of VAP in critically ill patient is significant concern for health care team in intensive care units (ICUs. Knowledge on prevention of VAP would have a significant impact on patient outcome. Aims and Objectives: To assess knowledge on prevention of VAP in critical care providers and to find the association between knowledge on prevention of VAP and educational qualification and years of experience in ICUs. Settings and Design: The study was conducted in 5 different ICUs of Kasturba Hospital, Manipal, and using descriptive study design. Material and Methods: The study involved a purposive sample of 138 critical care providers. Critical care providers who were willing to participate in the study were included. Tools on demographic proforma and self-administered structured knowledge questionnaire on prevention of VAP were developed and content validity was established. The reliability of the tools was established.The data was categorized and analyzed by using descriptive and inferential statistics. The SPSS 16.0 version was used for the analysis of the study. Result: Majority 89.1% of the participant were 20-29 years, 63% unmarried 51.4% had completed diploma course and majority 81.2% were from nursing discipline. The study revealed that only 55.80% of subjects were having adequate knowledge on prevention of VAP based on median score. There was no significant association between knowledge score and educational qualification (÷²=0, p=0.833, years of experience in ICU (÷²= 2.221, p=0.329.

  9. Fostering critical thinking skills: a strategy for enhancing evidence based wellness care

    Directory of Open Access Journals (Sweden)

    Jamison Jennifer R

    2005-09-01

    Full Text Available Abstract Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of "wellness coaches". Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of interfacing with an increasingly evidence based health care system. Methods This case study describes how health may be promoted and disease prevented through development of personalized wellness programs. As critical thinking is essential to the provision of evidence based wellness care, diverse learning opportunities for developing and refining critical thinking skills have been created. Three of the learning opportunities are an intrinsic component of the subject and, taken together, contributed over 50% of the final grade of the unit. They include a literature review, developing a client wellness contract and peer evaluation. In addition to these 3 compulsory exercises, students were also given an opportunity to develop their critical appraisal skills by undertaking voluntary self- and unit evaluation. Several opportunities for informal self-appraisal were offered in a structured self-study guide, while unit appraisal was undertaken by means of a questionnaire and group discussion at which the Head of School was present. Results Formal assessment showed all students capable of preparing a wellness program consistent with current thinking in contemporary health care. The small group of students who appraised the unit seemed to value the diversity of learning experiences provided. Opportunities for voluntary unit and self-appraisal were used to varying degrees. Unit evaluation provided useful feedback that led to substantial changes in unit structure

  10. Cognitive Performance Associated With Self-care Activities in Mexican Adults With Type 2 Diabetes

    OpenAIRE

    Compeán Ortiz, Lidia Guadalupe; Gallegos Cabriales, Esther C; Gonzalez Gonzalez, Jose G; GÓMEZ MEZA, MARCO VINICIO; Therrien, Barbara; Salazar Gonzalez, Bertha C

    2010-01-01

    PURPOSE: The purpose of this study was to determine the effect of memory-learning on self-care activities in adults with type 2 diabetes moderated by previous education/understanding in diabetes and to explore the explicative capacity of age, gender, schooling, diabetes duration, and glycemic control in memory-learning. METHODS: A descriptive correlational study was conducted in a randomized sample of 105 Mexican adult patients with type 2 diabetes at a community-based outpatient clinic. Eval...

  11. When Antimicrobial Stewardship Isn't Watching: The Educational Impact of Critical Care Prospective Audit and Feedback.

    Science.gov (United States)

    Fleming, Dimitra; Ali, Karim F; Matelski, John; D'Sa, Ryan; Powis, Jeff

    2016-09-01

    Prospective audit and feedback (PAF) is an effective strategy to optimize antimicrobial use in the critical care setting, yet whether skills gained during PAF influence future antimicrobial prescribing is uncertain. This multisite study demonstrates that knowledge learned during PAF is translated and incorporated into the practice of critical care physicians even when not supported by an antimicrobial stewardship program. PMID:27382599

  12. Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

    OpenAIRE

    DuGoff, Eva H.; Bandeen-Roche, Karen; Anderson, Gerard F.

    2016-01-01

    Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. M...

  13. Critical Illness Polyneuromyopathy Developing After Diabetic Ketoacidosis in an Intensive Care Unit

    OpenAIRE

    Mehmet Salih Sevdi; Meltem Turkay; Tolga Totoz; Serdar Demirgan; Melahat Karatmanlı Erol; Ali Özalp; Kerem Erkalp; Ayşin Alagöl

    2015-01-01

    Critical illness polyneuromyopathy (CIPNM) is a primary axonal-degenerative condition that occurs in sensory and motor fibers after the onset of a critical illness. It is thought that it develops due to tissue damage due to hypoxia/ischemia. When 24-year-old female patient was followed in the intensive care unit (ICU) due to diabetic ketoacidosis, she was extubated on the second day. She was reintubated on the third day because of respiratory acidosis. Sedation was withdrawn on the fifth day,...

  14. CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS.

    Science.gov (United States)

    De Jongh, Ad; Resick, Patricia A; Zoellner, Lori A; van Minnen, Agnes; Lee, Christopher W; Monson, Candice M; Foa, Edna B; Wheeler, Kathleen; Broeke, Erik Ten; Feeny, Norah; Rauch, Sheila A M; Chard, Kathleen M; Mueser, Kim T; Sloan, Denise M; van der Gaag, Mark; Rothbaum, Barbara Olasov; Neuner, Frank; de Roos, Carlijn; Hehenkamp, Lieve M J; Rosner, Rita; Bicanic, Iva A E

    2016-05-01

    According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed. As reviewed in this paper, the research supporting the need for phase-based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase-based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front-line trauma-focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma-focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence-based treatments from which they might profit. PMID:26840244

  15. Predictors of Adult Quality of Life for Foster Care Alumni with Physical and/or Psychiatric Disabilities

    Science.gov (United States)

    Anctil, Tina M.; McCubbin, Laurie D.; O'Brien, Kirk; Pecora, Peter; Anderson-Harumi, Cheryl A.

    2007-01-01

    Introduction: This study used quality of life and resilience as theoretical frameworks for evaluating predictors of outcomes for adults who received foster care services alumni of foster care and were diagnosed with a physical or psychiatric disability while in foster care. Method: First, outcomes for foster care alumni with and without physical…

  16. Seroprevalence of hepatitis B and C virus in two institutions caring for mentally handicapped adults.

    OpenAIRE

    Cramp, M.E.; Grundy, H C; Perinpanayagam, R M; Barnado, D. E.

    1996-01-01

    Hepatitis B virus infection is common in institutions caring for the mentally handicapped. Hepatitis B virus and hepatitis C virus share routes of transmission but the prevalence of hepatitis C virus infection in this population is unknown. We have tested 101 patients from two institutions in South-East England caring for adults with mental handicap for the presence of hepatitis C antibody, hepatitis B core antibody, and if necessary hepatitis B surface antigen. None tested positive for hepat...

  17. [Respiratory care with prone position for diffuse atelectasis in critically ill patients].

    Science.gov (United States)

    Shichinohe, Y; Ujike, Y; Kurihara, M; Yamamoto, S; Oota, K; Tsukamoto, M; Imaizumi, H; Kaneko, M

    1991-01-01

    Diffuse atelectasis often occurs in the dorsal region of the lung of critically ill patients under long term mechanical ventilation. Conventional physical therapies (ex. PEEP, Sigh) have little effect on diffuse dorsal atelectasis. We provided respiratory care with prone position for 7 patients with severe respiratory distress (Two patients were treated twice). Improvement of their Respiratory Indexes (RI, mean 2.97) was obtained in the prone position for 6-163 (mean 35.8) hours. Ventilation efficiency also improved. Static lung compliance didn't change. It was assumed that the prone position was the factor responsible for the improvement of pulmonary V/Q ratio, the change of movement pattern of the diaphragm, and the ease of postural drainage of sputum. There were no complications. We conclude that prone position respiratory care has high utility for critically ill patients with diffuse dorsal atelectasis. PMID:2024073

  18. Validation of the Danish version of the Critical Care Pain Observation Tool

    DEFF Research Database (Denmark)

    Frandsen, J B; Poulsen, Kristian S.O.; Laerkner, E;

    2016-01-01

    BACKGROUND: Assessing pain in critically ill patients is a challenge even in an intensive care unit (ICU) with a no sedation protocol. The aim of this study was to validate the Danish version of the pain assessment method; Critical Care Pain Observation Tool (CPOT) in an ICU with a no sedation...... in the data collection and CPOT scores were blinded to each other. Calculations of interrater reliability, criterion validity and discriminant validity were performed to validate the Danish version of CPOT. RESULTS: The results indicated a good correlation between the two raters (all scores > 0.9 and P ....05). About 48 (68.6%) of the included patients were able to self-report pain. We found a significantly higher mean CPOT score at the nociceptive procedure than at rest or the non-nociceptive procedure (P

  19. Prophylactic use of dressings for pressure ulcer prevention in the critical care unit.

    Science.gov (United States)

    Thorpe, Elaine

    2016-06-23

    Multiple comorbidities and intensive therapy increase the risk of pressure ulcer (PU) development in critical care unit (CCU) patients. Given the high number of risk factors that CCU patients present with, it is important to acknowledge that not all PUs are entirely preventable, and incidence is thought to be between 14% and 42%. The consequences of acquiring a PU in critical care include increased mortality, morbidity and longer length of stay. Implementing prevention strategies as soon as the patient enters the unit can significantly reduce incidence. By adopting a proactive versus reactive mind-set, one CCU abandoned traditional PU risk assessment and implemented a number of intensive interventions, including the use of a prophylactic sacral dressing as an adjunct. As a result, PU incidence fell from 19.9 per 1000 patient population to 0.84 per 1000 patient population in 2014. In addition, 310 PU-free days were achieved. PMID:27345087

  20. Ultrasound findings in critical care patients: the "liver sign" and other abnormal abdominal air patterns.

    Science.gov (United States)

    Dahine, Joseph; Giard, Annie; Chagnon, David-Olivier; Denault, André

    2016-12-01

    In critical care patients, point of care abdominal ultrasound examination, although it has been practiced for over 30 years, is not as widespread as its cardiac or pulmonary counterparts. We report two cases in which detection of air during abdominal ultrasound allowed the early detection of life-threatening pathologies. In the first case, a patient with severe Clostridium difficile was found to have portal venous gas but its significance was confounded by a recent surgery. Serial ultrasonographic exams triggered a surgical intervention. In the second case, we report what we call the "liver sign" a finding in patients with pneumoperitoneum. These findings, all obtained prior to conventional abdominal imaging, had immediate clinical impact and avoided unnecessary delays and radiation. Detection of abdominal air should be part of the routine-focused ultrasonographic exam and for critically ill patients an algorithm is proposed. PMID:26968407

  1. Using Edward de Bono's six hats game to aid critical thinking and reflection in palliative care.

    Science.gov (United States)

    Kenny, Lesley J

    2003-03-01

    This article describes the use of a creative thinking game to stimulate critical thinking and reflection with qualified health professionals undertaking palliative care education. The importance of reflective practice in nursing is well documented and numerous models are available. However, the author as a nurse teacher has found that many of these models are either too simple or too complex to be valuable in practice. The six hats game, devised by Edward de Bono, is a method that stimulates a variety of types of thinking and when used as a means of reflection helps students to become more critical about their practice. Using this game with a palliative care case study the author demonstrates how thinking more creatively about the patients' perceived needs and problems can assist in developing reflective skills. The article concludes with a discussion on some of the challenges of using this method and suggestions for future practical uses.

  2. Advance care planning: A systematic review of randomised controlled trials conducted with older adults.

    Science.gov (United States)

    Weathers, Elizabeth; O'Caoimh, Rónán; Cornally, Nicola; Fitzgerald, Carol; Kearns, Tara; Coffey, Alice; Daly, Edel; O'Sullivan, Ronan; McGlade, Ciara; Molloy, D William

    2016-09-01

    Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors. PMID:27451328

  3. Critical appraisal skills training for health care professionals: a randomized controlled trial [ISRCTN46272378

    Directory of Open Access Journals (Sweden)

    Ewings Paul E

    2004-12-01

    Full Text Available Abstract Introduction Critical appraisal skills are believed to play a central role in an evidence-based approach to health practice. The aim of this study was to evaluate the effectiveness and costs of a critical appraisal skills educational intervention aimed at health care professionals. Methods This prospective controlled trial randomized 145 self-selected general practitioners, hospital physicians, professions allied to medicine, and healthcare managers/administrators from the South West of England to a half-day critical appraisal skills training workshop (based on the model of problem-based small group learning or waiting list control. The following outcomes were assessed at 6-months follow up: knowledge of the principles necessary for appraising evidence; attitudes towards the use of evidence about healthcare; evidence seeking behaviour; perceived confidence in appraising evidence; and ability to critically appraise a systematic review article. Results At follow up overall knowledge score [mean difference: 2.6 (95% CI: 0.6 to 4.6] and ability to appraise the results of a systematic review [mean difference: 1.2 (95% CI: 0.01 to 2.4] were higher in the critical skills training group compared to control. No statistical significant differences in overall attitude towards evidence, evidence seeking behaviour, perceived confidence, and other areas of critical appraisal skills ability (methodology or generalizability were observed between groups. Taking into account the workshop provision costs and costs of participants time and expenses of participants, the average cost of providing the critical appraisal workshops was approximately £250 per person. Conclusions The findings of this study challenge the policy of funding 'one-off' educational interventions aimed at enhancing the evidence-based practice of health care professionals. Future evaluations of evidence-based practice interventions need to take in account this trial's negative findings

  4. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

    OpenAIRE

    Connolly, Bronwen; Salisbury, Lisa; O'Neill, Brenda; Geneen, Louise; Douiri, Abdel; Grocott, Michael PW; Hart, Nicholas; Walsh, Timothy S; Blackwood, Bronagh; Griffith, David

    2015-01-01

    BACKGROUND: Skeletal muscle wasting and weakness are significant complications of critical illness, associated with degree of illness severity and periods of reduced mobility during mechanical ventilation. They contribute to the profound physical and functional deficits observed in survivors. These impairments may persist for many years following discharge from the intensive care unit (ICU) and can markedly influence health-related quality of life. Rehabilitation is a key strategy in the reco...

  5. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

    OpenAIRE

    Connolly, Bronwen; Salisbury, Lisa; O'Neill, Brenda; Geneen, Louise; Douiri, Abdel; Grocott, Michael P. W.; Hart, Nicholas; Walsh, Timothy S; Blackwood, Bronagh

    2015-01-01

    Background: Skeletal muscle wasting and weakness are significant complications of critical illness, associated with the degree of illness severity and periods of reduced mobility during mechanical ventilation. They contribute to the profound physical and functional deficits observed in survivors. These impairments may persist for many years following discharge from the intensive care unit (ICU) and may markedly influence health-related quality of life. Rehabilitation is a key strategy in the ...

  6. Video laryngoscopy in pre-hospital critical care – a quality improvement study

    OpenAIRE

    Rhode, Marianne Grønnebæk; Vandborg, Mads Partridge; Bladt, Vibeke; Rognås, Leif

    2016-01-01

    Background Pre-hospital endotracheal intubation is challenging and repeated endotracheal intubation is associated with increased morbidity and mortality. We investigated whether the introduction of the McGrath MAC video laryngoscope as the primary device for pre-hospital endotracheal intubation could improve first-pass success rate in our anaesthesiologist-staffed pre-hospital critical care services. We also investigated the incidence of failed pre-hospital endotracheal intubation, the use of...

  7. Mead Johnson Critical Care Symposium for the Practising Surgeon. 2. Complications of monitoring systems.

    Science.gov (United States)

    Todd, T R

    1988-09-01

    Current invasive monitoring techniques, although valuable in the care of critically ill patients, also have disadvantages. Complications of these techniques include errors in interpretation of measurements and complications of venous access and indwelling lines. To prevent these, the author recommends a standard routine for inserting and changing catheters, regular calibration of transducers and insertion of Swan-Ganz catheters with the balloon inflated with 1.0 to 1.5 ml of air. PMID:3046728

  8. Clinical accompaniment: the critical care nursing students’ experiences in a private hospital

    OpenAIRE

    N. Tsele; Marie Muller

    2000-01-01

    The quality of clinical accompaniment of the student enrolled for the post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General) is an important dimension of the educational/learning programme. The clinical accompanist/mentor is responsible for ensuring the student’s compliance with the clinical outcomes of the programme in accordance with the requirements laid down by the Nursing Education Institution and the South African Nursing Council. The purpose of this...

  9. The ethical dimension in published animal research in critical care: the dark side of our moon

    OpenAIRE

    Huet, Olivier; de Haan, Judy B.

    2014-01-01

    The replacement, refinement, and reduction (3Rs) guidelines are the cornerstone of animal welfare practice for medical research. Nowadays, no animal research can be performed without being approved by an animal ethics committee. Therefore, we should expect that any published article would respect and promote the highest standard of animal welfare. However, in the previous issue of Critical Care, Bara and Joffe reported an unexpected finding: animal welfare is extremely poorly reported in crit...

  10. Affordable Care Act Provision Had Similar, Positive Impacts For Young Adults With And Without Disabilities.

    Science.gov (United States)

    Porterfield, Shirley L; Huang, Jin

    2016-05-01

    Beginning in 2010 the Affordable Care Act (ACA) allowed young adults (ages 19-25) to remain on their parents' private health insurance plans, even if they were not full-time students. This study investigated the impact of the ACA on health insurance coverage for young adults with disabilities, comparing their experience with that of young adults without disabilities and that of a group of older adults (ages 26-34) with disabilities. We analyzed the periods 2006-09 and 2011-14, which were before and after implementation of the dependent coverage provision in the ACA, respectively. Coverage gains for older adults with disabilities were entirely attributable to changes in public insurance. Gains for young adults overall were driven by changes in private insurance. Both young adults with and without disabilities experienced a 4-percentage-point increase in private health insurance coverage between the two time periods, so the gap in private coverage between the two groups did not change significantly over time. Gains in coverage affected perhaps 2.9 million young adults overall and nearly 300,000 young adults with disabilities.

  11. A Periodization of North American Adult Education (1919-1970): A Critical Sociological Analysis of Trends and Perspectives

    Science.gov (United States)

    Grace, André P.

    2014-01-01

    This article provides a critical sociological analysis of trends and perspectives pervasive during the emergence of North American adult education (1919-1970). In discussing transitions during the first 50 years of what is considered modern practice, it draws on Webster E. Cotton's (1986, "On Behalf of Adult Education: A Historical…

  12. Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States: A Methodological Review.

    Science.gov (United States)

    Halpern, Neil A; Pastores, Stephen M

    2015-11-01

    This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the ICU bed supply, use, occupancy, and costs in the United States. Data for total ICU beds, use, and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System maintained by the federal Centers for Medicare and Medicaid Services and the proprietary Hospital Statistics of the American Hospital Association. Two costing methodologies can be used to calculate U.S. ICU costs: the Russell equation and national projections. Both methods are based on cost and use data from the national hospital datasets or from defined groups of hospitals or patients. At the national level, an understanding of U.S. ICU bed supply, use, occupancy, and costs helps provide clarity to the width and scope of the critical care medicine enterprise within the U.S. healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to critical care medicine and be better prepared to participate in their own local hospital organizations or regional critical care medicine programs. PMID:26308432

  13. How to protect incompetent clinical research subjects involved in critical care or emergency settings.

    Science.gov (United States)

    Zamperetti, Nereo; Piccinni, Mariassunta; Bellomo, Rinaldo; Citerio, Giuseppe; Mistraletti, Giovanni; Gristina, Giuseppe; Giannini, Alberto

    2016-04-01

    Clinical research is an essential component of medical activity, and this is also true in intensive care. Adequate information and consent are universally considered necessary for the protection of research subjects. However, in emergency situations, the majority of critical patients are unable to consent and a valid legal representative is often unavailable. The situation is even more complex in Italy, where the relevant legislation fails to specify how investigators should manage research in emergency or critical care setting when it involves incompetent patients who do not have an appointed legal representative. While special measures for the protection of incompetent subjects during emergency research are necessary, not allowing such research at all dooms critically ill patients to receive non-evidence-based treatments without the prospect of improvement. The recently-issued EU Regulation n. 536/2014 will probably help shed light on this situation. Indeed, it specifically addresses the issue of "research in emergency situations" and introduces detailed rules aimed at protecting patients while allowing research. In this article, we argue that obtaining informed consent during emergency research on incompetent subjects in unrealistic, and that in most cases substituted judgment on the part of a proxy carries major flaws. Strict criteria in evaluating the risk-benefit ratio of proposed intervention and a careful evaluation of the trial by a local or national Research Ethics Committee are perhaps the most practicable solution. PMID:26154445

  14. A Device for Automatically Measuring and Supervising the Critical Care Patient’S Urine Output

    Directory of Open Access Journals (Sweden)

    Roemi Fernández

    2010-01-01

    Full Text Available Critical care units are equipped with commercial monitoring devices capable of sensing patients’ physiological parameters and supervising the achievement of the established therapeutic goals. This avoids human errors in this task and considerably decreases the workload of the healthcare staff. However, at present there still is a very relevant physiological parameter that is measured and supervised manually by the critical care units’ healthcare staff: urine output. This paper presents a patent-pending device capable of automatically recording and supervising the urine output of a critical care patient. A high precision scale is used to measure the weight of a commercial urine meter. On the scale’s pan there is a support frame made up of Bosch profiles that isolates the scale from force transmission from the patient’s bed, and guarantees that the urine flows properly through the urine meter input tube. The scale’s readings are sent to a PC via Bluetooth where an application supervises the achievement of the therapeutic goals. The device is currently undergoing tests at a research unit associated with the University Hospital of Getafe in Spain.

  15. Mechanical circulatory assist devices: a primer for critical care and emergency physicians.

    Science.gov (United States)

    Sen, Ayan; Larson, Joel S; Kashani, Kianoush B; Libricz, Stacy L; Patel, Bhavesh M; Guru, Pramod K; Alwardt, Cory M; Pajaro, Octavio; Farmer, J Christopher

    2016-01-01

    Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment. Patients with LVADs who come to the ED or are admitted to the ICU usually have nonspecific clinical symptoms, most commonly shortness of breath, hypotension, anemia, chest pain, syncope, hemoptysis, gastrointestinal bleeding, jaundice, fever, oliguria and hematuria, altered mental status, headache, seizure, and back pain. Other patients are seen for cardiac arrest, psychiatric issues, sequelae of noncardiac surgery, and trauma. Although most patients have LVADs, some may have biventricular support devices or total artificial hearts. Involving a team of cardiac surgeons, perfusion experts, and heart-failure physicians, as well as ED and ICU physicians and nurses, is critical for managing treatment for these patients and for successful outcomes. This review is designed for critical care providers who may be the first to see these patients in the ED or ICU. PMID:27342573

  16. Care of Adults With Intellectual and Developmental Disabilities: Down Syndrome.

    Science.gov (United States)

    Wilson, Benjamin; Jones, Kyle Bradford; Weedon, Dean; Bilder, Deborah

    2015-12-01

    Down syndrome (DS) is a genetic disorder involving excess genetic material from chromosome 21. The incidence of DS is increasing, and the life expectancy for individuals with DS has increased to a median age of 55 years. Adults with DS are at increased risk of several conditions, including significant neurologic, cardiovascular, pulmonary, gastrointestinal, musculoskeletal, endocrine, psychiatric, hematologic, and social comorbidities, and additional screening or monitoring may be needed. Additional preventive measures for patients with DS include regular screening for thyroid dysfunction, hearing loss, eye disorders, heart disease, osteoporosis, and dementia, and one-time vaccination with the polyvalent pneumococcal polysaccharide vaccine (PPV23). Quality of life should be the main focus of treatment, with patients being involved in medical decisions as much as possible.

  17. Self-care behaviors and health indicators in adults with type 2 diabetes.

    Science.gov (United States)

    Compeán Ortiz, Lidia Guadalupe; Gallegos Cabriales, Esther Carlota; González González, José Gerardo; Gómez Meza, Marco Vinicio

    2010-01-01

    This descriptive correlational study aimed to analyze self-care behaviors and their relationship with health indicators represented by glycemic control, lipid profile, Body Mass Index [BMI], waist circumference and body fat percentage in a sample of 98 adults with type 2 diabetes in an area of Nuevo Leon, Mexico (August 2005/May 2006). The results showed a low self-care behaviors index (X = 36.94, SD=15.14). A significant relationship was found between self-care behaviors and glycosilated hemoglobin [HbA1c] (r s=-.379, pdiet was the most predictive for health indicators, moderated by gender and understanding of diabetes contents (p< .05).

  18. Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 2)

    LENUS (Irish Health Repository)

    Maher, Ann Butler

    2012-10-23

    The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus. This includes (in the first, earlier, part):\\r\

  19. Connecting teens to caring adults in a school-based health center: a case study.

    Science.gov (United States)

    Blacksin, Beth A; Kelly, Patricia J

    2015-01-01

    The traditional medical care system is generally unable to provide the broad health and wellness services needed by many adolescents, especially those from low-income and racial/ethnic minority communities. Using a theoretical framework adapted from Bronfenbrenner's ecological model of multiple influencers, this case study examined how a school-based health center was able to provide a network of connections for adolescents to caring adults within the school and the local community. Contributors to this network were the creation of a student-centered community with access to adolescent-friendly services, providers acting as connectors, and care of the whole adolescent.

  20. Critical care surveillance: insights into the impact of the 2010/11 influenza season relative to the 2009/10 pandemic season in England.

    Science.gov (United States)

    Green, H K; Ellis, J; Galiano, M; Watson, J M; Pebody, R G

    2013-01-01

    In 2010/11, the influenza season in England was marked by a relative increase in impact on the population compared to that seen during the 2009/10 pandemic, with the same influenza subtype, A(H1N1)pdm09, circulating. The peaks in critical care bed occupancy in both seasons coincided with peaks in influenza A(H1N1)pdm09 activity, but onset of influenza in 2010/11 additionally coincided with notably cold weather, a comparatively smaller peak in influenza B activity and increased reports of bacterial co-infection. A bigger impact on critical care services was seen across all regions in England in 2010/11, with, compared to 2009/10, a notable age shift in critical care admissions from children to young adults. The peak of respiratory syncytial virus (RSV) activity did not coincide with critical care admissions, and regression analysis suggested only a small proportion of critical care bed days might be attributed to the virus in either season. Differences in antiviral policy and improved overall vaccine uptake in 2010/11 with an influenza A(H1N1)pdm09 strain containing vaccine between seasons are unlikely to explain the change in impact observed between the two seasons. The reasons behind the relative high level of severe disease in the 2010/11 winter are likely to have resulted from a combination of factors, including an age shift in infection, accumulation of susceptible individuals through waning immunity, new susceptible individuals from new births and cold weather. The importance of further development of severe influenza disease surveillance schemes for future seasons is reinforced. PMID:23787130

  1. Food and Nutrition Practices and Education Needs in Florida's Adult Family Care Homes

    Science.gov (United States)

    Dahl, Wendy J.; Ford, Amanda L.; Gal, Nancy J.

    2014-01-01

    A statewide survey was carried out to determine food and nutrition practices and education needs of Florida's adult family care homes (AFCHs). The 30-item survey included questions on food and nutrition education, supplement use, and menu planning. Infrequent use of menus and nutrition supplements was reported. A strong need was indicated for…

  2. A Survey on Mental Health Care for Adults with Intellectual Disabilities in Asia

    Science.gov (United States)

    Kwok, H. W. M.; Chui, E. M. C.

    2008-01-01

    Background: Mental Health Services for adults with Intellectual Disabilities (ID) in Asia is less described than those in the western world. With the improvements in the economy and medical care in Asia, there is an increase in awareness of mental health services for people with ID in this part of the world. A study was carried out to look into…

  3. Functional prognosis of dizziness in older adults in primary care: a prospective cohort study.

    NARCIS (Netherlands)

    Dros, J.; Maarsingh, O.R.; Beem, L.; Horst, H.E. van der; Riet, G. ter; Schellevis, F.G.; Weert, H.C.P.M. van

    2012-01-01

    Objectives: To investigate the 6-month functional prognosis of dizziness in older adults in primary care, to identify important predictors of dizziness-related impairment, and to construct a score to assist risk prediction. Design: Prospective cohort study with 6-month follow-up. Setting: Twenty-fou

  4. Health and Social Care Interventions Which Promote Social Participation for Adults with Learning Disabilities: A Review

    Science.gov (United States)

    Howarth, Sharon; Morris, David; Newlin, Meredith; Webber, Martin

    2016-01-01

    People with learning disabilities are among the most socially excluded in society. There is a significant gap in research evidence showing how health and social care workers can intervene to improve the social participation of adults with learning disabilities. A systematic review and modified narrative synthesis was used to appraise the quality…

  5. Needing smart home technologies: the perspectives of older adults in continuing care retirement communities

    Directory of Open Access Journals (Sweden)

    Karen Courtney

    2008-11-01

    Conclusions Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary.

  6. Hazards of Immobility: Bedsores. Adult Residential Care Home, Lesson Plan No. 5.

    Science.gov (United States)

    Lin, Kathleen

    Developed as part of a 104-hour course on adult residential care homes (ARCHs), this 50-minute lesson is designed to enable a student to: (1) define a bedsore; (2) list and describe three major causes of bedsores; (3) identify potential bedsore sites in the back-lying, side-lying, and sitting positions; and (4) calculate the risk for developing…

  7. Health, Quality of Care and Quality of Life: A Case of Frail Older Adults

    Science.gov (United States)

    Hsieh, Chang-Ming

    2009-01-01

    This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…

  8. 76 FR 34541 - Child and Adult Care Food Program Improving Management and Program Integrity

    Science.gov (United States)

    2011-06-13

    ... improve Program management and integrity in the Child and Adult Care Food Program (CACFP), at 67 FR 43447 (June 27, 2002) and at 69 FR 53501 (September 1, 2004). Section 243 of Public Law 106-224, the... rule was issued in proposed form on September 12, 2000 (65 FR 55101). In response to State and...

  9. Care of the Older Adult in the Emergency Department: Nurses Views of the Pressing Issues

    Science.gov (United States)

    Boltz, Marie; Parke, Belinda; Shuluk, Joseph; Capezuti, Elizabeth; Galvin, James E.

    2013-01-01

    Purpose: The purpose of the study was to describe nurses' views of the issues to be addressed to improve care of the older adult in the emergency department (ED). Design and Methods: An exploratory content analysis examined the qualitative responses of 527 registered nurses from 49U.S. hospitals who completed the Geriatric Institutional Profile.…

  10. Low maternal care exacerbates adult stress susceptibility in the chronic mild stress rat model of depression

    DEFF Research Database (Denmark)

    Henningsen, Kim; Dyrvig, Mads; Bouzinova, Elena V;

    2012-01-01

    In the present study we report the finding that the quality of maternal care, in early life, increased the susceptibility to stress exposure in adulthood, when rats were exposed to the chronic mild stress paradigm. Our results indicate that high, as opposed to low maternal care, predisposed rats...... to a differential stress-coping ability. Thus rats fostered by low maternal care dams became more prone to adopt a stress-susceptible phenotype developing an anhedonic-like condition. Moreover, low maternal care offspring had lower weight gain and lower locomotion, with no additive effect of stress. Subchronic...... exposure to chronic mild stress induced an increase in faecal corticosterone metabolites, which was only significant in rats from low maternal care dams. Examination of glucocorticoid receptor exon 17 promoter methylation in unchallenged adult, maternally characterized rats, showed an insignificant...

  11. Suicide risk in primary care: identification and management in older adults.

    Science.gov (United States)

    Raue, Patrick J; Ghesquiere, Angela R; Bruce, Martha L

    2014-09-01

    The National Strategy for Suicide Prevention (2012) has set a goal to reduce suicides by 20% within 5 years. Suicide rates are higher in older adults compared to most other age groups, and the majority of suicide completers have visited their primary care physician in the year before suicide. Primary care is an ideal setting to identify suicide risk and initiate mental health care. We review risk factors for late-life suicide; methods to assess for different levels of suicidality; and recent research developments regarding both effective assessment and management of suicide risk among older primary care patients. We highlight that broader scale screening of suicide risk may be considered in light of findings that suicidality can occur even in the absence of major risk factors like depression. We also highlight collaborative care models targeting suicide risk, and recent innovative interventions that aim to prevent the development of suicidal ideation and suicidal behavior.

  12. The Longitudinal Elder Initiative: helping students learn to care for older adults.

    Science.gov (United States)

    Davis, Rebecca L; Beel-Bates, Cindy; Jensen, Susan

    2008-04-01

    This paper describes an educational innovation called the Longitudinal Elder Initiative (LEI), which was developed by a BSN program to improve students' knowledge about the health needs and nursing care of older adults. In the LEI, new nursing students are paired with older adults in the community and develop a relationship with them over the duration of the nursing program. Students complete a variety of assignments designed to facilitate learning gerontological nursing concepts. They also complete specific assessments designed to target common problems in aging. Students develop nursing care plans and interventions during the course of the project and monitor progress toward goals over time. Through the LEI, students develop relationships with older adults in the community and view their health changes longitudinally. In addition, students can observe how social, financial, and health-related factors affect health and well-being over time.

  13. Case-management for nursing care of patient with stroke: a cross-cultural critical reflective analysis

    OpenAIRE

    Theofanidis, Dimitrios

    2016-01-01

    Introduction: Stroke remains a heavy financial burden on health care systems around the world. Yet, health care reforms have called for sophisticated management systems in order to provide high-quality care on equal terms for the entire population within a cost-conscious environment.  Aim: The main aim of this discussion paper is to define and reflect cross-culturally on the merits of the Case-Management (CM) approach for contemporary stroke care delivery. Methods: Critical refle...

  14. Documentation of best interest by intensivists: a retrospective study in an Ontario critical care unit

    Directory of Open Access Journals (Sweden)

    Scales Damon C

    2010-02-01

    Full Text Available Abstract Background Intensive care physicians often must rely on substitute decision makers to address all dimensions of the construct of "best interest" for incapable, critically ill patients. This task involves identifying prior wishes and to facilitate the substitute decision maker's understanding of the incapable patient's condition and their likely response to treatment. We sought to determine how well such discussions are documented in a typical intensive care unit. Methods Using a quality of communication instrument developed from a literature search and expert opinion, 2 investigators transcribed and analyzed 260 handwritten communications for 105 critically ill patients who died in the intensive care unit between January and June 2006. Cohen's kappa was calculated before analysis and then disagreements were resolved by consensus. We report results on a per-patient basis to represent documented communication as a process leading up to the time of death in the ICU. We report frequencies and percentages for discrete data, median (m and interquartile range (IQR for continuous data. Results Our cohort was elderly (m 72, IQR 58-81 years and had high APACHE II scores predictive of a high probability of death (m 28, IQR 23-36. Length of stay in the intensive care unit prior to death was short (m 2, IQR 1-5 days, and withdrawal of life support preceded death for more than half (n 57, 54%. Brain death criteria were present for 18 patients (17%. Although intensivists' communications were timely (median 17 h from admission to critical care, the person consenting on behalf of the incapable patient was explicitly documented for only 10% of patients. Life support strategies at the time of communication were noted in 45% of charts, and options for their future use were presented in 88%. Considerations relevant to determining the patient's best interest in relation to the treatment plan were not well documented. While explicit survival estimates were

  15. Critical feeding periods for last instar nymphal and pharate adults of the whiteflies, Trialeurodes vaporariorum and Bemisia tabaci.

    Science.gov (United States)

    Gelman, Dale B; Hu, Jing S

    2007-01-01

    A critical feeding period is the time after which 50% of a given species of insect can be removed from its food source and complete development by undergoing adult eclosion. The critical feeding period was determined for the greenhouse white fly, Trialeurodes vaporariorum, and the sweet potato whitefly, Bemisia tabaci (Biotype B) (Homptera/Hemiptera: Aleyrodidae). Fourth (last) instar and pharate adult whiteflies were removed from green bean leaves, staged, placed on filter paper in small Petri dishes containing drops of water, and observed daily for eclosion. For T. vaporariorum reared at 25 degrees C and L:D 16:8, 55 and 80% adult eclosion were observed when whiteflies were removed at stages 4 (0.23-0.26 mm in body depth) and 5 (> or = 0.27 mm in body depth), respectively, so that at least 50% eclosion was only achieved in this species of whitefly when adult eye development had already been initiated (in Stage 4), and 80% eclosion when adult wing development had been initiated (Stage 5). In contrast, 63% of B. tabaci emerged as adults if removed from the leaf at Stage 3 (0.18-0.22 mm in body depth), and 80% emerged if removed at Stage 4/5, stages in which adult formation had not yet been initiated. The mean number of eggs laid by experimental (those removed at Stages 4-5, 6-7 or 8-9) and control (those that remained on the leaf prior to eclosion) whiteflies, and the mean percent hatch of these eggs were not significantly different in experimental and control groups. Stages 7, 8 and 9 are characterized by a light red adult eye, medium red bipartite adult eye and dark red or red-black bipartite adult eye, respectively. Mean adult longevity also was not significantly different between experimental and control groups. However, for all groups of T. vaporariorum, adult female longevity was significantly (at least 2 times) greater than male longevity. Our results identify the critical feeding periods for last instar/pharate adults of two important pest species of

  16. Provision of Transition Education and Referral Patterns from Pediatric Cardiology to Adult Cardiac Care.

    Science.gov (United States)

    Harbison, Anna L; Grady, Stafford; Chi, Kevin; Fernandes, Susan M

    2016-02-01

    ACC/AHA guidelines recommend a structured preparation for and transfer to adult-oriented cardiac care for adult survivors of pediatric onset heart disease (POHD). Given this, we sought to describe the transition and transfer practices for a cohort of young adults with POHD and to determine factors associated with successful transfer to adult-oriented cardiac care. We performed a single-center, retrospective chart review on patients ≥18 years of age, with POHD likely to require lifelong cardiac care, who were seen in outpatient pediatric cardiology (PC) between 2008 and 2011. Successful transfer was defined as the subsequent attendance at adult cardiology (AC) within 2 years of PC visit. We identified 118 patients who met study criteria. Mean age 22.4 ± 2.0 years, 59 % male, 64 % white and 40 % Hispanic. Mean transition education topics noted was 3.3 ± 1.8 out of 20 and covered the underlying cardiac disease (89 %), follow-up and current medications (56 %) and exercise limitations (34 %). Recommendations for follow-up were AC (57 %) and PC (33 %). Of those told to transfer to AC, 79 % successfully transferred. Characteristics of successful transfer included: prior cardiac surgery (p = 0.008), cardiac medication use (p = 0.006) and frequency of follow-up ≤1 year (p = 0.037). One-quarter of all subjects did not follow-up within at least 2 years. Despite published guidelines, transition education appears lacking and the approach to transfer to adult cardiac care is not consistent. Given the increased risk of morbidity and mortality in this patient population, standardization of transition education and transfer processes appear warranted. PMID:26385471

  17. "Fighting the system": Families caring for ventilator-dependent children and adults with complex health care needs at home

    Directory of Open Access Journals (Sweden)

    Nielsen Erik W

    2011-07-01

    Full Text Available Abstract Background An increasing number of individuals with complex health care needs now receive life-long and life-prolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation. Methods Using qualitative research methods, a Grounded Theory influenced approach was used to explore the families' experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults were recruited for 10 in-depth interviews. Results The core category, "fighting the system," became the central theme as family members were asked to describe their experiences. In addition, we identified three subcategories, "lack of competence and continuity", "being indispensable" and "worth fighting for". This study revealed no major differences in the families' experiences that were dependent on whether the ventilator-dependent individual was a child or an adult. Conclusions These findings show that there is a large gap between family members' expectations and what the community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further.

  18. Taking values seriously: Ethical challenges in organ donation and transplantation for critical care professionals.

    Science.gov (United States)

    Aulisio, Mark P; Devita, Michael; Luebke, Donna

    2007-02-01

    Last year, >28,000 people received organ transplants from >14,000 donors in the United States. Unfortunately, the wait list now tops 91,000, with the gap between recipient needs and available donor organs at around 60,000. This has motivated a host of efforts to increase organ supply, including driver's license and donor registry initiatives, educational and advertising campaigns, and "required request" and mandatory Organ Procurement Organization notification when a patient's death is imminent. Other more controversial efforts to increase the donor pool include expanded criteria for cadaveric donors, such as older or sicker donors and so-called non-heart-beating donation, now referred to as donation after cardiac death. Perhaps the most controversial of all efforts to address the organ shortage have focused on increasing the number of living organ donors, which in 2001 for the first time exceeded the number of cadaveric donors. Critical care professionals know the sad reality behind the statistical scarcity of organ supply. They must manage anxious patients and family members who may be waiting for an organ that never comes, triage patients into and out of the intensive care unit, and work through the propriety of shifting goals from cure to comfort when those same patients deteriorate to the point that transplant may no longer be an appropriate medical option or when a transplant fails. Equally significant ethical challenges arise on the donor side, whether it is working through difficult end-of-life decisions, identifying when to call the organ procurement organization, caring for brain-dead patients, managing a candidate for donation after cardiac death, or caring for a living donor postoperatively. This article discusses some of the difficult ethical challenges raised by organ donation and transplantation for critical care professionals, focusing on end-of-life decision making, donation after cardiac death, and living organ donation. PMID:17242610

  19. Smart Care™ versus respiratory physiotherapy–driven manual weaning for critically ill adult patients: a randomized controlled trial

    OpenAIRE

    Taniguchi, Corinne; Elivane S Victor; Pieri, Talita; Henn, Renata; Santana, Carolina; Giovanetti, Erica; Saghabi, Cilene; Timenetsky, Karina; Caserta Eid, Raquel; Silva, Eliezer; Matos, Gustavo F. J.; Guilherme P. P. Schettino; Barbas, Carmen S. V.

    2015-01-01

    Introduction A recent meta-analysis showed that weaning with SmartCare™ (Dräger, Lübeck, Germany) significantly decreased weaning time in critically ill patients. However, its utility compared with respiratory physiotherapist–protocolized weaning is still a matter of debate. We hypothesized that weaning with SmartCare™ would be as effective as respiratory physiotherapy–driven weaning in critically ill patients. Methods Adult critically ill patients mechanically ventilated for more than 24 hou...

  20. Critical illness myopathy and polyneuropathy - A challenge for physiotherapists in the intensive care units

    Directory of Open Access Journals (Sweden)

    Renu B Pattanshetty

    2011-01-01

    Full Text Available The development of critical patient related generalized neuromuscular weakness, referred to as critical illness polyneuropathy (CIP and critical illness myopathy (CIM, is a major complication in patients admitted to intensive care units (ICU. Both CIP and CIM cause muscle weakness and paresis in critically ill patients during their ICU stay. Early mobilization or kinesiotherapy have shown muscle weakness reversion in critically ill patients providing faster return to function, reducing weaning time, and length of hospitalization. Exercises in the form of passive, active, and resisted forms have proved to improve strength and psychological well being. Clinical trials using neuromuscular electrical stimulation to increase muscle mass, muscle strength and improve blood circulation to the surrounding tissue have proved beneficial. The role of electrical stimulation is unproven as yet. Recent evidence indicates no difference between treated and untreated muscles. Future research is recommended to conduct clinical trials using neuromuscular electrical stimulation, exercises, and early mobilization as a treatment protocol in larger populations of patients in ICU.

  1. Prevalence of oral pain and barriers to use of emergency oral care facilities among adult Tanzanians

    Directory of Open Access Journals (Sweden)

    Kahabuka Febronia

    2008-09-01

    Full Text Available Abstract Background Oral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania. Methods Questionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations. Results Forty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%; self medication (17.6%; respondents thinking that pain would disappear with time (15.7%; and lack of money to pay for transport to the dental clinic (15.0%. Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07–1.57, P dental clinics far from home (OR = 5.31, CI = 2.09–13.54, P and being treated by traditional healer (OR = 5.31, CI = 2.25–12.49, P as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas. Conclusion Oral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended.

  2. The meaning of posttraumatic stress-reactions following critical illness or injury and intensive care treatment.

    Science.gov (United States)

    Corrigan, Ingrid; Samuelson, Karin A M; Fridlund, Bengt; Thomé, Bibbi

    2007-08-01

    Traumatic events connected with a critical condition and treatment in the intensive care unit (ICU) may result in subsequent posttraumatic stress-reactions. The aim of this phenomenological study was to describe the meaning of posttraumatic stress-reactions as experienced by individuals following a critical illness or injury and intensive care. Fourteen informants, testing positive for posttraumatic stress-reactions as a clinical concern, were interviewed. The data was analysed following the principles indicated by Giorgi [Giorgi A. The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure. J Phenomenol Psychol 1997;28:235-61]. The essence of the phenomenon of posttraumatic stress-reactions was understood as a transition to a life-situation beyond control, where the traumatic experiences have a profound impact and are ever-present. The variations of the phenomenon presented themselves as a need to make sense of the traumatic memories, which live on; being haunted by the trauma; a need to escape; distress and strain in the life-situation; transformation of self and, finally, interactions with others affected. The need for caring strategies and support is emphasised, both in the ICU and afterwards, thus preventing or alleviating some of the suffering. PMID:17449252

  3. Development road of critical care medicine in China: reference, integration and improvement

    Directory of Open Access Journals (Sweden)

    Hai-tao ZHANG

    2013-07-01

    Full Text Available Fundamental critical care medicine (FCCM and specialty critical care medicine (SCCM have their own independent developmental itinerary and have made indelible contributions to intensive treatment in the long history of CCM. The experts in FCCM are usually dominant in the cross-sectional study for various severe illnesses, and lay emphases on balancing the relationship among the dysfunctional organs under the guidance of overall treatment concept. SCCM experts emphasize longitudinal in-depth study for a specialized subject or special disease in order to solve the principal problem of the severe illness under the guidance of its own principal. At present, the main challenge of CCM is to avoid the habitual linear thinking. It is necessary for the members of FCCM to learn the knowledge of different problems pertaining to various specialties from SCCM, thus FCCM doctors would be able to take care of patients suffering from derangements of specific organs. SCCM members also need to learn from FCCM for strengthening the concept of overall treatment, optimizing various treatment resources, and improving treatment effects. Members of FCCM and SCCM need to learn from each other, in order to integrate and improve treatment strategies together, so as to complement each other. This will broaden the knowledge of SCCM and deepen that of FCCM. The integration of knowledge and skill will enrich the connotation of the CCM.

  4. Factors affecting ED length-of-stay in surgical critical care patients.

    Science.gov (United States)

    Davis, B; Sullivan, S; Levine, A; Dallara, J

    1995-09-01

    To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated with prolonged ED LOS, such as use of computed tomographic (CT), radiology special procedures, and the number of plain radiographs and consultants. ED LOS was considered to be the time from triage until a decision was made to admit the patient. Using a Cox proportional hazards model, use of CT and special procedures were the strongest independent predictors of prolonged ED length-of-stay. The number of plain radiographs and consultants had only a minimal effect. Use of a protocol-driven trauma evaluation system was associated with a shorter ED LOS. In addition to external factors that affect ED overcrowding, ED patient management decisions may also be associated with prolonged ED length-of-stay. Such ED-based factors may be more important in surgical critical care patients, whose overall ED LOS is affected more by the length of the ED work-up rather than the time spent waiting for a ICU bed or operating suite.

  5. Risk Factors for Acute Kidney Injury in Older Adults With Critical Illness: A Retrospective Cohort Study

    Science.gov (United States)

    Kane-Gill, Sandra L.; Sileanu, Florentina E.; Murugan, Raghavan; Trietley, Gregory S.; Handler, Steven M.; Kellum, John A.

    2014-01-01

    Background Risk for acute kidney injury (AKI) in older adults has not been systematically evaluated. We sought to delineate the determinants of risk for AKI in older compared to younger adults. Study Design Retrospective analysis of patients hospitalized in July 2000–September 2008. Setting & Participants We identified all adult patients admitted to an intensive care unit (ICU) (n=45,655) in a large tertiary care university hospital system. We excluded patients receiving dialysis or kidney transplant prior to hospital admission, and patients with baseline creatinine ≥ 4 mg/dl, liver transplantation, indeterminate AKI status, or unknown age, leaving 39,938 patients. Predictor We collected data on multiple susceptibilities and exposures including age, sex, race, body mass, comorbid conditions, severity of illness, baseline kidney function, sepsis, and shock. Outcomes We defined AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. We examined susceptibilities and exposures across age strata for impact on development of AKI. Measurements We calculated area under the receiver operating characteristic curve (AUC) for prediction of AKI across age groups. Results 25,230 patients (63.2%) were aged 55 years or older. Overall 25,120 patients (62.9%) developed AKI (69.2% aged 55 years or older). Examples of risk factors for AKI in the oldest age category (75 years or older) were drugs (vancomycin, aminoglycosides, nonsteroidal anti-inflammatories), history of hypertension (OR, 1.13; 95% CI, 1.02–1.25) and sepsis (OR, 2.12; 95% CI, 1.68–2.67). Fewer variables remained predictive of AKI as age increased and the model for older patients was less predictive (p<0.001). For the age categories 18–54, 55–64, 65–74, and 75 years or older, the AUCs were 0.744 (95% CI, 0.735–0.752), 0.714 (95% CI, 0.702–0.726), 0.706 (95% CI, 0.693–0.718), and 0.673 (95% CI, 0.661–0.685), respectively. Limitations Analysis may not apply to non-ICU patients

  6. Activating Older Adults With Serious Mental Illness for Collaborative Primary Care Visits

    Science.gov (United States)

    Bartels, Stephen J.; Aschbrenner, Kelly A.; Rolin, Stephanie A.; Hendrick, Delia Cimpean; Naslund, John A.; Faber, Marjan J.

    2016-01-01

    Objective Persons with serious mental illness frequently receive inadequate medical care and are more likely to experience difficulty navigating the health care system compared with the general population. To address this gap in quality, we developed a program of peer co-led collaborative activation training for primary care (CAT-PC) designed to improve “patient activation” and person-centered care in primary care visits for middle-aged and older adults with serious mental illness and cardiovascular risk. This report presents pilot study feasibility and participant outcomes for CAT-PC. Method A pre-post pilot evaluation of CAT-PC included N = 17 adults (age ≥ 50) with serious mental illness and cardiovascular health risk conditions, and N = 6 primary care providers. CAT-PC consists of 9 weekly peer co-led patient education and skills training sessions and a 45-min video-based training for primary care providers. Pre-post measures included the Patient Activation Measure (PAM), Perceived Efficacy in Patient-Physician Interactions (PEPPI), Autonomy Preference Index (API) for preferred role in primary care encounters, and Social Skills Performance Assessment (SSPA) role-play test for medical visits. Results All 17 participants attended 5 or more sessions. Post-intervention improvement was found for patient activation and simulated performance of medical visit communication skills. Trends were observed for improved self-efficacy in provider interactions and greater preference for a more collaborative role in decision-making. Conclusions and Implications CAT-PC is a brief, peer co-led education and skills training intervention potentially improving patient activation in primary care encounters and providing an important missing component in emerging models of “patient-centered behavioral health homes” for this high-risk group. PMID:24219769

  7. Validation of an information–motivation–behavioral skills model of self-care among Chinese adults with type 2 diabetes

    OpenAIRE

    Gao, Junling; Wang, Jingli; Zhu, Yaocheng; Yu, Jinming

    2013-01-01

    Background Self-care is a crucial component of diabetes management. But comprehensive behavior change frameworks are needed to provide guidance for the design, implementation, and evaluation of diabetes self-care programs in diverse populations. We tested the Information–Motivation–Behavioral Skills (IMB) model in a sample of Chinese adults with Type 2 diabetes. Methods A cross-sectional study of 222 Chinese adults with type 2 diabetes was conducted in a primary care center. We collected info...

  8. European legislation impedes critical care research and fails to protect patients' rights

    DEFF Research Database (Denmark)

    Berg, Ronan M G; Møller, Kirsten; Rossel, Peter Johannes Hancke

    2011-01-01

    The European Clinical Trials Directive requires an informed consent from the patient or a proxy in drug trials. Although informed consent is a valuable tool to protect patients' rights in clinical trials, this requirement largely impedes research in critical care settings, and if pursued in this ......The European Clinical Trials Directive requires an informed consent from the patient or a proxy in drug trials. Although informed consent is a valuable tool to protect patients' rights in clinical trials, this requirement largely impedes research in critical care settings, and if pursued...... in this context, it does not provide the patient with adequate protection. Instead of insisting on informed consent, we suggest that the focus should be shifted towards two other ethically relevant elements in human experimentation: risk assessment and selection of research subjects. When reviewing protocols...... in which a waiver of consent is deemed necessary, the Ethical Review Board should ensure that non-therapeutic risks are minimal, that the research is specifically designed to benefit critically ill patients, and that it cannot be conducted under circumstances where an informed consent can be obtained...

  9. Delivering Flexible Education and Training to Health Professionals: Caring for Older Adults in Disasters.

    Science.gov (United States)

    Altman, Brian A; Gulley, Kelly H; Rossi, Carlo; Strauss-Riggs, Kandra; Schor, Kenneth

    2016-08-01

    The National Center for Disaster Medicine and Public Health (NCDMPH), in collaboration with over 20 subject matter experts, created a competency-based curriculum titled Caring for Older Adults in Disasters: A Curriculum for Health Professionals. Educators and trainers of health professionals are the target audience for this curriculum. The curriculum was designed to provide breadth of content yet flexibility for trainers to tailor lessons, or select particular lessons, for the needs of their learners and organizations. The curriculum covers conditions present in the older adult population that may affect their disaster preparedness, response, and recovery; issues related to specific types of disasters; considerations for the care of older adults throughout the disaster cycle; topics related to specific settings in which older adults receive care; and ethical and legal considerations. An excerpt of the final capstone lesson is included. These capstone activities can be used in conjunction with the curriculum or as part of stand-alone preparedness training. This article describes the development process, elements of each lesson, the content covered, and options for use of the curriculum in education and training for health professionals. The curriculum is freely available online at the NCDMPH website at http://ncdmph.usuhs.edu (Disaster Med Public Health Preparedness. 2016;10:633-637). PMID:27109606

  10. Medication transitions and polypharmacy in older adults following acute care

    Directory of Open Access Journals (Sweden)

    Gamble JM

    2014-03-01

    Full Text Available John-Michael Gamble,1,* Jill J Hall,2,* Thomas J Marrie,3 Cheryl A Sadowski,2 Sumit R Majumdar,4 Dean T Eurich5 1School of Pharmacy, Memorial University of Newfoundland, St John's, NL, 2Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, 3Faculty of Medicine, Dalhousie University, Halifax, NS, 4Faculty of Medicine and Dentistry, 5School of Public Health, University of Alberta, Edmonton, AB, Canada *These authors contributed equally to this work Background/objective: Medication changes at transitions of care and polypharmacy are growing concerns that adversely impact optimal drug use. We aimed to describe transitions and patterns of medication use before and 1 year after older patients were hospitalized for community-acquired pneumonia, the second-most common reason for admission in North America. Materials and methods: This was an analysis of a population-based clinical registry of patients treated in any of the six hospitals or seven emergency departments in Edmonton, Alberta, Canada, comprising 2,105 patients 65 years and older with community-acquired pneumonia who had survived at least 1 year. The prevalence of polypharmacy (five or more unique prescription drugs, as well as new use and persistence of common drug classes were assessed. Results: The mean age was 78 years (standard deviation 8 years, 50% were female, 62% were hospitalized, and 58% had severe pneumonia. Among the 2,105 patients, 949 (45% were using five or more medications prior to hospitalization, increasing to 1,559 (74% within 90 days postdischarge and remaining over 70% at 1 year. Overall, 1,690 (80% patients newly started and 1,553 (74% patients stopped at least one medication in the first 90 days of follow-up. The prevalence of the most common drug classes (ie, cardiovascular, alimentary/metabolism remained stable, with the exception of anti-infective agents, whereby 25% of patients were dispensed an anti-infective agent 3 months to 1 year

  11. Skin care in nursing: A critical discussion of nursing practice and research.

    Science.gov (United States)

    Kottner, Jan; Surber, Christian

    2016-09-01

    Skin (self-)care is part of human life from birth until death. Today many different skin care practices, preferences, traditions and routines exist in parallel. In addition, preventive and therapeutic skin care is delivered in nursing and healthcare by formal and informal caregivers. The aim of this contribution is a critical discussion about skin care in the context of professional nursing practice. An explicit skin assessment using accurate diagnostic statements is needed for clinical decision making. Special attention should be paid on high risk skin areas, which may be either too dry or too moist. From a safety perspective the protection and maintenance of skin integrity should have the highest priority. Skin cleansing is the removal of unwanted substances from the skin surface. Despite cleansing efficacy soap, other surfactants and water will inevitably always result in the destruction of the skin barrier. Thousands of products are available to hydrate, moisturize, protect and restore skin properties dependent upon their formulation and the concentration of ingredients. These products intended to left in contact with skin exhibit several actions on and in the skin interfering with skin biology. Unwanted side effects include hyper-hydration and disorganization of lipid bilayers in the stratum corneum, a dysfunctional barrier, increased susceptibility to irritants and allergies, and increases of skin surface pH. Where the skin barrier is impaired appropriate interventions, e.g. apply lipophilic products in sufficient quantity to treat dry skin or protect the skin from exposure to irritants should be provided. A key statement of this contribution is: every skin care activity matters. Every time something is placed on the skin, a functional and structural response is provoked. This response can be either desired or undesired, beneficial or harmful. The choice of all skin care interventions in nursing and healthcare practice must be based on an accurate assessment

  12. Skin care in nursing: A critical discussion of nursing practice and research.

    Science.gov (United States)

    Kottner, Jan; Surber, Christian

    2016-09-01

    Skin (self-)care is part of human life from birth until death. Today many different skin care practices, preferences, traditions and routines exist in parallel. In addition, preventive and therapeutic skin care is delivered in nursing and healthcare by formal and informal caregivers. The aim of this contribution is a critical discussion about skin care in the context of professional nursing practice. An explicit skin assessment using accurate diagnostic statements is needed for clinical decision making. Special attention should be paid on high risk skin areas, which may be either too dry or too moist. From a safety perspective the protection and maintenance of skin integrity should have the highest priority. Skin cleansing is the removal of unwanted substances from the skin surface. Despite cleansing efficacy soap, other surfactants and water will inevitably always result in the destruction of the skin barrier. Thousands of products are available to hydrate, moisturize, protect and restore skin properties dependent upon their formulation and the concentration of ingredients. These products intended to left in contact with skin exhibit several actions on and in the skin interfering with skin biology. Unwanted side effects include hyper-hydration and disorganization of lipid bilayers in the stratum corneum, a dysfunctional barrier, increased susceptibility to irritants and allergies, and increases of skin surface pH. Where the skin barrier is impaired appropriate interventions, e.g. apply lipophilic products in sufficient quantity to treat dry skin or protect the skin from exposure to irritants should be provided. A key statement of this contribution is: every skin care activity matters. Every time something is placed on the skin, a functional and structural response is provoked. This response can be either desired or undesired, beneficial or harmful. The choice of all skin care interventions in nursing and healthcare practice must be based on an accurate assessment

  13. An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care.

    Science.gov (United States)

    Peltonen, Laura-Maria; McCallum, Louise; Siirala, Eriikka; Haataja, Marjaana; Lundgrén-Laine, Heljä; Salanterä, Sanna; Lin, Frances

    2015-01-01

    The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22-67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review. PMID:26558286

  14. An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care

    Directory of Open Access Journals (Sweden)

    Laura-Maria Peltonen

    2015-01-01

    Full Text Available The literature shows that delayed admission to the intensive care unit (ICU and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients’ admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1 explanatory research about discharge delays is scarce and one study on admission delays was found, (2 delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3 redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.

  15. Evaluating components of dental care utilization among adults with diabetes and matched controls via hurdle models

    Directory of Open Access Journals (Sweden)

    Chaudhari Monica

    2012-07-01

    Full Text Available Abstract Background About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental care utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes. Methods Data included secondary enrollment and demographic data from Washington Dental Service (WDS and Group Health Cooperative (GH, clinical data from GH, and dental-utilization data from WDS claims during 2002–2006. Dental and medical records from WDS and GH were linked for enrolees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups. Results We found that adults with diabetes had lower odds of visiting a dentist (OR = 0.74, p  0.001. Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxes (OR = 0.77, fillings (OR = 0.80 and crowns (OR = 0.84 (p 0.005 for all and higher odds of receiving periodontal maintenance (OR = 1.24, non-surgical periodontal procedures (OR = 1.30, extractions (OR = 1.38 and removable prosthetics (OR = 1.36 (p  Conclusions Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes.

  16. Concerns about usage of smartphones in operating room and critical care scenario

    Directory of Open Access Journals (Sweden)

    J P Attri

    2016-01-01

    Full Text Available Smartphones and tablets have taken a central place in the lives of health care professionals. Their use has dramatically improved the communication and has become an important learning tool as the medical information can be assessed online at anytime. In critical care settings, use of smartphone facilitates quick passage of information through E-mail messaging and getting feedback from the concerned physician quickly, thereby reducing medical errors. However, in addition to the benefits offered, these devices have become a significant source of nosocomial infections, distraction for medical professionals and interfere with medical equipments. They may also put privacy and security of patients at stake. The benefits could be severely undermined if abuse and over use are not kept in check. This review article focuses on various applications of smartphones in healthcare practices, drawback of the use of these devices and the recommendations regarding the safe use of these devices.

  17. Computer-assisted learning in critical care: from ENIAC to HAL.

    Science.gov (United States)

    Tegtmeyer, K; Ibsen, L; Goldstein, B

    2001-08-01

    Computers are commonly used to serve many functions in today's modern intensive care unit. One of the most intriguing and perhaps most challenging applications of computers has been to attempt to improve medical education. With the introduction of the first computer, medical educators began looking for ways to incorporate their use into the modern curriculum. Prior limitations of cost and complexity of computers have consistently decreased since their introduction, making it increasingly feasible to incorporate computers into medical education. Simultaneously, the capabilities and capacities of computers have increased. Combining the computer with other modern digital technology has allowed the development of more intricate and realistic educational tools. The purpose of this article is to briefly describe the history and use of computers in medical education with special reference to critical care medicine. In addition, we will examine the role of computers in teaching and learning and discuss the types of interaction between the computer user and the computer. PMID:11496040

  18. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine

    Science.gov (United States)

    Brierley, Joe; Carcillo, Joseph A.; Choong, Karen; Cornell, Tim; DeCaen, Allan; Deymann, Andreas; Doctor, Allan; Davis, Alan; Duff, John; Dugas, Marc-Andre; Duncan, Alan; Evans, Barry; Feldman, Jonathan; Felmet, Kathryn; Fisher, Gene; Frankel, Lorry; Jeffries, Howard; Greenwald, Bruce; Gutierrez, Juan; Hall, Mark; Han, Yong Y.; Hanson, James; Hazelzet, Jan; Hernan, Lynn; Kiff, Jane; Kissoon, Niranjan; Kon, Alexander; Irazusta, Jose; Lin, John; Lorts, Angie; Mariscalco, Michelle; Mehta, Renuka; Nadel, Simon; Nguyen, Trung; Nicholson, Carol; Peters, Mark; Okhuysen-Cawley, Regina; Poulton, Tom; Relves, Monica; Rodriguez, Agustin; Rozenfeld, Ranna; Schnitzler, Eduardo; Shanley, Tom; Skache, Sara; Skippen, Peter; Torres, Adalberto; von Dessauer, Bettina; Weingarten, Jacki; Yeh, Timothy; Zaritsky, Arno; Stojadinovic, Bonnie; Zimmerman, Jerry; Zuckerberg, Aaron

    2013-01-01

    Background The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote “best practices” and to improve patient outcomes. Objective 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock. Participants Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001–2006). Methods The Pubmed/MEDLINE literature database (1966–2006) was searched using the keywords and phrases: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation (ECMO), and American College of Critical Care Medicine guidelines. Best practice centers that reported best outcomes were identified and their practices examined as models of care. Using a modified Delphi method, 30 experts graded new literature. Over 30 additional experts then reviewed the updated recommendations. The document was subsequently modified until there was greater than 90% expert consensus. Results The 2002 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and AHA sanctioned recommendations. Centers that implemented the 2002 guidelines reported best practice outcomes (hospital mortality 1%–3% in previously healthy, and 7%– 10% in chronically ill children). Early use of 2002 guidelines was associated with improved outcome in the community hospital emergency department (number needed to treat = 3.3) and tertiary pediatric intensive care setting (number needed to treat = 3.6); every hour that went by without guideline adherence was associated with a 1.4-fold increased mortality risk. The updated 2007 guidelines continue to recognize an increased likelihood that

  19. Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness.

    Science.gov (United States)

    Duggleby, Wendy; Robinson, Carole A; Kaasalainen, Sharon; Pesut, Barbara; Nekolaichuk, Cheryl; MacLeod, Roderick; Keating, Norah C; Santos Salas, Anna; Hallstrom, Lars K; Fraser, Kimberly D; Williams, Allison; Struthers-Montford, Kelly; Swindle, Jennifer

    2016-06-01

    Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts - in rural aging, rural palliative care, and navigation - as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation. PMID:27093177

  20. No place like home? Potential pathways to loneliness in older adults under the care of a live-in foreign home care worker.

    Science.gov (United States)

    Ayalon, Liat; Shiovitz-Ezra, Sharon; Palgi, Yuval

    2012-01-01

    The arrangement in which frail older adults from the developed world are cared for in their homes by individuals from the developing world has become increasingly prevalent worldwide. In Israel, this arrangement is termed foreign home care. In this article, the authors first describe the global phenomenon of foreign home care of frail older adults as well as the more local characteristics of this arrangement in Israel. The authors then describe the concept of loneliness. Based on empirical and theoretical knowledge in the field of loneliness, the authors argue that older adults under live-in foreign home care may be particularly prone to feelings of loneliness for several reasons: some that are general to older adults with cognitive or physical disability and others that are specific to this particular caregiving arrangement. The authors conclude by providing ideas for future practice and research on this highly vulnerable group that, to date, has received only minimal research attention. PMID:22303620

  1. A critical review of Singapore's policies aimed at supporting families caring for older members.

    Science.gov (United States)

    Mehta, Kalyani K

    2006-01-01

    This article critically examines the family-oriented social policies of the Singapore government aimed at supporting families caring for older members. The sectors focused on are financial security, health, and housing. Singaporeans have been reminded that the family should be the first line of defense for aging families, followed by the community - the state would step in as the last resort. Drawing from recent research and examination of the state policies, the author argues that more should be done to help family caregivers looking after elder relatives. Recommendations for innovative ways to recognize and reward family carers conclude the paper.

  2. Animal-Assisted Therapy and Application to Older Adults in Long Term Care

    OpenAIRE

    Kimberly Ann Mercer

    2015-01-01

    In the past thirty years animal-assisted therapy (AAT) has moved beyond anecdotal status to a scientific evidence-based intervention. AAT comes in many shapes and sizes. There are a variety of animals which can be used such as dogs, cats, rabbits, horses, guinea pigs, goats, dolphins, and even fish aquariums. Loneliness is a common theme among older adults in long term care (LTC). Many older adults living in LTC facilities feel isolated. Some have little contact with family members or friends...

  3. Managed-Medicare Health Club Benefit and Reduced Health Care Costs Among Older Adults

    Directory of Open Access Journals (Sweden)

    Huong Q. Nguyen, PhD

    2008-01-01

    Full Text Available IntroductionOur study was undertaken to determine the association between use of a health plan-sponsored health club benefit by older adults and total health care costs over 2 years.MethodsThis retrospective cohort study used administrative and claims data from a Medicare Advantage plan. Participants (n = 4766 were enrolled in the plan for at least 1 year before participating in the plan-sponsored health club benefit (Silver Sneakers. Controls (n = 9035 were matched to participants by age and sex according to the index date of Silver Sneakers enrollment. Multivariate regression models were used to estimate health care use and costs and to make subgroup comparisons according to frequency of health club visits.ResultsCompared with controls, Silver Sneakers participants were older and more likely to be male, used more preventive services, and had higher total health care costs at baseline. Adjusted total health care costs for Silver Sneakers participants and controls did not differ significantly in year 1. By year 2, compared with controls, Silver Sneakers participants had significantly fewer inpatient admissions (−2.3%, 95% confidence interval, −3.3% to −1.2%; P < .001 and lower total health care costs (−$500; 95% confidence interval, −$892 to −$106; P = .01]. Silver Sneakers participants who averaged at least two health club visits per week over 2 years incurred at least $1252 (95% confidence interval, −$1937 to −$567; P < .001 less in health care costs in year 2 than did those who visited on average less than once per week.ConclusionRegular use of a health club benefit was associated with slower growth in total health care costs in the long term but not in the short term. These findings warrant additional prospective investigations to determine whether policies to offer health club benefits and promote physical activity among older adults can reduce increases in health care costs.

  4. Informal Care Provided by Family Caregivers: Experiences of Older Adults With Multimorbidity.

    Science.gov (United States)

    Lindvall, Agneta; Kristensson, Jimmie; Willman, Ania; Holst, Göran

    2016-08-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Informal Care Provided by Family Caregivers: Experiences of Older Adults With Multimorbidity" found on pages 24-31, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until July 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe how older adults with multimorbidity experience care provided from informal

  5. Informal Care Provided by Family Caregivers: Experiences of Older Adults With Multimorbidity.

    Science.gov (United States)

    Lindvall, Agneta; Kristensson, Jimmie; Willman, Ania; Holst, Göran

    2016-08-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Informal Care Provided by Family Caregivers: Experiences of Older Adults With Multimorbidity" found on pages 24-31, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until July 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe how older adults with multimorbidity experience care provided from informal

  6. Variation in quality of preventive care for well adults in Indigenous community health centres in Australia

    Directory of Open Access Journals (Sweden)

    Hains Jenny

    2011-06-01

    Full Text Available Abstract Background Early onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. However, there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities. This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia. Methods During 2005-2009, clinical audits were conducted on a random sample (stratified by age and sex of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories (sample size 1839. Main outcome measures: i adherence to delivery of guideline-scheduled services within the previous 24 months, including basic measurements, laboratory investigations, oral health checks, and brief intervention on lifestyle modification; and ii follow-up of abnormal findings. Results Overall delivery of guideline-scheduled preventive services varied widely between health centres (range 5-74%. Documentation of abnormal blood pressure reading ([greater than or equal to]140/90 mmHg, proteinuria and abnormal blood glucose ([greater than or equal to]5.5 mmol/L was found to range between 0 and > 90% at the health centre level. A similarly wide range was found between health centres for documented follow up check/test or management plan for people documented to have an abnormal clinical finding. Health centre level characteristics explained 13-47% of variation in documented preventive care, and the remaining variation was explained by client level characteristics. Conclusions There is substantial room to improve preventive care for well adults in Indigenous primary care settings. Understanding of health centre and client level factors affecting variation in the care should assist clinicians, managers and policy makers to develop strategies to improve quality of preventive care in Indigenous communities.

  7. Socio-Economic Determinants of the Need for Dental Care in Adults.

    Directory of Open Access Journals (Sweden)

    Gilda Trohel

    Full Text Available Oral health has improved in France. However, there are still inequalities related to the socio-economic status.The aim of this study was to measure the prevalence of dental care needs in an adult population and to identify the demographic, socio-economic and behavioral variables that may explain variations in this parameter.A cross-sectional analysis of the French SIRS cohort (n = 2,997 adults from the Paris region; 2010 data was carried out to determine the prevalence of self-reported dental care needs relative to demographic, socio-economic and behavioral variables. A logistic regression model was used to identify the variables that were most strongly associated with the level of need.In 2010, the prevalence of the need for dental care in the SIRS cohort was 35.0% (95% CI [32.3-37.8]. It was lower in people with higher education levels (31.3% [27.9-34.6], without immigrant background (31.3% [28.0-34.6] and with comprehensive health insurance (social security + complementary health cover; 32.8% [30.2-35.4]. It decreased as the socio-economic status increased, but without following a strict linear change. It was also lower among individuals who had a dental check-up visit in the previous two years. In multivariate analyses, the socioeconomic variables most strongly associated with the need for dental care were: educational attainment (OR = 1.21 [1.02-1.44], income level (OR = 1.66 [1.92-2.12] and national origin (OR = 1.53 [1.26-1.86].These results confirm that the prevalence of dental care needs is higher among adults with low socio-economic status. Education level, income level and also national origin were more strongly associated with the need for dental care than insurance cover level.

  8. Disturbances of sodium in critically ill adult neurologic patients: a clinical review.

    Science.gov (United States)

    Tisdall, Martin; Crocker, Matthew; Watkiss, Jonathan; Smith, Martin

    2006-01-01

    Disorders of sodium and water balance are common in critically ill adult neurologic patients. Normal aspects of sodium and water regulation are reviewed. The etiology of possible causes of sodium disturbance is discussed in both the general inpatient and the neurologic populations. Areas of importance are highlighted with regard to the differential diagnosis of sodium disturbance in neurologic patients, and management strategies are discussed. Specific discussions of the etiology, diagnosis, and management of cerebral salt wasting syndrome, the syndrome of inappropriate antidiuretic hormone secretion, and central diabetes insipidus are presented, as well as the problems of overtreatment. The importance of diagnosis at an early stage of these diseases is stressed, with a recommendation for conservative management of milder cases.

  9. Diagnosis of overt disseminated intravascular coagulation in critically Ill adults by Sonoclot coagulation analysis.

    Science.gov (United States)

    Wan, Peng; Tong, Hua-Sheng; Zhang, Xing-Qin; Duan, Peng-Kai; Tang, You-Qing; Su, Lei

    2014-08-01

    Disseminated intravascular coagulation (DIC) diagnosis is hampered by the limited availability of reliable clinical or laboratory tests. Currently available tests are time consuming and expensive. We investigated whether coagulation and platelet function analyses using the Sonoclot system were suitable for overt DIC diagnosis in critically ill adults. This was an observational diagnostic study performed in 498 patients presenting with an underlying disorder associated with DIC. Overt DIC patients were identified according to an International Society on Thrombosis and Hemostasis (ISTH) score of >5. Coagulation and platelet parameters were analyzed using the Sonoclot system, and compared with ISTH as the gold standard. Receiver operating characteristic curves and area under the curves were used to evaluate the value of the Sonoclot parameters. There were no differences for age or gender between the groups. Significant correlations were observed between activated clotting time (ACT) and ISTH score (r = 0.7; P coagulation dysfunction in patients with overt DIC.

  10. Evaluation of health care services provided for older adults in primary health care centers and its internal environment. A step towards age-friendly health centers

    OpenAIRE

    Alhamdan , A.A.; Alshammari , S.A.; Al-Amoud, M.M.; Hameed , T.A.; Al-Muammar , M.N.; Bindawas , S.M.; Al-Orf , S.M.; Mohamed , A.G.; Al-Ghamdi , E.A.; P.C. Calder

    2015-01-01

    Objectives: to evaluate the health care services provided for older adults by primary health care centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia (KSA), and the ease of use of these centers by older adults. Methods: between October 2013 and January 2014, we conducted a descriptive cross-sectional study of 15 randomly selected PHCCs in Riyadh City, KSA. The evaluation focused on basic indicators of clinical services offered and factors indicative of the ease of use of the centers by o...

  11. Challenges Caring for Adults With Congenital Heart Disease in Pediatric Settings: How Nurses Can Aid in the Transition.

    Science.gov (United States)

    Anton, Kristin

    2016-08-01

    As surgery for complex congenital heart disease is becoming more advanced, an increasing number of patients are surviving into adulthood, yet many of these adult patients remain in the pediatric hospital system. Caring for adult patients is often a challenge for pediatric nurses, because the nurses have less experience and comfort with adult care, medications, comorbid conditions, and rehabilitation techniques. As these patients age, the increased risk of complications and comorbid conditions from their heart disease may complicate their care further. Although these patients are admitted on a pediatric unit, nurses can aid in promoting their independence and help prepare them to transition into the adult medical system. Nurses, the comprehensive medical teams, and patients' families can all effectively influence the process of preparing these patients for transition to adult care. PMID:27481810

  12. Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

    OpenAIRE

    Hantikainen Virpi; Jeitziner Marie-Madlen; Conca Antoinette; Hamers Jan PH

    2011-01-01

    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...

  13. Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

    OpenAIRE

    Jeitziner, Marie-Madlen; Hantikainen, Virpi; Conca, Antoinette; Hamers, Jan PH

    2011-01-01

    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...

  14. Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

    OpenAIRE

    Jeitziner, Marie-Madlen; Hantikainen, Virpi; Conca, Antoinette; Hamers, Jan P. H.

    2011-01-01

    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 ...

  15. Arterial waveform analysis in anesthesia and critical care: Theory, practical applications, and use in goal-directed strategies

    OpenAIRE

    Montenij, L.J.

    2016-01-01

    Cardiac output and preload are important variables in the hemodynamic optimization of critically ill patients in the operating room and intensive care unit. Arterial waveform analysis (AWA) enables continuous, minimally invasive measurement of CO from an arterial line, and provides dynamic assessment of cardiac preload. The present thesis investigates the theory and current applications of AWA in anesthesia and critical care, explores the methodological challenges in CO method comparison rese...

  16. Teaching effectiveness and learning outcomes of baccalaureate nursing students in a critical care practicum: a lebanese experience.

    Science.gov (United States)

    Makarem, S; Dumit, N Y; Adra, M; Kassak, K

    2001-01-01

    This process-product replicated study examines the relationship between the clinical teacher behavior effectiveness of critical care instructors and baccalaureate nursing students' learning outcomes in a critical care practicum. Teacher behaviors that were found to be significantly associated with student learning outcomes included flexibility, giving opportunity to observe, quality of answering questions, quality of discourse, feedback specificity, and concern for the learner's progress and problems.

  17. Performance of the measures of processes of care for adults and service providers in rehabilitation settings

    Directory of Open Access Journals (Sweden)

    Bamm EL

    2015-06-01

    Full Text Available Elena L Bamm,1 Peter Rosenbaum,1,2 Seanne Wilkins,1 Paul Stratford11School of Rehabilitation Science, 2CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, CanadaIntroduction: In recent years, client-centered care has been embraced as a new philosophy of care by many organizations around the world. Clinicians and researchers have identified the need for valid and reliable outcome measures that are easy to use to evaluate success of implementation of new concepts.Objective: The current study was developed to complete adaptation and field testing of the companion patient-reported measures of processes of care for adults (MPOC-A and the service provider self-reflection measure of processes of care for service providers working with adult clients (MPOC-SP(A.Design: A validation studySettings: In-patient rehabilitation facilities.Main outcome measures: MPOC-A and measure of processes of care for service providers working with adult clients (MPOC-SP(A.Results: Three hundred and eighty-four health care providers, 61 patients, and 16 family members completed the questionnaires. Good to excellent internal consistency (0.71–0.88 for health care professionals, 0.82–0.90 for patients, and 0.87–0.94 for family members, as well as moderate to good correlations between domains (0.40–0.78 for health care professionals and 0.52–0.84 for clients supported internal reliability of the tools. Exploratory factor analysis of the MPOC-SP(A responses supported the multidimensionality of the questionnaire.Conclusion: MPOC-A and MPOC-SP(A are valid and reliable tools to assess patient and service-provider accounts, respectively, of the extent to which they experience, or are able to provide, client-centered service. Research should now be undertaken to explore in more detail the relationships between client experience and provider reports of their own behavior.Keywords: client-centered care, service evaluation, MPOC, models of

  18. Nursing home staffing and training recommendations for promoting older adults' quality of care and life: Part 1. Deficits in the quality of care due to understaffing and undertraining.

    Science.gov (United States)

    Maas, Meridean L; Specht, Janet P; Buckwalter, Kathleen C; Gittler, Josephine; Bechen, Kate

    2008-04-01

    Caught between the inability or unwillingness of nursing home corporations and owners to redistribute revenue and the reluctance of federal and state agencies to increase payments to nursing homes, the nation's most vulnerable older adults are not receiving the care they deserve. Widespread recognition of substandard care and quality of life of older adults in nursing homes has existed for decades. In addition, there is substantial evidence that poor quality of care is related to inadequate numbers and training of nursing staff. Still, policy makers and nursing home owners have failed to take needed action. In the first article of this two-part series, major deficits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home staffing and the quality of care and life of residents is summarized.

  19. Nursing home staffing and training recommendations for promoting older adults' quality of care and life: Part 1. Deficits in the quality of care due to understaffing and undertraining.

    Science.gov (United States)

    Maas, Meridean L; Specht, Janet P; Buckwalter, Kathleen C; Gittler, Josephine; Bechen, Kate

    2008-04-01

    Caught between the inability or unwillingness of nursing home corporations and owners to redistribute revenue and the reluctance of federal and state agencies to increase payments to nursing homes, the nation's most vulnerable older adults are not receiving the care they deserve. Widespread recognition of substandard care and quality of life of older adults in nursing homes has existed for decades. In addition, there is substantial evidence that poor quality of care is related to inadequate numbers and training of nursing staff. Still, policy makers and nursing home owners have failed to take needed action. In the first article of this two-part series, major deficits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home staffing and the quality of care and life of residents is summarized. PMID:20078025

  20. Acute nursing care of the older adult with fragility hip fracture

    DEFF Research Database (Denmark)

    Maher, A.B.; Meehan, A.J.; Hertz, K.;

    2013-01-01

    The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from....... Pressure Ulcers. Fluid Balance/Nutrition. Constipation/Catheter Associated Urinary Tract Infection. Vigilant nursing assessment and prompt intervention may prevent the development of the complications we discuss. If they do occur and are identified early on, they may resolve with appropriate and timely...