WorldWideScience

Sample records for adult critical care

  1. 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

  2. Early mobilization in the critical care unit: A review of adult and pediatric literature.

    Science.gov (United States)

    Cameron, Saoirse; Ball, Ian; Cepinskas, Gediminas; Choong, Karen; Doherty, Timothy J; Ellis, Christopher G; Martin, Claudio M; Mele, Tina S; Sharpe, Michael; Shoemaker, J Kevin; Fraser, Douglas D

    2015-08-01

    Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. Pediatric ICU data are limited, but recent studies also suggest that early mobilization is achievable without increasing patient risk. In this review, we provide a current and comprehensive appraisal of ICU mobilization techniques in both adult and pediatric critically ill patients. Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations. PMID:25987293

  3. 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

  4. 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, ...

  5. 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...

  6. 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. PMID:25452406

  7. 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 ...

  8. 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....

  9. 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.

  10. 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

  11. Society of Critical Care Medicine

    Science.gov (United States)

    ... You are encouraged to participate in the American Society for Parenteral and Enteral Nutrition’s (ASPEN) fifth annual ... the 46th Critical Care Congress Register for the Society of Critical Care Medicine's (SCCM) 46th Critical Care ...

  12. 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

  13. Hotspots critical care evaluation

    OpenAIRE

    D. Humphris; N A Connell; Meyer, E.; Lees, A

    2006-01-01

    This report evaluates a series of critical care education interventions for nurses which took place within Southampton University Hospital Trust (SUHT) and Portsmouth Hospital Trust (PHT) in 2004 and 2005. These interventions were funded by the Hotspots project and commissioned by the Hampshire and Isle of Wight Workforce Development Directorate (WDD). As part of the ongoing commitment to incorporate evidence into practice, the WDD commissioned an independent impact evaluation of these interv...

  14. Building effective critical care teams

    OpenAIRE

    Manthous, Constantine; Nembhard, Ingrid M; Hollingshead, Andrea B

    2011-01-01

    Critical care is formulated and delivered by a team. Accordingly, behavioral scientific principles relevant to teams, namely psychological safety, transactive memory and leadership, apply to critical care teams. Two experts in behavioral sciences review the impact of psychological safety, transactive memory and leadership on medical team outcomes. A clinician then applies those principles to two routine critical care paradigms: daily rounds and resuscitations. Since critical care is a team en...

  15. Building effective critical care teams.

    Science.gov (United States)

    Manthous, Constantine; Nembhard, Ingrid M; Hollingshead, Andrea B

    2011-01-01

    Critical care is formulated and delivered by a team. Accordingly, behavioral scientific principles relevant to teams, namely psychological safety, transactive memory and leadership, apply to critical care teams. Two experts in behavioral sciences review the impact of psychological safety, transactive memory and leadership on medical team outcomes. A clinician then applies those principles to two routine critical care paradigms: daily rounds and resuscitations. Since critical care is a team endeavor, methods to maximize teamwork should be learned and mastered by critical care team members, and especially leaders. PMID:21884639

  16. Training in critical care echocardiography

    OpenAIRE

    Mayo, Paul H

    2011-01-01

    Echocardiography is useful for the diagnosis and management of hemodynamic failure in the intensive care unit so that competence in some elements of echocardiography is a core skill of the critical care specialist. An important issue is how to provide training to intensivists so that they are competent in the field. This article will review issues related to training in critical care echocardiography.

  17. O impacto da obesidade no tratamento intensivo de adultos Impact of obesity on critical care treatment in adult patients

    Directory of Open Access Journals (Sweden)

    Marcelo Moock

    2010-06-01

    Full Text Available OBJETIVOS: Verificar o prognóstico de pacientes obesos e eutróficos internados em Unidade de Terapia Intensiva (UTI de adultos. DESENHO: Estudo retrospectivo e observacional MÉTODOS: Todos os pacientes admitidos na UTI durante 52 meses foram incluídos. Foram selecionados pacientes com IMC ≥30 Kg/M² para compor o grupo obeso e outros com IMC 40 Kg/M² totalizaram apenas 10 pacientes. Não se observou diferença na taxa de mortalidade real, na mortalidade prevista pelo APACHE II, na mediana do tempo de ventilação mecânica e na freqüência da realização de traqueostomia. As diferenças observadas foram na mediana do tempo de internação na unidade de terapia intensiva (7,0 versus 5,0 dias respectivamente; p 40Kg/M². CONCLUSÕES: Neste estudo a obesidade não aumentou a taxa de mortalidade, mas aumentou o tempo médio de permanência na UTI. Os atuais indicadores prognósticos ao não incluírem o IMC poderiam subestimar o risco de morrer e interferir em outros indicadores de qualidade do desempenho assistencial. Como ainda não há um consenso sobre a interferência da obesidade na mortalidade, a inclusão do índice de massa corpórea nos indicadores permanece controversa. Novos estudos, com maior número de obesos, poderão apontar qual o ponto de corte a partir do qual o índice de massa corpórea determinaria o incremento da taxa de mortalidade.STUDY OBJECTIVE: Obese patients seem to have worse outcomes and more complications during intensive care unit (ICU stay. This study describes the clinical course, complications and prognostic factors of obese patients admitted to an intensive care unit compared to a control group of nonobese patients. DESIGN: Retrospective observational study. SETTING: A 10-bed adult intensive care unit in a university-affiliated hospital. METHODS: All patients admitted to the intensive care unit over 52 months (April 01/2005 to November 30/2008 were included. Obese patients were defined as those with a

  18. Critical care in difficult areas.

    Science.gov (United States)

    Prayag, Shirish

    2004-08-01

    Critical care in India has grown very rapidly in the past decade. The Indian Society of Critical Care Medicine has developed into a strong national body that has established its own journal, academic program, and Web site. Its annual national congresses are well organized and very well attended and have a high degree of academic content. International publications have started coming out of India despite limitations. International recognition of the standards of critical care in India has begun. Besides other common patients seen everywhere, those with tropical diseases form a significant group of patients in Indian ICUs. Development of guidelines, starting formal training through a certificate course, and formation of a resuscitation council have been some of the other achievements of Indian Society of Critical Care Medicine. A number of problems still exist in the field of critical care in India. Considering that India as a portal for medical tourism, growth of this field is expected in the next decade. PMID:15258502

  19. Team science and critical care.

    Science.gov (United States)

    Manthous, Constantine A; Hollingshead, Andrea B

    2011-07-01

    Because critical care is administered by multidisciplinary teams, it is plausible that behavioral methods to enhance team performance may impact the quality and outcomes of care. This review highlights the social and behavioral scientific principles of team building and briefly reviews four features of teams--leadership, psychological safety, transactive memory, and accountability--that are germane to critical care teams. The article highlights how team principles might be used to improve patient care and navigate hospital hierarchies, and concludes with implications for future educational and scientific efforts. PMID:21471081

  20. 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% ...

  1. Trials in adult critical care that show increased mortality of the new intervention: Inevitable or preventable mishaps?

    Science.gov (United States)

    Russell, James A; Williams, Mark D

    2016-12-01

    Several promising therapies assessed in the adult critically ill in large, multicenter randomized controlled trials (RCTs) were associated with significantly increased mortality in the intervention arms. Our hypothesis was that there would be wide ranges in sponsorship (industry or not), type(s) of intervention(s), use of DSMBs, presence of interim analyses and early stopping rules, absolute risk increase (ARI), and whether or not adequate prior proof-of-principle Phase II studies were done of RCTs that found increased mortality rates of the intervention compared to control groups. We reviewed RCTs that showed a statistically significant increased mortality rate in the intervention compared to control group(s). We recorded source of sponsorship, sample sizes, types of interventions, mortality rates, ARI (as well as odds ratios, relative risks and number needed to harm), whether there were pre-specified interim analyses and early stopping rules, and whether or not there were prior proof-of-principle (also known as Phase II) RCTs. Ten RCTs (four industry sponsored) of many interventions (high oxygen delivery, diaspirin cross-linked hemoglobin, growth hormone, methylprednisolone, hetastarch, high-frequency oscillation ventilation, intensive insulin, NOS inhibition, and beta-2 adrenergic agonist, TNF-α receptor) included 19,126 patients and were associated with wide ranges of intervention versus control group mortality rates (25.7-59 %, mean 29.9 vs 17-49 %, mean 25 %, respectively) yielding ARIs of 2.6-29 % (mean 5 %). All but two RCTs had pre-specified interim analyses, and seven RCTs were stopped early. All RCTs were preceded by published proof-of-principle RCT(s), two by the same group. Seven interventions (except diaspirin cross-linked hemoglobin and the NOS inhibitor) were available for use clinically at the time of the pivotal RCT. Common, clinically available interventions used in the critically ill were associated with increased mortality in large

  2. 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

  3. 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 ...

  4. 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

  5. [Critical care for organ failure].

    Science.gov (United States)

    Shiga, H; Hirasawa, H

    1998-08-01

    We retrospectively studied the critical care regimen for multiple organ failure (MOF) in 141 surgical MOF patients treated in the intensive care unit of Chiba University Hospital between January 1988 and April 1998. Patients with gut failure received parenteral instead of enteral nutrition for various reasons such as concomitant ileus. Of the patients with respiratory failure. 138 were placed on a ventilator and 6 received percutaneous cardiopulmonary support. Continuous hemodiafiltration (CHDF) was performed in 98 patients with renal failure. Plasma exchange was carried out in 13 patients with liver failure. Of these patients, 62 (44%) survived. Colloid osmotic pressure was used as an indicator for fluid therapy. For prophylaxis against bacterial translocation, we performed selective digestive decontamination. Recently blood purification methods, particularly CHDF, have become common in the critical care setting. CHDF is efficacious not only as continuous renal replacement therapy but also as a humoral mediator modulator and is currently the first-choice method for blood purification in critical care. In conclusion, there have been many advances in the critical care of patients with organ failure. Multidisciplinary treatment, including artificial support for failing organs, is necessary for the survival of these patients. PMID:9789289

  6. 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.

  7. 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 ...

  8. 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...

  9. American Association of Critical-Care Nurses

    Science.gov (United States)

    ... American Journal of Critical Care AACN Bold Voices Critical Care Nurse eNewsletter NTI Voices Career Options Books Search The ... Ambassadors Chapters Privacy Policy Disclaimer © American Association of Critical-Care Nurses Learn more about what we have to offer ...

  10. Intensive Care in Critical Access Hospitals

    Science.gov (United States)

    Freeman, Victoria A.; Walsh, Joan; Rudolf, Matthew; Slifkin, Rebecca T.; Skinner, Asheley Cockrell

    2007-01-01

    Context: Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services. Purpose: To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of…

  11. 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...

  12. 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...

  13. 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...

  14. Advanced technologies in trauma critical care management.

    Science.gov (United States)

    Cannon, Jeremy W; Chung, Kevin K; King, David R

    2012-08-01

    Care of critically injured patients has evolved over the 50 years since Shoemaker established one of the first trauma units at Cook County Hospital in 1962. Modern trauma intensive care units offer a high nurse-to-patient ratio, physicians and midlevel providers who manage the patients, and technologically advanced monitors and therapeutic devices designed to optimize the care of patients. This article describes advances that have transformed trauma critical care, including bedside ultrasonography, novel patient monitoring techniques, extracorporeal support, and negative pressure dressings. It also discusses how to evaluate the safety and efficacy of future advances in trauma critical care. PMID:22850154

  15. 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...

  16. [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

  17. Critical care nursing: Embedded complex systems.

    Science.gov (United States)

    Trinier, Ruth; Liske, Lori; Nenadovic, Vera

    2016-01-01

    Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals. Information flow through the system allows for identification of deteriorating patient status and timely interventionfor rescue from further deleterious effects. Nurses provide the majority of direct patient care in the critical care setting in 2:1, 1:1 or 1:2 nurse-to-patient ratios. The bedside nurse-critically ill patient relationship represents the primary, real-time feedback loop of information exchange, monitoring and treatment. Variables that enhance information flow through this loop and support timely nursing intervention can improve patient outcomes, while barriers can lead to errors and adverse events. Examining patient information flow in the critical care environment from a dynamic systems perspective provides insights into how nurses deliver effective patient care and prevent adverse events. PMID:27047997

  18. 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

  19. 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 …

  20. Critical care education in general surgery residencies.

    Science.gov (United States)

    Meyer, A A; Fakhry, S M; Sheldon, G F

    1989-08-01

    Surgical critical care (SCC) was recently identified as an essential component of general surgery by the American Board of Surgery (ABS). Previous studies have found limited attention to critical care education in general surgery programs. This survey was developed to determine the changes in critical care education, following the emphasis by the ABS. The survey determined the format for SCC education, the time and resources committed, and the views of the program directors toward SCC. Program directors of all 296 approved general surgery residencies were surveyed, with a 79% response. Most program directors (91%) agree that SCC is an essential component of general surgery, and 72% believe a separate intensive care unit (ICU) rotation should be used in SCC education. Education in SCC was provided by a separate ICU service in 110 (47%) of the programs. The remaining 53% used care of patients in the ICU during traditional services as their educational experience. The average ICU rotation for surgery residents was 9 weeks and usually occurred in the second year of training. In 97% of the 110 programs with an ICU service, lectures and conferences were conducted regularly. Seventeen programs sponsored critical care fellowships, and 25 additional programs were considering them. Ninety percent of surgical ICU services had faculty that consisted exclusively of surgeons or surgeons and other specialists. Only 53% of surgeons attending on an ICU service had a reduction in their other responsibilities. Despite overwhelming agreement that critical care is an essential component of general surgery, less than half of the training programs have an ICU service to coordinate resident education in SCC. If surgeons are to continue to provide total care to their patients, there needs to be increased commitment to SCC education. PMID:2763037

  1. Critical-care visitation: the patients' perspective.

    Science.gov (United States)

    Hardin, Sonya R; Bernhardt-Tindal, Kim; Hart, Ann; Stepp, Amber; Henson, April

    2011-01-01

    The purpose of this study was to determine critically ill patients' satisfaction and preference with the restricted visiting hours in the critical-care units in a 435-bed acute-care hospital in North Carolina. The major aims of the study were to (1) identify the time that most patients preferred for visitation and (2) identify how often patients wanted to have visitors. This article discusses the findings of this study, one of which is that patients want more control over visitation. PMID:21135614

  2. 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.

  3. 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. PMID:27086002

  4. 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.

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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...

  10. "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,…

  11. [Extracorporeal membrane oxygenation for critically ill adults].

    Science.gov (United States)

    Maekawa, Kunihiko; Gando, Satoshi

    2016-02-01

    Extracorporeal membrane oxygenation therapy (ECMO) is an artificial life support for severe respiratory and/or cardiac failure, and refractory cardiac arrest. It consists of a hollow-fiber membrane that oxygenates the blood and removes carbon dioxide and a centrifugal pump that drain blood from central venous circulation, pump through membrane, and return to the patients. Veno-venous ECMO provides gas change in hemodynamically stable patients with respiratory failure. Veno-arterial ECMO offers hemodynamic support in addition to gas change for cardiac failure or refractory cardiac arrest. We describe the physiological principles and the clinical evidence supporting the use of ECMO in critically ill adult patients. PMID:26915254

  12. 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 ...

  13. Interrater agreement for Critical Care EEG Terminology

    Science.gov (United States)

    Gaspard, Nicolas; Hirsch, Lawrence J.; LaRoche, Suzette M.; Hahn, Cecil D.; Westover, M. Brandon

    2016-01-01

    Summary Objective The interpretation of critical care electroencephalography (EEG) studies is challenging because of the presence of many periodic and rhythmic patterns of uncertain clinical significance. Defining the clinical significance of these patterns requires standardized terminology with high interrater agreement (IRA). We sought to evaluate IRA for the final, published American Clinical Neurophysiology Society (ACNS)–approved version of the critical care EEG terminology (2012 version). Our evaluation included terms not assessed previously and incorporated raters with a broad range of EEG reading experience. Methods After reviewing a set of training slides, 49 readers independently completed a Web-based test consisting of 11 identical questions for each of 37 EEG samples (407 questions). Questions assessed whether a pattern was an electrographic seizure; pattern location (main term 1), pattern type (main term 2); and presence and classification of eight other key features (“plus” modifiers, sharpness, absolute and relative amplitude, frequency, number of phases, fluctuation/evolution, and the presence of “triphasic” morphology). Results IRA statistics (κ values) were almost perfect (90–100%) for seizures, main terms 1 and 2, the +S modifier (superimposed spikes/sharp waves or sharply contoured rhythmic delta activity), sharpness, absolute amplitude, frequency, and number of phases. Agreement was substantial for the +F (superimposed fast activity) and +R (superimposed rhythmic delta activity) modifiers (66% and 67%, respectively), moderate for triphasic morphology (58%), and fair for evolution (21%). Significance IRA for most terms in the ACNS critical care EEG terminology is high. These terms are suitable for multicenter research on the clinical significance of critical care EEG patterns. PMID:24888711

  14. 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...

  15. 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.

  16. [Transition in health care, from pediatrics to adult care].

    Science.gov (United States)

    De Cunto, Carmen L

    2012-08-01

    The number of adolescent patients with chronic diseases and special heath needs are increasing, and they are reaching adulthood. Sometimes the passage to the adult health care is abrupt, depending upon the chronological age reached or because of an acute health problem that requires hospitalization. In order to facilitate the transition process, preparation of the child, the family and the health professionals involved is needed, as well as the coordination between the pediatric group and the adult team that will be incharge of the patient. This review shows the obstacles to this process and the recommended implementation steps required to a successful transition. It also describes the main aspects of a program that we implemented at the Hospital Italiano de Buenos Aires in conjunction with some departments of adult health care high lighting the main steps to follow before and during program´s implementation. PMID:22859330

  17. 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

  18. 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)

  19. Young Adults Seeking Medical Care: Do Race and Ethnicity Matter?

    Science.gov (United States)

    ... Reports from the National Medical Care Utilization and Expenditure Survey Clearinghouse on Health Indexes Statistical Notes for Health Planners ... Adults Seeking Medical Care: Do Race and Ethnicity ...

  20. 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

  1. Selenium supplementation for critically ill adults

    DEFF Research Database (Denmark)

    Allingstrup, Mikkel; Afshari, Arash

    2015-01-01

    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...... supplementation and number of infections, duration of mechanical ventilation, length of intensive care unit stay and length of hospital stay. SEARCH METHODS: In this update, we searched the current issue of the Cochrane Central Register of Controlled Trials, the Cochrane Library (2014, Issue 5); MEDLINE (Ovid SP...... sequential analysis. MAIN RESULTS: We included six new RCTs in this review update. In total we included 16 RCTs (2084 participants) in this review. Most trials were at high risk of bias. The availability of outcome data was limited and trials involving selenium supplementation were, with the exception of one...

  2. 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 …

  3. 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…

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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 …

  12. 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. ...

  13. 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

  14. 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...

  15. 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

  16. Comparison of two pain assessment tools in nonverbal critical care patients.

    Science.gov (United States)

    Paulson-Conger, Melissa; Leske, Jane; Maidl, Carolyn; Hanson, Andrew; Dziadulewicz, Laurel

    2011-12-01

    It is recommended that patient's self-report of pain should be obtained as often as possible as the "gold standard." Unfortunately in critical care, many factors can alter verbal communication with patients, making pain assessment more difficult. Scientific advances in understanding pain mechanisms, multidimensional methods of pain assessment, and analgesic pharmacology have improved pain management strategies. However, pain assessment for nonverbal patients in critical care continues to present a challenge for clinicians and researchers. The purpose of this study was to compare the Pain Assessment in Advanced Dementia (PAINAD) and the Critical-Care Pain Observation Tool (CPOT) scores for assessment in nonverbal critical care patients. A descriptive, comparative, prospective design was used in this study. A convenience sample of 100 critical care, nonverbal, adult patients of varying medical diagnoses who required pain evaluation were assessed with the PAINAD and CPOT scales. Data were collected over a 6-month period in all critical care areas. Observations of pain assessments for nonverbal patients who required pain evaluation were recorded on the PAINAD and the CPOT successively. Internal consistency reliability for the PAINAD was 0.80 and for the CPOT 0.72. Limits of agreement indicated that there was no difference in PAINAD and CPOT scores for assessing pain in nonverbal patients in critical care. Further research in the area of pain assessment for nonverbal patients in critical care is needed. PMID:22117753

  17. 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...

  18. Glycemia management in critical care patients

    Directory of Open Access Journals (Sweden)

    Federico Bilotta

    2012-01-01

    Full Text Available Over the last decade, the approach to clinical management of blood glucose concentration (BGC in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL, and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.

  19. 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

  20. Diabetes care for emerging adults: transition from pediatric to adult diabetes care systems

    OpenAIRE

    Lee, Young Ah

    2013-01-01

    With the increasing prevalence of diabetes mellitus in children, transitioning patients from childhood to adulthood are increasing. High-risk behaviors and poor glycemic control during the transition period increase the risk for hypoglycemia and hyperglycemia as well as chronic microvascular and macrovascular complications. Discussions regarding complications and preparations for transition must take place before the actual transition to adult care systems. Pediatric care providers should foc...

  1. 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. …

  2. 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

  3. 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.

  4. 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

  5. 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.,

  6. Radiology for anesthesia and critical care

    International Nuclear Information System (INIS)

    This book contains 14 chapters. Some of the chapter titles are: Understanding the Image; Preoperative Evaluation; Adult Respiratory Distress Syndrome; The Abdomen; Special Imaging Modalities; Radiographic Anatomy and Pathology of the Child's Airway; and The Neonate in Distress: Pulmonary Etiologies

  7. MIMIC-III, a freely accessible critical care database.

    Science.gov (United States)

    Johnson, Alistair E W; Pollard, Tom J; Shen, Lu; Lehman, Li-Wei H; Feng, Mengling; Ghassemi, Mohammad; Moody, Benjamin; Szolovits, Peter; Celi, Leo Anthony; Mark, Roger G

    2016-01-01

    MIMIC-III ('Medical Information Mart for Intensive Care') is a large, single-center database comprising information relating to patients admitted to critical care units at a large tertiary care hospital. Data includes vital signs, medications, laboratory measurements, observations and notes charted by care providers, fluid balance, procedure codes, diagnostic codes, imaging reports, hospital length of stay, survival data, and more. The database supports applications including academic and industrial research, quality improvement initiatives, and higher education coursework. PMID:27219127

  8. 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

  9. 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 care provider - adult ... Questions you should ask: Can I eat dairy foods? What foods can make my problem worse? Can I have greasy or spicy foods? ...

  10. 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…

  11. 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 ...

  12. 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

  13. 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…

  14. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer

    Directory of Open Access Journals (Sweden)

    Wiener L

    2015-01-01

    phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA’s quality of life as end of life nears. Keywords: palliative care, education, training, adolescent, young adult 

  15. 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...

  16. Depression in Older Adults in Primary Care: An Integrative Approach to Care.

    Science.gov (United States)

    Lill, Sheila

    2015-09-01

    Depression in older adults is a problem often encountered in primary care. While depression is evident in all populations in the primary care setting, assessment and care are more complicated in the older adult due to factors such as comorbidities, clinical presentation, adverse drug effects and drug interactions, and psychosocial factors. Due to these complications, it is essential to incorporate both conventional and alternative methods in assessment and treatment. This article aims to define depression in older adults, present the epidemiology, discuss clinical presentation and screening, and offer an integrative approach to intervention, including both pharmacological and nonpharmacological methods. Providing holistic and integrative care to older adults diagnosed with depression in the primary care setting is essential to promote healing and recovery. This article aims to provide insight for nurses, nurse practitioners, and other providers regarding the holistic and integrative care of depression in older adults in the primary care setting. PMID:25673577

  17. Year in review 2006: Critical Care--Resource management.

    Science.gov (United States)

    Schultz, Marcus J; Kuiper, Michael; Spronk, Peter E; Vroom, Margreeth B; Gajic, Ognjen

    2007-01-01

    As health care resources become increasingly constrained, it is imperative that intensive care unit resources be optimized. In the years to come, a number of challenges to intensive care medicine will need to be addressed as society changes. Last year's Critical Care papers provided us with a number of interesting and highly accessed original papers dealing with health care resources. The information yielded by these studies can help us to deal with issues such as prognostication, early detection and treatment of delirium, prevention of medical errors and use of radiology resources in critically ill patients. Finally, several aspects of scientific research in critically ill patients were investigated, focusing on the possibility of obtaining informed consent and recall of having given informed consent. PMID:17764592

  18. Year in review 2006: Critical Care – resource management

    Science.gov (United States)

    Schultz, Marcus J; Kuiper, Michael; Spronk, Peter E; Vroom, Margreeth B; Gajic, Ognjen

    2007-01-01

    As health care resources become increasingly constrained, it is imperative that intensive care unit resources be optimized. In the years to come, a number of challenges to intensive care medicine will need to be addressed as society changes. Last year's Critical Care papers provided us with a number of interesting and highly accessed original papers dealing with health care resources. The information yielded by these studies can help us to deal with issues such as prognostication, early detection and treatment of delirium, prevention of medical errors and use of radiology resources in critically ill patients. Finally, several aspects of scientific research in critically ill patients were investigated, focusing on the possibility of obtaining informed consent and recall of having given informed consent. PMID:17764592

  19. 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

  20. 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...

  1. The War against People: Adult education practice for critical democracy

    OpenAIRE

    Connolly, Brid; Hussey, Peter

    2013-01-01

    The purpose of this article is to explore the role of adult education for criti - cal democracy, in order to address the social suffering (Bourdieu, 1999) that we encounter in our work as critical adult community educators. We explore this through dialogue, as a process of education and research. Dialogue is the moment where humans meet to reflect on their reality as they make and remake it (Shor, Freire, 1987: 13). The purpose of dialogue is to transform social rela - ...

  2. Visualization Method for Finding Critical Care Factors in Variance Analysis

    OpenAIRE

    YUI, Shuntaro; BITO, Yoshitaka; OBARA, Kiyohiro; KAMIYAMA, Takuya; SETO, Kumiko; Ban, Hideyuki; HASHIZUME, Akihide; HAGA, Masashi; Oka, Yuji

    2006-01-01

    We present a novel visualization method for finding care factors in variance analysis. The analysis has two stages: first stage enables users to extract a significant variance, and second stage enables users to find out a critical care factors of the variance. The analysis has been validated by using synthetically created inpatient care processes. It was found that the method is efficient in improving clinical pathways.

  3. MIMIC-III, a freely accessible critical care database

    Science.gov (United States)

    Johnson, Alistair E.W.; Pollard, Tom J.; Shen, Lu; Lehman, Li-wei H.; Feng, Mengling; Ghassemi, Mohammad; Moody, Benjamin; Szolovits, Peter; Anthony Celi, Leo; Mark, Roger G.

    2016-01-01

    MIMIC-III (‘Medical Information Mart for Intensive Care’) is a large, single-center database comprising information relating to patients admitted to critical care units at a large tertiary care hospital. Data includes vital signs, medications, laboratory measurements, observations and notes charted by care providers, fluid balance, procedure codes, diagnostic codes, imaging reports, hospital length of stay, survival data, and more. The database supports applications including academic and industrial research, quality improvement initiatives, and higher education coursework. PMID:27219127

  4. 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 ...

  5. 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

  6. Primary Care Endocrinology in the Adult Woman.

    Science.gov (United States)

    Thomas, Celeste C; Zeytinoglu, Meltem

    2016-06-01

    Diabetes mellitus, thyroid disorders, and osteoporosis are endocrine conditions affecting a significant proportion of women presenting to the obstetrician-gynecologist. Obstetrician-gynecologists are often the first health-care providers that young women see in adulthood, and thus, have a critical opportunity to identify women at risk for gestational and overt diabetes and manage the condition in those who have developed it. The obstetrician-gynecologist should be aware of the appropriate therapeutic options and treatment goals (eg, hemoglobin A1c) for women with diabetes. Thyroid disorders often present with menstrual irregularities or infertility, can affect pregnancy outcomes, and contribute to cardiovascular and bone disorders as women age. Finally, osteoporosis and low bone mineral density affect a substantial proportion of older women and some younger women with risk factors for secondary osteoporosis. The morbidity and mortality of osteoporotic fractures is substantial. There are many lifestyle interventions and therapeutic options available for these conditions, and the gynecologist plays a key role in optimizing risk factor assessment, screening, and providing treatment when appropriate. PMID:27212095

  7. 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

  8. 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;

    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: 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 in...

  9. 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…

  10. Temporal Artery versus Bladder Thermometry during Adult Medical-Surgical Intensive Care Monitoring: An Observational Study

    OpenAIRE

    Stelfox Henry T; Straus Sharon E; Ghali William A; Conly John; Laupland Kevin; Lewin Adriane

    2010-01-01

    Abstract Background We sought to evaluate agreement between a new and widely implemented method of temperature measurement in critical care, temporal artery thermometry and an established method of core temperature measurement, bladder thermometry as performed in clinical practice. Methods Temperatures were simultaneously recorded hourly (n = 736 observations) using both devices as part of routine clinical monitoring in 14 critically ill adult patients with temperatures ranging ≥1°C prior to ...

  11. 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 …

  12. 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 ...

  13. 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 ...

  14. 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.

  15. Reiki therapy: a nursing intervention for critical care.

    Science.gov (United States)

    Toms, Robin

    2011-01-01

    Complementary and alternative medicine (CAM) is not generally associated with the complexity and intensity of critical care. Most CAM therapies involve slow, calming techniques that seem to be in direct contrast with the fast-paced, highly technical nature of critical care. However, patients in critical care often find themselves coping with the pain and stress of their illness exacerbated by the stress of the critical care environment. Complementary and alternative medicine-related research reveals that complementary therapies, such as Reiki, relieve pain and anxiety and reduce symptoms of stress such as elevated blood pressure and pulse rates. Patients and health care professionals alike have become increasingly interested in complementary and alternative therapies that do not rely on expensive, invasive technology, and are holistic in focus. Reiki is cost-effective, noninvasive, and can easily be incorporated into patient care. The purpose of this article is to examine the science of Reiki therapy and to explore Reiki as a valuable nursing intervention. PMID:21670620

  16. 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...

  17. 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…

  18. 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…

  19. 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...

  20. Child Nutrition Programs: Child and Adult Care Food Program. Family Day Care Home Handbook.

    Science.gov (United States)

    Oklahoma State Dept. of Education, Oklahoma City.

    This handbook details requirements for family day care homes in Oklahoma for providing child nutrition through the Child and Adult Care Food Program. The handbook includes contact information for state consultants. The basic responsibilities for sponsors of family day care home child nutrition programs are outlined, and the sponsoring organization…

  1. 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...

  2. 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

  3. 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.

  4. 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

  5. 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...

  6. 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

    ... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2013 Through June 30, 2014 AGENCY: Food and Nutrition Service...-risk afterschool care centers, and adult day care centers; the food service payment rates for meals...

  7. 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.

  8. Why start a new pulmonary/critical care journal?

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2010-10-01

    Full Text Available No abstract available. Article truncated at 150 words. With apologies to Paul McCartney, “You'd think that people would have had enough of [pulmonary and critical care journals]. But I look around me and I see it isn't so” (1. With the inception of the Southwest Journal of Pulmonary and Critical Care (SWJPCC we have several goals, not adequately filled by the present pulmonary and critical care publications.First, the primary goal of the SWJPCC is pulmonary and critical care medicine fellow education. The American College of Graduate Medical Education has placed increasing requirements for clinical education in post-graduate medical education while simultaneously increasing the requirements for scholarly activity for fellows and faculty, yet restricting fellow work hours (2. It seems that these conflicting goals are unrealistic, unless clinical scholarly activity can be incorporated into a training program. In starting the SWJPCC, we hope to fulfill the scholarly needs of both fellows and faculty while emphasizing clinical medicine through …

  9. 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 ...

  10. Acute metabolic changes in critical care and cardiac care: Role of potassium, glucose and lactate

    OpenAIRE

    Hoekstra, Miriam

    2016-01-01

    This thesis describes the relation of potassium, glucose and lactate with outcome in critical care and cardiac care and computer-assisted regulation of glucose and potassium in the intensive care. In patient with acute myocardial infarction it is important to identify those who have the highest risk for adverse outcome. Several markers can be used for this purpose. This thesis demonstrates that hyperglycemia predicts short-term prognosis associated with a larger infarct size whereas HbA1c pre...

  11. 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...... psychosocial issues the YA cancer patient may present with. The role of the FP in follow-up care seems to be very limited. CONCLUSIONS: YACs in the western world seem to have comparable medical and psychosocial problems. However, the nature of health insurance is such that it impacts differently on the care of...... this group of cancer patients. Primary care features such as patient-centered, integrated, and comprehensive care over extended periods of time bring the FP into the unique position to provide follow-up for YAC. However, this will require integrating patient's perspectives on their care, professional...

  12. 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

  13. Care of Older Adults: Role of Primary Care Physicians in the Treatment of Cataracts and Macular Degeneration.

    Science.gov (United States)

    Marra, Kyle V; Wagley, Sushant; Kuperwaser, Mark C; Campo, Rafael; Arroyo, Jorge G

    2016-02-01

    This article aims to facilitate optimal management of cataracts and age-related macular degeneration (AMD) by providing information on indications, risk factors, referral guidelines, and treatments and to describe techniques to maximize quality of life (QOL) for people with irreversible vision loss. A review of PubMed and other online databases was performed for peer-reviewed English-language articles from 1980 through August 2012 on visual impairment in elderly adults. Search terms included vision loss, visual impairment, blind, low vision, QOL combined with age-related, elderly, and aging. Articles were selected that discussed vision loss in elderly adults, effects of vision impairment on QOL, and care strategies to manage vision loss in older adults. The ability of primary care physicians (PCPs) to identify early signs of cataracts and AMD in individuals at risk of vision loss is critical to early diagnosis and management of these common age-related eye diseases. PCPs can help preserve vision by issuing aptly timed referrals and encouraging behavioral modifications that reduce risk factors. With knowledge of referral guidelines for soliciting low-vision rehabilitation services, visual aids, and community support resources, PCPs can considerably increase the QOL of individuals with uncorrectable vision loss. By offering appropriately timed referrals, promoting behavioral modifications, and allocating low-vision care resources, PCPs may play a critical role in preserving visual health and enhancing the QOL for the elderly population. PMID:26825587

  14. 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

  15. The critical link between health care and jails.

    Science.gov (United States)

    Marks, James S; Turner, Nicholas

    2014-03-01

    As a group, jail-involved individuals, which we define here as people with a history of arrest and jail admission in the recent past, carry a heavy illness burden, with high rates of infectious and chronic disease as well as mental illness and substance use. Because these people have tended to also be uninsured, jail frequently has been their only regular source of health care. Three thousand three hundred local and county jails processed 11.6 million admissions during the twelve-month period ending midyear 2012. The Urban Institute estimated as much as 30 percent of some local corrections budgets is allocated to inmate health care services. This investment is largely lost when people are released back into the community, where they typically do not get treatment. For people with untreated substance use or mental illness, this issue reaches beyond public health, because without treatment, these people are at heightened risk of cycling into and out of jail for low-level, nonviolent offenses. This article offers eight policy recommendations to build a continuum of care that will ensure that jail-involved people get the care they need, regardless of where they reside. With the expansion of Medicaid eligibility under the Affordable Care Act, there is now a critical opportunity to bring the jail-involved population into the mainstream health care system, which benefits the health care and criminal justice systems and society at large. PMID:24590943

  16. June 2015 Phoenix critical care journal club: interventions in ARDS

    OpenAIRE

    Robbins RA; Raschke RA

    2015-01-01

    No abstract available. Article truncated at 150 words. Mortality has been declining in the adult respiratory distress syndrome (ARDS) (1). However, the cause of the decline in mortality is unclear. The only intervention shown to improve survival has been low tidal volume ventilation but the mortality was improving before this intervention was widely used (2). Nevertheless, it was suggested that we look at system performance regarding ARDS management from a critical appraisal standpoint. This ...

  17. 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

  18. Care participation and burden among informal caregivers of older adults with care needs and associations with dementia

    OpenAIRE

    Vaingankar, Janhavi Ajit; Chong, Siow Ann; Abdin, Edimansyah; Picco, Louisa; Jeyagurunathan, Anitha; Zhang, Yunjue; Sambasivam, Rajeswari; Chua, Boon Yiang; Ng, Li Ling; Prince, Martin; Subramaniam, Mythily

    2015-01-01

    Background: Few studies have estimated care burden in large, representative, multi-ethnic Asian population-based informal caregivers of older adults with care needs. This study describes informal caregivers’ care participation for a population-based sample of older adults with care needs in Singapore, investigates differences by dementia status, and examines correlates of caregivers’ burden. Methods: Data collected from 693 pairs of older adults, aged 60 to 100 years, having any care needs, a...

  19. 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

  20. 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 ...

  1. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit

    Science.gov (United States)

    Critical illness has a major impact on the nutritional status of both children and adults. A retrospective study was conducted to evaluate the incidence of hospital malnutrition at a pediatric tertiary intensive care unit (PICU). Serum concentrations of IL-6 in subgroups of well-nourished and malnou...

  2. 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

  3. Continuing education: a bridge to excellence in critical care nursing.

    Science.gov (United States)

    Skees, Janet

    2010-01-01

    A professional nurse engages in lifelong learning that will influence practice and ultimately impact the quality of care that a patient receives. The technical skills and critical thinking acumen demonstrated by the critical care nurse at the bedside are not enough to sustain an evidence-based practice environment. Nurses need to cultivate and internalize a passion for learning throughout their careers. They need to adopt a healthy work environment that gives merit to continuing education (CE). This article will discuss perspectives in CE for the nurse. Research findings to illustrate the significance of professional development will be presented. The integration of passion for learning that provides a foundation for excellence in practice will be addressed. Finally, a variety of strategies that can be used to participate in and develop interactive CE programs to meet the needs of savvy professional nurse consumers will be explored. PMID:20234199

  4. 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.

  5. 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.

  6. 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... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2011 Through June 30, 2012 AGENCY: Food and Nutrition...

  7. 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... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2010 Through June 30, 2011 AGENCY: Food and Nutrition...

  8. 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...

  9. 2011 critical care transport workplace and salary survey.

    Science.gov (United States)

    Greene, Michael J

    2011-01-01

    Critical care transport (CCT) leaders from 260 organizations were invited to participate in an online, hosted survey of industry compensation and workplace practices. Approximately 150 questions were presented to participants, soliciting a broad base of information on CCT organizations, personnel, compensation, and workplace practices, notably alertness and fatigue management. CCT organizational salaries are represented by common job class and reported by summary with minimum, middle, and maximum hourly rates in a national aggregate and by Association of Air Medical Services region. PMID:22055178

  10. 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...

  11. 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...

  12. 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. ...

  13. [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

  14. Research in Review: Driving Critical Care Practice Change.

    Science.gov (United States)

    Bridges, Elizabeth; McNeill, Margaret; Munro, Nancy

    2016-01-01

    During the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. This article summarizes some of this important work and considers it in the context of previous research and practice. Examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma. Care challenges addressed include ethical considerations in light of the Ebola epidemic, infection prevention associated with chlorhexidine bathing, bedside alarm management, evidence to enhance moral courage, and interventions to mitigate thirst in critically ill patients. Research that portends future care includes a discussion of fecal microbiota transplant for patients with refractory infection with refractory infection with Clostridium difficile. PMID:26724298

  15. Workplace violence: a primer for critical care nurses.

    Science.gov (United States)

    Alexy, Eileen M; Hutchins, Joseph A

    2006-09-01

    This review illustrates the various types of workplace violence nurses can encounter in critical care settings. Lack of a clear definition of workplace violence impedes research on the topic; however, the typology offered by the UIIPRC provides a framework to guide further studies of physical and nonphysical workplace violence. Further investigation of individual and organizational factors will assist nurses and agencies in identifying effective methods to manage, prevent, educate, and respond to each type of workplace violence. Fear, burnout, anxiety, depression, and acute and posttraumatic stress disorders are some of the sequelae that can occur after an incident of workplace violence. Debriefing strategies should be a fundamental component of workplace violence policies to prevent the development of longterm consequences. Additional research is needed on all types of workplace violence, as well as research addressing the needs of specialized setting, such as critical care unit. Critical care nurses have valuable insights regarding the risks they face on their units and should be part of a multidisciplinary team developing policies and workplace violence prevention and education programs. PMID:16962452

  16. Pain assessment in the critically ill adult: Recent evidence and new trends.

    Science.gov (United States)

    Gélinas, Céline

    2016-06-01

    Pain assessment in the critically ill adult remains a daily clinical challenge. Position statements and practice guidelines exist to guide the ICU care team in the pain assessment process. The patient's self-report of pain remains the gold standard measure for pain and should be obtained as often as possible. When self-report is impossible to obtain, observational pain scales including the Behavioural Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) have been recommended for clinical use in the critically ill adult. However, their adaptation and validation in brain-injured and burn ICU patients is required. Family caregivers may help in the identification of pain-related behaviours and should be more involved in the ICU pain assessment process. Fluctuations in vital signs should only be considered as cues for further assessment of pain with appropriate tools, and may better represent adverse events of severe pain. Other physiologic measures of pain should be explored in the ICU, and pupillometry appears as a promising technique to further study. Implementation of systematic pain assessment approaches using tools adapted to the patient's ability to communicate and condition has shown positive effects on ICU pain practices and patient outcomes, but randomised control trials are needed to confirm these conclusions. PMID:27067745

  17. 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

  18. 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

  19. 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.

  20. 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…

  1. 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

  2. Interdisciplinary collaboration: the slogan that must be achieved for models of delivering critical care to be successful.

    Science.gov (United States)

    Irwin, Richard S; Flaherty, Helen M; French, Cynthia T; Cody, Shawn; Chandler, M Willis; Connolly, Ann; Lilly, Craig M

    2012-12-01

    There is wide acceptance of the concept that interdisciplinary collaboration is an essential building block for successful health-care teams. This belief is grounded in our understanding of how teams function to address complex care needs that change with acute illness or injury. This general agreement has been validated in studies that have reported favorable outcomes associated with successfully implementing interdisciplinary models of health-care delivery in non-critical care settings. The very short time frames over which the care needs of critically ill or injured adults change and the team approach taken by nearly all ICUs strongly suggest that interdisciplinary collaboration is also beneficial in this setting. In this commentary, we define interdisciplinary collaboration and share the story of how we successfully redesigned and transformed our system-wide, interdisciplinary collaborative model for delivering critical care in order to share the lessons we learned as the process evolved with those who are about to embark on a similar challenge. We anticipate that those health-care systems that successfully implement interdisciplinary collaboration will be ahead of the curve in providing high-quality care at as low a cost as possible. Such institutions will also potentially be better positioned for improving teaching and providing a better foundation for critical care research in their institutions. PMID:23208334

  3. 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 …

  4. 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

  5. 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

  6. 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.

  7. 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 ...

  8. Finishes and furnishings: considerations for critical care environments.

    Science.gov (United States)

    Chambers, Misty; Bowman, Ken L

    2011-01-01

    When selecting finishes and furnishings within a critical care unit, multiple factors can ultimately affect patient outcomes, impact costs, and contribute to operational efficiencies. First, consider the culture of the regional location, operations of the specific facility, and the recent focus on patient-centered care. The intention is to create an appropriate familiarity and comfort level with the environment for the patient and family. Second, safety and infection control are of utmost concern, particularly for the critical care patient with limited mobility. The planning and design team must be acutely aware of the regulations and guidelines of various governing agencies, local codes, and best design practices that can directly affect choices of finishes and furnishings. Flooring, wall, and window finishes, lighting, art and color, as well as furniture and fabric selection should be considered. Issues to address include maintenance, durability, sustainability, infection control, aesthetics, safety, wayfinding, and acoustics. Balancing these issues with comfort, patient and staff satisfaction, accommodations for an aging population, increasing bariatric needs, efficient operations, and avoidance of "never events" requires team collaboration and communication, knowledge of product advancements, a keen awareness of how environmental stimuli are perceived, and utilization of the best available evidence to make informed design decisions. PMID:21921717

  9. 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.

  10. 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....

  11. Caring for young adults on a paediatric ward.

    Science.gov (United States)

    Heaton, Paul A J; Routley, Christine; Paul, Siba Prosad

    The need for adolescents and young adults (AYA) to have suitable age-specific inpatient facilities has been recognised for many years, yet has received relatively little attention. This article reports the successful introduction of an inpatient facility for AYA, aged 17-24 years, on a general paediatric ward in a small district general hospital. From December 2010, a young person's unit (YPU) consisting of an 8-bed area was opened within a 24-bed children's ward. Nursing care was provided by the ward staff, all of whom had been trained in the care of young adults. Policies regarding admission criteria, safeguarding, patient choice, visiting and 'house rules' were drafted, implemented and modified as necessary. Discussions with the adult clinicians (for medical care) and site managers were held to ensure smooth running of the system, and to address any concerns or difficulties. Paediatric patients had priority of admission at times of bed crisis. During 2012, there were a total of 2351 inpatient admissions to the paediatric ward, of whom 379 (16%) were YPU patients aged from 17-24 years. Median length of stay was 2 days for patients aged 17-24 years as compared with 1 day for patients aged less than or equal to 16 years. Patients who chose admission to the paediatric ward tended to be younger, in transition from paediatric to adult services for chronic conditions, or with special needs. Patient surveys showed a high level of satisfaction with the facility. Young adults can be cared for safely and effectively on a paediatric ward with minimal additional costs. The essential ingredients for success include discussion with affected parties to address specific concerns, and the establishment of a clear, simple and unambiguous admission policy. PMID:24165407

  12. Ebola virus disease: the UK critical care perspective.

    Science.gov (United States)

    Martin, D; Howard, J; Agarwal, B; Rajalingam, Y; Athan, B; Bhagani, S; Cropley, I; Hopkins, S; Mepham, S; Rodger, A; Warren, S; Jacobs, M

    2016-05-01

    The recent outbreak of Ebola virus disease (EVD) has required the treatment of affected patients in the NHS system within the UK. Managing patients with a confirmed viral haemorrhagic fever requires a thorough understanding of treatment options within the confines of an effective biocontainment setting. The Royal Free Hospital High Level Isolation Unit (HLIU) in London, is a purpose built facility that allows healthcare workers to safely treat patients with highly contagious diseases. This HLIU uses Trexler isolator tents to prevent the spread of infection from patients to healthcare workers. Provision of invasive organ support can be provided in this environment, if considered appropriate, and is achievable without posing additional risk to staff. We report our recent experiences of managing patients with EVD, with particular focus on those aspects of care pertinent to anaesthesia and critical care medicine. PMID:27106962

  13. Workflow: a new modeling concept in critical care units.

    Science.gov (United States)

    Yousfi, F; Beuscart, R; Geib, J M

    1995-01-01

    The term Groupware concerns computer-based systems that support groups of people engaged in a common task (goal) and that provide an interface to a shared environment [1]. The absence of a common tool for exchanges between physicians and nurses causes a multiplication of paper supports for the recording of information. Our objective is to study software architectures in particular medical units that allow task coordination and managing conflicts between participants within a distributed environment. The final goal of this research is to propose a computer solution that could answer the user requirements in Critical Care Units (CCUs). This paper describes the Workflow management approach [5] for supporting group work in health care field. The emphasis is especially on asynchronous cooperation. This approach was applied to CCUs through the analysis and the proposal of a new architecture [6]. We shall limit ourselves to explaining control board and analyzing the message management we support. PMID:8591248

  14. 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

  15. 2010 Critical Care Transport Workplace and Salary Survey.

    Science.gov (United States)

    Greene, Michael J

    2010-01-01

    Critical care transport (CCT) leaders and managers from 300 organizations were invited to participate in an online survey (participation rate, 34%) with approximately 150 questions covering a broad base of CCT organizational, workplace, personnel, and salary matters. In addition to medical team composition, recruitment and retention, training, education, and benefits, the survey presents CCT crew salary data by job class by Bowley's seven-figure summary, as well as average, minimum, and maximum hourly rates. Salaries are reported in a national aggregate and by Association of Air Medical Services region. PMID:20826354

  16. Dose Adjustment- An Important Issue in Critical Care

    Directory of Open Access Journals (Sweden)

    Dr. M. C. Joshi

    2006-01-01

    Full Text Available There is at times marked variability in drug responsiveness especially in critically ill patients admitted in the Intensive care units. In order to obtain therapeutic effectiveness with in pharmacokinetic parameters related to therapeutic dose, it is always desirable to monitor and to maintain drug dose adjustment in such a way especially in presence of organ failure like renal failure, hepatic failure or any other clinical situation necessitating Therapeutic Drug Monitoring (TDM so that one can use safe and effective drug therapy with least toxicity due to inaccurate and invalid drug doses.

  17. [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

  18. 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.

  19. 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...

  20. 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 ...

  1. Access to Care Among Disabled Adults on Medicaid

    OpenAIRE

    Long, Sharon K.; Coughlin, Teresa A.; Kendall, Stephanie J.

    2002-01-01

    Although disabled individuals account for a disproportionate share of Medicaid expenditures, little is known about their health care needs and experiences. This article explores differences in access and use among key disability subgroups—adults with physical disabilities, mental illness, and mental retardation/development disabilities (MR/DD). We find that disabled Medicaid beneficiaries with mental illness and those with greater health and functional limitations face more difficulties in ob...

  2. 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...

  3. 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

  4. Assisting the Adult with a Respiratory Condition: Pharmacology. Care of the Adult.

    Science.gov (United States)

    Anoka-Hennepin Area Vocational Technical Inst., MN.

    These two units for students in a practical nursing program provide supplemental instruction, with a focus on pharmacology, in caring for adult patients with a respiratory condition. Unit titles are Antibiotics, and Drugs that Affect the Respiratory System. Each unit contains the following: objectives, an introduction, and five to nine learning…

  5. [Introduction of Hemodynamic Monitoring in Critical Care Units].

    Science.gov (United States)

    Lin, Chen-Wei; Wang, Shiao-Pei

    2016-02-01

    Hemodynamic monitoring is a very important treatment in intensive care units. Measurements taken during monitoring include pulmonary artery catheter (PAC), pulse-induced contour output (PiCCO), and non-invasive hemodynamic monitoring. PAC measures cardiopulmonary parameters using the thermodilution principle. PiCCO uses transpulmonary thermodilution and pulse contour analysis to measure cardiopulmonary parameters and extra-vascular lung water, to predict lung edema, and to differentiate between cardiogenic and non-cardiogenic respiratory failure. Non-invasive hemodynamic monitoring uses the thoracic electrical bioimpedance principle to measure electrical conductivity and then calculates stroke volume and cardiopulmonary parameters using the arrangement of red blood cells. The author is a nurse in an intensive care unit who is familiar with the various methods used in hemodynamic monitoring, with preparing the related devices, with briefing patients and family members prior to procedures, with related aseptic skills, with preventing complications during the insertion procedure, and with analyzing and interpreting those parameters accurately. The issues addressed in this paper are provided as a reference for nurses and other medical personnel to choose appropriate treatments when caring for critical patients. PMID:26813070

  6. Critical thinking: what does it mean in the care of elderly hospitalized patients?

    Science.gov (United States)

    Heffner, Susan; Rudy, Sally

    2008-01-01

    In today's complex healthcare environment, it is more important than ever that nurses possess critical thinking skills to provide optimal care for their patients. This article offers a definition of critical thinking for nurses and describes the importance of critical thinking in the care of our growing elderly patient population. Examples related to geriatric nursing care, including acute care, dementia care, and end-of-life care, are provided to reinforce the importance of critical thinking and its benefits to our elderly patient population. PMID:18316940

  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

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 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, "Familism and Health Care Provision to Hispanic Older Adults" found on pages 21-29, 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 December 31, 2018. 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. Explain familism and its potential effect on health care provision to Hispanic older adults. 2. Describe cultural

  8. Stress and burnout among critical care fellows: preliminary evaluation of an educational intervention

    OpenAIRE

    Kashani, Kianoush; Carrera, Perliveh; Gallo De Moraes, Alice; Sood, Amit; Onigkeit, James A; Ramar, Kannan

    2015-01-01

    Background: Despite a demanding work environment, information on stress and burnout of critical care fellows is limited.Objectives: To assess 1) levels of burnout, perceived stress, and quality of life in critical care fellows, and 2) the impact of a brief stress management training on these outcomes.Methods: In a tertiary care academic medical center, 58 critical care fellows of varying subspecialties and training levels were surveyed to assess baseline levels of stress and burnout. Twenty-o...

  9. 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

  10. 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.

  11. Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study

    Science.gov (United States)

    Coombs, Maureen; Darlington, Anne-Sophie; Richardson, Alison

    2015-01-01

    Background: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. Aim: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. Design: Exploratory two-stage qualitative study Setting/participants: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. Findings: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. Conclusion: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting. PMID:25519147

  12. 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. PMID:24267938

  13. Gut failure in critical care: old school versus new school

    Science.gov (United States)

    Sertaridou, Eleni; Papaioannou, Vasilios; Kolios, George; Pneumatikos, Ioannis

    2015-01-01

    The concept of bacterial translocation and gut-origin sepsis as causes of systemic infectious complications and multiple organ deficiency syndrome in surgical and critically ill patients has been a recurring issue over the last decades attracting the scientific interest. Although gastrointestinal dysfunction seemingly arises frequently in intensive care unit patients, it is usually underdiagnosed or underestimated, because the pathophysiology involved is incompletely understood and its exact clinical relevance still remains controversial with an unknown yet probably adverse impact on the patients’ outcome. The purpose of this review is to define gut-origin sepsis and related terms, to describe the mechanisms leading to gut-derived complications, and to illustrate the therapeutic options to prevent or limit these untoward processes. PMID:26130136

  14. 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

  15. 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 ...

  16. Intensive care for the adult population in Ireland: a multicentre study of intensive care population demographics

    OpenAIRE

    ,

    2008-01-01

    Introduction This prospective observational study was conducted to describe the nature of the intensive care population across Ireland, identify adherence to international benchmarks of practice, and describe patient outcomes in critically ill patients. Methods A prospective observational multicentre study of demographics and organ failure incidence was carried out over a 10-week period in 2006 across the intensive care units (ICUs) of 14 hospitals in both the Republic and Northern Ireland. R...

  17. 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

  18. More... or Less? Towards a Critical Pedagogy of Adult Numeracy

    Science.gov (United States)

    Ackland, Aileen

    2014-01-01

    The development of socio-cultural understandings of mathematics combined with policy interest in adult numeracy as a result of international studies, which compare skill levels in different countries, have impacted adult education practice in recent years. In Scotland, a "social practice approach" is espoused and adult numeracy tutors…

  19. 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…

  20. Primary Care for the Older Adult Patient: Common Geriatric Issues and Syndromes.

    Science.gov (United States)

    Thompson, Katherine; Shi, Sandra; Kiraly, Carmela

    2016-06-01

    Older adults are the fastest growing segment of the US population and the majority of older adults are women. Primary care for the older adult patient requires a wide variety of skills, reflecting the complexity and heterogeneity of this patient population. Individualizing care through consideration of patients' goals, medical conditions, and prognosis is paramount. Quality care for the older adult patient requires familiarity with common geriatric syndromes, such as dementia, falls, and polypharmacy. In addition, developing the knowledge and communication skills necessary for complex care and end-of-life care planning is essential. PMID:27212097

  1. A critical review of approaches to the treatment of dental anxiety in adults.

    Science.gov (United States)

    Gordon, Dina; Heimberg, Richard G; Tellez, Marisol; Ismail, Amid I

    2013-05-01

    Dental anxiety and specific phobia of dental procedures are prevalent conditions that can result in substantial distress and oral health impairment. This paper critically reviews 22 randomized treatment trials aimed at reducing dental anxiety and avoidance in adults, published in peer-reviewed journals between 1974 and 2012. The following treatment techniques are reviewed: various forms of cognitive-behavioral therapy (CBT), relaxation training, benzodiazepine premedication, music distraction, hypnotherapy, acupuncture, nitrous oxide sedation, and the use of lavender oil scent. CBT delivered in a variety of formats, including one-session treatment, has the most evidence for its efficacy. Cognitive techniques, relaxation, and techniques to increase patients' sense of control over dental care are also efficacious but perform best when combined with repeated, graduated exposure. Other interventions require further study in randomized trials before conclusions about their efficacy are warranted. Limitations of the extant outcome research and implications for future treatment and research are discussed. PMID:23746494

  2. 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.

  3. Integration and continuity of Care in health care network models for frail older adults

    Science.gov (United States)

    Veras, Renato Peixoto; Caldas, Célia Pereira; da Motta, Luciana Branco; de Lima, Kenio Costa; Siqueira, Ricardo Carreño; Rodrigues, Renata Teixeira da Silva Vendas; Santos, Luciana Maria Alves Martins; Guerra, Ana Carolina Lima Cavaletti

    2014-01-01

    A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change. PMID:24897058

  4. 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…

  5. 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…

  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. June 2015 Phoenix critical care journal club: interventions in ARDS

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-06-01

    Full Text Available No abstract available. Article truncated at 150 words. Mortality has been declining in the adult respiratory distress syndrome (ARDS (1. However, the cause of the decline in mortality is unclear. The only intervention shown to improve survival has been low tidal volume ventilation but the mortality was improving before this intervention was widely used (2. Nevertheless, it was suggested that we look at system performance regarding ARDS management from a critical appraisal standpoint. This journal club was hoped to help as a starting point in that regard. Four potential beneficial interventions were discussed: 1. Conservative fluid management; 2. Optimal PEEP as determined by esophageal pressure; 3. Prone positioning; and 4. Mechanical ventilation driving pressure. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl ...

  8. 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...

  9. 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.

  10. 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.

  11. 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

  12. 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. PMID:27113144

  13. Height measurement in the critically ill patient: A tall order in the critical care unit

    Directory of Open Access Journals (Sweden)

    Ramesh Venkataraman

    2015-01-01

    Full Text Available Height measurement in the critical care unit is necessary for estimating ideal body weight and providing titrated patient care. In this study, we compare three methods of height assessment and evaluate their level of correlation and inter-observer reproducibility. Heights of 100 consecutive patients were assessed independently by two nurses by supine, four point, and arm span methods. Paired sample t-test, one-way analysis of variance, Tukey′s honestly significant difference post-hoc analysis and Bland-Altman plots were performed to assess agreement between measurements. Arm span method showed higher mean height compared to supine and four point methods. Mean heights derived by supine and four point measurements were similar to each other but were significantly different from that of arm span method (P < 0.001. Inter-observer correlation of the measured heights was very good among all three methods. The supine method seems to be easy, accurate, and reproducible in our study.

  14. 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.

  15. 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

    ... 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 of Day Care Homes for the Period July 1, 2011 Through June 30, 2012 Correction In notice document...

  16. 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…

  17. 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…

  18. Taking care: practice and philosophy of communication in a critical care follow-up clinic.

    Science.gov (United States)

    Hazzard, Anthony; Harris, Wendy; Howell, David

    2013-06-01

    Human consciousness is inextricable from communication. The conditions of communication in the clinical context are defined by the caring intention and the unequal relationship, which imply special responsibilities on the part of the clinician. The conventional hermeneutic model of communication proposes a close examination of the context of the other, and an objective effort to get close to their consciousness by interpretation of their expressions. The clinician is supposed to lay aside subjective factors but make use of her/his clinical knowledge and skills. At University College Hospital Critical Care follow-up clinic, the communicative task involves history taking; partly by questionnaire and partly by attention to the patient's agenda - assessing needs, providing information and facilitating access to further help. In recent years the provision of Critical Care has become ever more complex, both in terms of the sophisticated medical and nursing techniques it can offer to patients and in the range of conditions it can undertake to treat. This range and complexity is reflected in the variety of problems and consequences that may be encountered at follow-up. Communicative techniques should take account of the emotional vulnerability of patients emerging from severe illness. Attentive listening should identify special anxieties, and care with phraseology aims to avoid further distress. Issues of memory, depression and trauma may be expected, and the interview technique must be flexible enough to offer emotional containment if need be. The consultation should be therapeutic in its conduct but should not embark upon actual psychotherapy or seek to dismantle the patient's defences. Contemporary hermeneutic perspectives emphasise the contextual situatedness of the clinician's consciousness, and propose a model of communication as 'blending of horizons' rather than as objective interpretation. Systems theory contributes to an understanding of the influence on

  19. 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

  20. 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

  1. Care of Adults With Intellectual and Developmental Disabilities: Cerebral Palsy.

    Science.gov (United States)

    Jones, Kyle Bradford; Wilson, Benjamin; Weedon, Dean; Bilder, Deborah

    2015-12-01

    Cerebral palsy (CP) is a group of disorders that primarily affect motor function. This developmental disability is becoming more common in adults as life expectancy increases for individuals with CP. Many physical, medical, mental, and behavioral health conditions are associated with CP, and assistance should be provided to patients with CP to optimize function, when available. These comorbidities include intellectual disabilities, seizures, muscle contractures, abnormal gait, osteoporosis, communication disorders, malnutrition, sleep disorders, and mental health disorders, such as depression and anxiety. The physician should be familiar with screening for and assisting patients with these issues. Optimizing quality of life requires individualized care plans that may include physical therapy, muscle relaxants, surgery, and nutritional support. Other issues to be addressed include methods to facilitate employment; sexual concerns; and support through local and national organizations for patients, families, and caregivers. PMID:26669212

  2. Adverse events associated with poor neurological outcome during targeted temperature management and advanced critical care after out-of-hospital cardiac arrest

    OpenAIRE

    Kim, Young-Min; Youn, Chun Song; Kim, Soo Hyun; Lee, Byung Kook; Cho, In Soo; Cho, Gyu Chong; Jeung, Kyung Woon; Oh, Sang Hoon; Choi, Seung Pill; Shin, Jong Hwan; Cha, Kyoung-Chul; Oh, Joo Suk; Yim, Hyeon Woo; Park, Kyu Nam; ,

    2015-01-01

    Introduction The aim of this study was to investigate the association of adverse events (AEs) during targeted temperature management (TTM) and other AEs and concomitant treatments during the advanced critical care period with poor neurological outcome at hospital discharge in adult out-of-hospital cardiac arrest (OHCA) patients. Methods This was a retrospective study using Korean Hypothermia Network registry data of adult OHCA patients treated with TTM in 24 teaching hospitals throughout Sout...

  3. 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

  4. 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

  5. Making cars and making health care: a critical review.

    Science.gov (United States)

    Winch, Sarah; Henderson, Amanda J

    2009-07-01

    The uncritical adoption of production-line manufacturing practices (such as "lean thinking") into work design processes in hospitals creates a fundamental tension between the production of health care and protection of the patient. There is scant evidence that re-engineering health care services in line with industrial models increases their efficiency. Indeed, reducing the richness of health care practice to impoverished snippets of work may add to the problems of hospital misadventure and inefficiency rather than solve them. PMID:19580533

  6. 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...

  7. 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.

  8. 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...

  9. 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.

  10. 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.

  11. 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

  12. Do earplugs stop noise from driving critical care patients into delirium?

    OpenAIRE

    Mills, Gary H; Bourne, Richard S

    2012-01-01

    Quality sleep is a problem for the critically ill who are cared for in an environment where interventions night and day are common, staff members are constantly present in relatively high numbers, and treatment is accompanied by a range of changing warning tones and alarms and lights. These critical care units are generally designed without a focus on patient comfort, sleep, and rest and often lack access to appropriate natural daylight. To add to this problem, critical illness, particularly ...

  13. 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…

  14. 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…

  15. 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)

  16. 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:…

  17. Clinical Innovation in pre-hospital care: An introduction to Critical Care Paramedics in the United Kingdom

    OpenAIRE

    Jashapara, Ashok

    2011-01-01

    The aim of the project was to evaluate the development of ‘Critical Care Paramedics’ (CCPs) at South East Coast Ambulance NHS Trust (SECAmb) in the UK. SECAmb has developed a new CCP role in response to numerous national reports critical of sub-standard pre-hospital care for seriously ill and injured patients, and the need to save more lives. There is an ongoing debate on the use of doctors and paramedics in pre-hospital care and the evidence is mixed whether one is more effective...

  18. 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

  19. Ebola at the National Institutes of Health: Perspectives From Critical Care Nurses.

    Science.gov (United States)

    Johnson, Susan S; Barranta, Neil; Chertow, Dan

    2015-01-01

    Infectious disease events were in the headlines in 2014. West Africa experienced the worst Ebola virus disease (EVD) outbreak ever recorded. The world was stunned when the deadly virus began to spread to other countries. The health care system in the United States responded by designating specialized centers to care for patients with EVD. All health care workers must understand the isolation processes involved in caring for these patients. Using personal protective equipment is imperative and requires adjustments in how care is provided. Staffing patterns must be altered to provide safe care, while maintaining safety of health care workers. This article provides perspectives of the critical care nurse manager and bedside nurse who participated in the development of the care processes for patients with EVD at the National Institutes of Health to help health care colleagues better understand issues experienced and to help prepare them if they encounter patients with EVD. PMID:26200735

  20. 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…

  1. Improvement Critical Care Patient Safety: Using Nursing Staff Development Strategies, At Saudi Arabia

    OpenAIRE

    2015-01-01

    Intensive care units (ICUs) provide lifesaving care for the critically ill patients and are associated with significant risks. Moreover complexity of care within ICUs requires that the health care professionals exhibit a trans-disciplinary level of competency to improve patient safety. This study aimed at using staff development strategies through implementing patient safety educational program that may minimize the medical errors and improve patient outcome in hospital. The study was carried...

  2. 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…

  3. Comparing Information Needs of Health Care Providers and Older Adults: Findings from a Wellness Study

    OpenAIRE

    Reeder, Blaine; Le, Thai; Thompson, Hilaire J.; Demiris, George

    2013-01-01

    Consumer health informatics technologies have the potential to enhance shared decision-making and communication between older adults, health care providers, and other stakeholders. The objective of this study was to characterize the information needs of these stakeholders to inform the design of informatics tools that support wellness in older adults. We conducted four focus groups with 31 older adults and three focus groups with 10 health care providers to explore information needs, goals, a...

  4. 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

  5. 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...

  6. 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...

  7. 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...

  8. 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…

  9. 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.

  10. 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…

  11. 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...

  12. 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...

  13. 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...

  14. 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

  15. Physician Perspectives on Providing Primary Medical Care to Adults with Autism Spectrum Disorders (ASD)

    Science.gov (United States)

    Warfield, Marji Erickson; Crossman, Morgan K.; Delahaye, Jennifer; Der Weerd, Emma; Kuhlthau, Karen A.

    2015-01-01

    We conducted in-depth case studies of 10 health care professionals who actively provide primary medical care to adults with autism spectrum disorders. The study sought to understand their experiences in providing this care, the training they had received, the training they lack and their suggestions for encouraging more physicians to provide this…

  16. 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 was......OBJECTIVE: The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING: The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where a...... protocol of no sedation is implemented. Data were generated during participant observation in practice and by interviews with 16 nurses. Data were analysed using thematic interpretive description. FINDINGS: An overall theme emerged: "Demanding, yet rewarding". The demanding aspects of caring for more awake...

  17. 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...

  18. 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....

  19. Emergencies and Critical Care of Commonly Kept Fowl.

    Science.gov (United States)

    Sabater González, Mikel; Calvo Carrasco, Daniel

    2016-05-01

    Fowl are birds belonging to one of the 2 biological orders, the game fowl or land fowl (Galliformes) and the waterfowl (Anseriformes). Studies of anatomic and molecular similarities suggest these two groups are close evolutionary relatives. Multiple fowl species have a long history of domestication. Fowl are considered food-producing animals in most countries and clinicians should follow legislation regarding reportable diseases and antibiotic use, even if they are pets. This article reviews aspects of emergency care for most commonly kept fowl, including triage, patient assessment, diagnostic procedures, supportive care, short-term hospitalization, and common emergency presentations. PMID:26948266

  20. 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

  1. 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.

  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. 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.

  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. Critical care of obese patients during and after spine surgery

    OpenAIRE

    Elgafy, Hossein; Hamilton, Ryan; Peters, Nicholas; Paull, Daniel; Hassan, Ali

    2016-01-01

    Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors mu...

  6. A critical review of arsenic exposures for Bangladeshi adults.

    Science.gov (United States)

    Joseph, Tijo; Dubey, Brajesh; McBean, Edward A

    2015-09-15

    Groundwater, the most important source of water for drinking, cooking, and irrigation in Bangladesh, is a significant contributor to the daily human intake of arsenic. Other arsenic intake pathways, established as relevant for Bangladeshi adults through this review, include consumption of contaminated edible plant parts and animal-origin food, inhalation of contaminated air, soil ingestion, betel quid chewing, and tobacco smoking. This review qualifies and quantifies these arsenic intake pathways through analysis of the range of arsenic levels observed in different food types, water, soil, and air in Bangladesh, and highlights the contributions of dietary intake variation and cooking method in influencing arsenic exposures. This study also highlights the potential of desirable dietary patterns and intakes in increasing arsenic exposure which is relevant to Bangladesh where nutritional deficiencies and lower-than-desirable dietary intakes continue to be a major concern. PMID:26004539

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

    Science.gov (United States)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

    2015-01-01

    Background 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. Methods 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. Results 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. Conclusion 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. PMID:26489096

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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

  10. Ethical Issues Recognized by Critical Care Nurses in the Intensive Care Units of a Tertiary Hospital during Two Separate Periods

    OpenAIRE

    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

    2015-01-01

    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...

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

    OpenAIRE

    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 conducte...

  12. 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...

  13. 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...

  14. Critical care management of systemic mastocytosis: when every wasp is a killer bee

    OpenAIRE

    van der Weide, Hinke Y.; van Westerloo, David J.; van den Bergh, Walter M.

    2015-01-01

    Since the critical care physician will most likely be involved in a life-threatening expression of systemic mastocytosis, recognition of this disease is of utmost importance in the critical care management of these patients. Mastocytosis is a severely under-recognized disease because it typically occurs secondary to another condition and thus may occur more frequently than assumed. In this article, we will review the current knowledge on the treatment of mastocytosis crises with an emphasis o...

  15. 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...

  16. 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...

  17. 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...

  18. 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.

  19. 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

  20. Critical Care in Human Immunodeficiency Virus-Infected Patients.

    Science.gov (United States)

    Akgün, Kathleen M; Miller, Robert F

    2016-04-01

    Intensive care unit (ICU) survival has been improved significantly for HIV-infected patients since the advent of antiretroviral therapy (ART). Non-AIDS conditions account for the majority of ICU admission diagnoses in areas with access to ART. However, opportunistic infections such as Pneumocystis jirovecii pneumonia still account for a significant proportion of ICU admissions, particularly in newly diagnosed HIV-infected patients, and are associated with increased ICU mortality. We discuss risk factors and outcomes for HIV-infected admitted to the ICU in the current ART era. We review the changing patterns in ICU admission diagnoses over time and how common ICU conditions are managed in HIV-infected compared with uninfected patients. We next address issues specific to the care for HIV-infected patients in the ICU, focusing on immune reconstitution inflammatory syndrome, ART continuation or initiation, and some common and potentially life-threatening ART-associated toxicities. PMID:26974306

  1. 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

  2. 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

  3. April 2016 critical care case of the month

    OpenAIRE

    Sultan S

    2016-01-01

    No abstract available. Article truncated after 150 words. History of Present Illness: The patient is a 22-year-old African-American man who was initially seen following a rapid response team called to the neonatal intensive care unit for a seizure. He was visiting his newborn child. The nurses described the seizure as tonic-clonic which resolved spontaneously without treatment before the rapid response team arrived. Past Medical History, Family History and Social History: The patient has a pa...

  4. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    OpenAIRE

    Yeliz İrem Tunçel; Menşure Kaya; Rukiye Neslihan Kuru; Saadet Menteş; Süheyla Ünver

    2014-01-01

    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 Depressi...

  5. 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 ...

  6. 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...

  7. 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

  8. Meaning and Practice of Palliative Care for Hospitalized Older Adults with Life Limiting Illnesses

    OpenAIRE

    Bethel Ann Powers; Norton, Sally A.; Schmitt, Madeline H.; Quill, Timothy E.; Maureen Metzger

    2011-01-01

    Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identi...

  9. 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 ...

  10. 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 ...

  11. 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...

  12. 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...

  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

    Directory of Open Access Journals (Sweden)

    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. Clinical major option: a model for implementing critical care nursing into baccalaureate preparation.

    Science.gov (United States)

    Robertson, K A

    2000-01-01

    What was initiated as a directive from a provincial government in an attempt to increase the number of critical care nurses has evolved into an exciting educational opportunity for many nurses and student nurses in the year 2000. Between 1993 and 1997 there has been significant downsizing of acute care beds across Canada (Code Blue: Critical Care Nursing in Nova Scotia, 1998). At the same time patient acuity has increased, due to shorter hospital stays, and the number of nurses working full-time has decreased with the increased use of casual nurses. Several studies at both the provincial and national levels report current and future shortages of specialized nurses (emergency, critical care and perioperative). It is expected that this shortage will continue into the future, a shortage that is driven by technological advances, as well as an aging general and nursing population. Continued shortages of these acute care nurses will result in fierce competition for skilled nurses as well as aggressive recruitment and retention strategies (Code Blue: Critical Care Nursing in Nova Scotia, 1998). It is generally agreed within the nursing community that specialty nurses in critical care require a unique body of knowledge that is not acquired in a basic undergraduate nursing program (Fitzsimmons, Hadley, & Shively, 1999). This specialized knowledge can be gained informally through experience; however, it is largely developed in additional formal education programs. The purpose of this article is to outline a strategy for the delivery of specialty education at three educational levels in acute care nursing with three streams: emergency, critical care and perioperative nursing. This clinical major option is to be delivered in partnership among the Queen Elizabeth Hospital II, the Health Science Centre and Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada. This model of offering specialty education in university preparation could be a template for preparing

  16. 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...

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

    Directory of Open Access Journals (Sweden)

    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. 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

  20. Prevention of Iatrogenic Anemia in Critical and Neonatal Care.

    Science.gov (United States)

    Jakacka, Natalia; Snarski, Emilian; Mekuria, Selamawit

    2016-01-01

    Iatrogenic anemia caused by diagnostic blood sampling is a common problem in the intensive care unit, where continuous monitoring of blood parameters is very often required. Cumulative blood loss associated with phlebotomy along with other factors render this group of patients particularly susceptible to anemia. As it has been proven that anemia in this group of patients leads to inferior outcomes, packed red blood cell transfusions are used to alleviate possible threats associated with low hemoglobin concentration. However, the use of blood components is a procedure conferring a set of risks to the patients despite improvements in safety. Iatrogenic blood loss has also gained particular attention in neonatal care, where cumulative blood loss due to samples taken during the first week of life could easily equal or exceed circulating blood volume. This review summarizes the current knowledge on the causes of iatrogenic anemia and discusses the most common preventive measures taken to reduce diagnostic blood loss and the requirement for blood component transfusions in the aforementioned clinical situations. PMID:26935514

  1. 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

  2. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    Directory of Open Access Journals (Sweden)

    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. 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...

  4. Contributors to Adult Sibling Relationships and Intention to Care of Siblings of Individuals With Down Syndrome.

    Science.gov (United States)

    Cuskelly, Monica

    2016-05-01

    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 about the quality of current relationships and of their intention to provide care for their brother/sister with Down syndrome in the future. Only behavior problems in the child with Down syndrome predicted warmth of the current adult relationship. Although adult sibling relationships were reported to be warm, the quality of neither the current nor the past relationship was associated with the reported intention to provide care. PMID:27119212

  5. 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...

  6. 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 ...

  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. 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

  10. Revision of Immediate Post-Open Heart Surgery Education for Critical Care RNs.

    Science.gov (United States)

    Mowry, Marianne J; Gabel, Mollie A

    2015-11-01

    Responding to the complex nature of critical care is imperative, as extensive clinical judgment is required during those vital moments when patients are experiencing complications related to open heart surgery, post-vessel bypass, or valve replacement. Critical care registered nurses must rely on evidence-based foundational knowledge and skills particular to cardiovascular pathophysiology, hemodynamic monitoring, and medications. This article reports on the critical care educator's revision of the immediate post-open heart surgery curriculum. Mixed educational methods within the plan were foundational to develop clinicians for competent care of these complex patients (within the first 8 hours). The revision included experiential learning and learner centeredness to bolster the learner's confidence, reduce the time to competence, and, most important, ensure positive patient outcomes. Kirkpatrick's classic four-level model provided the framework for evaluation. Lessons learned were discussed following the program initiation. PMID:26509403

  11. Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study

    Directory of Open Access Journals (Sweden)

    Garvey KC

    2014-10-01

    Full Text Available Katharine C Garvey,1,5 Margaret G Beste,2 Donna Luff,3,5 Astrid Atakov-Castillo,2 Howard A Wolpert,2,5 Marilyn D Ritholz4–61Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA; 2Adult Section, Joslin Diabetes Center, Boston, MA, USA; 3Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Boston, MA, USA; 4Behavioral and Mental Health Unit, Joslin Diabetes Center, Boston, MA, USA; 5Harvard Medical School, Boston, MA, USA; 6Department of Psychiatry, Boston Children's Hospital, Boston, MA, USAObjective: This qualitative study aimed to explore the experience of transition from pediatric to adult diabetes care reported by posttransition emerging adults with type 1 diabetes (T1D, with a focus on preparation for the actual transfer in care.Methods: Twenty-six T1D emerging adults (mean age 26.2±2.5 years receiving adult diabetes care at a single center participated in five focus groups stratified by two levels of current glycemic control. A multidisciplinary team coded transcripts and conducted thematic analysis.Results: Four key themes on the process of transfer to adult care emerged from a thematic analysis: 1 nonpurposeful transition (patients reported a lack of transition preparation by pediatric providers for the transfer to adult diabetes care; 2 vulnerability in the college years (patients conveyed periods of loss to follow-up during college and described health risks and diabetes management challenges specific to the college years that were inadequately addressed by pediatric or adult providers; 3 unexpected differences between pediatric and adult health care systems (patients were surprised by the different feel of adult diabetes care, especially with regards to an increased focus on diabetes complications; and 4 patients’ wish list for improving the transition process (patients recommended enhanced pediatric transition counseling, implementation of adult clinic orientation programs, and peer

  12. 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.

  13. Assessing general practitioners' care of adult patients with learning disability: case-control study.

    OpenAIRE

    Whitfield, M.; Langan, J; Russell, O

    1996-01-01

    OBJECTIVE--To compare general practitioners' care of adult patients with learning disability with that of control patients in the same practice. DESIGN--Case-control study of patients and controls by a structured interview study of general practitioners. SETTING--Avon. PATIENTS--78 adult patients with learning disability and 78 age and sex matched controls--cared for by 62 general practitioners. MAIN MEASURES--Number and content of consultations and opinions of the general practitioners. RESU...

  14. 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 ...

  15. 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

  16. 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

  17. 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. ...

  18. 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

  19. 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

  20. 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…

  1. Critical care of obese patients during and after spine surgery.

    Science.gov (United States)

    Elgafy, Hossein; Hamilton, Ryan; Peters, Nicholas; Paull, Daniel; Hassan, Ali

    2016-02-01

    Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes. PMID:26855897

  2. 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.

  3. 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

  4. 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 ...

  5. 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

  6. 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. ...

  7. "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…

  8. 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…

  9. 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,…

  10. 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

  11. 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

  12. Temporal Artery versus Bladder Thermometry during Adult Medical-Surgical Intensive Care Monitoring: An Observational Study

    Directory of Open Access Journals (Sweden)

    Stelfox Henry T

    2010-08-01

    Full Text Available Abstract Background We sought to evaluate agreement between a new and widely implemented method of temperature measurement in critical care, temporal artery thermometry and an established method of core temperature measurement, bladder thermometry as performed in clinical practice. Methods Temperatures were simultaneously recorded hourly (n = 736 observations using both devices as part of routine clinical monitoring in 14 critically ill adult patients with temperatures ranging ≥1°C prior to consent. Results The mean difference between temporal artery and bladder temperatures measured was -0.44°C (95% confidence interval, -0.47°C to -0.41°C, with temporal artery readings lower than bladder temperatures. Agreement between the two devices was greatest for normothermia (36.0°C to Conclusions Temporal artery thermometry produces somewhat surprising disagreement with an established method of core temperature measurement and should not to be used in situations where body temperature needs to be measured with accuracy.

  13. Older Parents Providing Child Care for Adult Children: Does It Pay Off?

    Science.gov (United States)

    Geurts, Teun; Poortman, Anne-Rigt; van Tilburg, Theo G.

    2012-01-01

    This study examined whether past grandparental child care is related to present support from adult children. On the basis of social exchange theory, the authors expected that grandparental child care creates a debt that is repaid in the form of receiving support later in life. Using data from the Longitudinal Aging Study Amsterdam (N = 349…

  14. 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

  15. 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...

  16. An audit of the quality of inpatient care for adults with learning disability in the UK

    OpenAIRE

    Sheehan, Rory; Gandesha, Aarti; Hassiotis, Angela; Gallagher, Pamela; Burnell, Matthew; Jones, Glyn; Kerr, Michael; Hall, Ian; Chaplin, Robert; Crawford, Michael J.

    2016-01-01

    Objectives To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. Setting Nine acute general hospital Trusts and six mental health services. Participants Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. Primary and secondary outcome measure...

  17. 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 ...

  18. Overview of outcome measurement for adults using social care services and support

    OpenAIRE

    Netten, Ann

    2011-01-01

    What is meant by outcome inevitably varies depending on the context and scope of what is under consideration. This review discusses the measurement of outcome for individuals and their carers for research purposes, particularly the type of research which evaluates the effectiveness and cost effectiveness of social care for adults and which has implications for social care practice. The review discusses what is meant by outcome in social care, presenting a model that describes different ‘types...

  19. 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

  20. 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

  1. 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...

  2. Geriatric simulation: practicing management and leadership in care of the older adult.

    Science.gov (United States)

    Miller, Sally; Overstreet, Maria

    2015-06-01

    According to the Centers for Disease Control and Prevention, patients age 65 and older account for 43% of hospital days. The complexity of caring for older adults affords nursing students opportunities to assess, prioritize, intervene, advocate, and experience being a member of an interdisciplinary health care team. However, these multifaceted hospital experiences are not consistently available for all students. Nursing clinical simulation (NCS) can augment or replace specific clinical hours and provide clinically relevant experiences to practice management and leadership skills while caring for older adults. This article describes a geriatric management and leadership NCS. PMID:25999076

  3. 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

  4. 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

  5. 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.

  6. Quality improvement in pre-hospital critical care: increased value through research and publication.

    Science.gov (United States)

    Rehn, Marius; Krüger, Andreas J

    2014-01-01

    Pre-hospital critical care is considered to be a complex intervention with a weak evidence base. In quality improvement literature, the value equation has been used to depict the inevitable relationship between resources expenditure and quality. Increased value of pre-hospital critical care involves moving a system from quality assurance to quality improvement. Agreed quality indicators can be integrated in existing quality improvement and complex intervention methodology. A QI system for pre-hospital critical care includes leadership involvement, multi-disciplinary buy-in, data collection infrastructure and long-term commitment. Further, integrating process control with governance systems allows evidence-based change of practice and publishing of results. PMID:24887186

  7. 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

  8. 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.

  9. 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

  10. 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...

  11. 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...

  12. 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

  13. 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

  14. 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

  15. 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 ...

  16. 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

  17. Incidence, biomarkers, and outcome of acute kidney injury in critically ill adults

    OpenAIRE

    Nisula, Sara

    2014-01-01

    Acute kidney injury (AKI) is a syndrome encompassing kidney damage from mild injury to total loss of function that seriously disturbs the homeostasis of fluid and electrolyte balances. The objectives of this study were to evaluate the incidence, risk factors, and outcome of acute kidney injury in adult intensive care unit (ICU) patients in Finland, and to test the ability of two new biomarkers to predict AKI, renal replacement therapy (RRT), and 90-day mortality in ICU patients. A prospe...

  18. 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. PMID:20019504

  19. 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.

  20. 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.

  1. 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

  2. Stress and burnout among critical care fellows: preliminary evaluation of an educational intervention

    Directory of Open Access Journals (Sweden)

    Kianoush Kashani

    2015-07-01

    Full Text Available Background: Despite a demanding work environment, information on stress and burnout of critical care fellows is limited. Objectives: To assess 1 levels of burnout, perceived stress, and quality of life in critical care fellows, and 2 the impact of a brief stress management training on these outcomes. Methods: In a tertiary care academic medical center, 58 critical care fellows of varying subspecialties and training levels were surveyed to assess baseline levels of stress and burnout. Twenty-one of the 58 critical care fellows who were in the first year of training at the time of this initial survey participated in a pre-test and 1-year post-test to determine the effects of a brief, 90-min stress management intervention. Results: Based on responses (n=58 to the abbreviated Maslach Burnout Inventory, reported burnout was significantly lower in Asian fellows (p=0.04 and substantially higher among graduating fellows (versus new and transitioning fellows (p=0.02. Among the intervention cohort, burnout did not significantly improve – though two-thirds of fellows reported using the interventional techniques to deal with stressful situations. Fellows who participated in the intervention rated the effectiveness of the course as 4 (IQR=3.75–5 using the 5-point Likert scale. Conclusions: In comparison with the new and transitioning trainees, burnout was highest among graduating critical care fellows. Although no significant improvements were found in first-year fellows’ burnout scores following the single, 90-min training intervention, participants felt the training did provide them with tools to apply during stressful situations.

  3. 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

  4. 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

  5. Meaning and practice of palliative care for hospitalized older adults with life limiting illnesses.

    Science.gov (United States)

    Powers, Bethel Ann; Norton, Sally A; Schmitt, Madeline H; Quill, Timothy E; Metzger, Maureen

    2011-01-01

    Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses. PMID:21584232

  6. 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...

  7. 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

  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. 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.

  10. 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…

  11. Global health care of the critically ill in low-resource settings.

    Science.gov (United States)

    Murthy, Srinivas; Adhikari, Neill K

    2013-10-01

    The care of the critically ill patient in low-resource settings is challenging because of many factors, including limitations in the existing infrastructure, lack of disposables, and low numbers of trained healthcare workers. Although cost constraints in low-resource settings have traditionally caused critical care to be relegated to a low priority, ethical issues and the potential for mitigation of the lethal effects of often reversible acute conditions, such as sepsis and traumatic hemorrhage, argue for prudent deployment of critical care resources. Given these challenges, issues that require prioritization include timely and reliable delivery of evidence-based or generally accepted interventions to acutely ill patients before the development of organ failure, context-specific adaptation and evaluation of clinical evidence, and sustained investments in quality improvement and health systems strengthening. Specific examples include fluid resuscitation algorithms for patients with sepsis and reliable, low-cost, high-flow oxygen concentrators for patients with pneumonia. The lessons from new research on clinical management and sustainable education and quality improvement approaches will likely improve the care of critically ill patients worldwide. PMID:24161054

  12. An ethical analysis of proxy and waiver of consent in critical care research

    DEFF Research Database (Denmark)

    Berg, Ronan M G; Møller, Kirsten; Rossel, Peter J. Hancke

    2013-01-01

    It is a central principle in medical ethics that vulnerable patients are entitled to a degree of protection that reflects their vulnerability. In critical care research, this protection is often established by means of so-called proxy consent. Proxy consent for research participation constitutes a...

  13. Critical care nurses’ attitude towards life-sustaining treatments in South East Iran

    Science.gov (United States)

    Razban, Farideh; Iranmanesh, Sedigheh; Aliabadi, Hasan Eslami; Forouzi, Mansooreh Azzizadeh

    2016-01-01

    BACKGROUND: Life-sustaining treatments (LSTs) may prolong life but greatly decrease the quality of death. One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses. This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran. METHODS: In this cross-sectional study, “Ethnicity and Attitudes towards Advance Care Directives Questionnaire” was used to investigate the attitude of 104 critical care nurses towards life-sustaining treatments in three hospitals affiliated to Kerman University of Medical Sciences. RESULTS: The findings of this study indicated that although a majority of critical care nurses (77%) did not have personal desire for use of LSTs including CPR and mechanical ventilation, they had moderately negative to neutral attitude towards general use of LSTs (2.95 of 5). CONCLUSIONS: These findings suggest that nurses’ attitude towards LSTs can be changed by inclusion of specific courses about death, palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula. Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes. PMID:27006741

  14. 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.

  15. 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

  16. Falls, Depression, and Other Hospitalization Risk Factors for Adults in Residential Care Facilities.

    Science.gov (United States)

    Gimm, Gilbert W; Kitsantas, Panagiota

    2016-06-01

    Prior research has shown a relationship between falls, hospitalizations, and depression among older adults in nursing home settings, but few studies have explored these relationships for younger and older adults in residential care facilities. This study examined risk factors for hospitalizations among assisted living residents. Using the 2010 National Survey of Residential Care Facilities, the study found that 24% of residents had a hospital stay in the past year. Residents with falls were more than twice as likely to have a hospitalization. For younger residents, depression was a key risk factor (OR = 1.74, p depression and severe mental illness, who are at greater risk of hospitalization. Reducing avoidable hospitalizations can improve well-being for older and younger adults in residential care facilities. PMID:27147680

  17. 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

  18. Caring for older adults: practice guided by Watson's caring-healing model.

    Science.gov (United States)

    Bernick, Laurie

    2004-04-01

    Caring for older people and listening attentively to what they say about themselves and their varied health situations, especially in relation to quality of life and peace of mind, body, and soul, are important matters to nurses aligned with Watson's caring-healing theory. Assumptions and key concepts of Watson's framework are described with examples that illustrate how a nursing framework has shaped the author's advanced nursing practice. Some of the key concepts discussed include intersubjectivity, transpersonal caring, spirituality, and caring moments. Watson's framework of caring-healing is shown to inform practice, education, and research. PMID:15090087

  19. 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.

  20. Memory for allergies and health foods: how younger and older adults strategically remember critical health information

    OpenAIRE

    Middlebrooks, C. D.; McGillivray, S.; Murayama, Kou; Castel, A. D.

    2016-01-01

    Objectives. While older adults often display memory deficits, with practice they can sometimes selectively remember valuable information at the expense of less value information. We examined age-related differences and similarities in memory for health-related information under conditions where some information was critical to remember. Method. In Experiment 1, participants studied three lists of allergens, ranging in severity from 0 (not a health risk) to 10 (potentially fatal), with the...

  1. 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.

  2. Personality Assessment Screener, Childhood Abuse, and Adult Partner Violence in African American Women Using Primary Care.

    Science.gov (United States)

    Porcerelli, John H; Hurrell, Kristen; Cogan, Rosemary; Jeffries, Keturah; Markova, Tsveti

    2015-12-01

    This study assessed the relationship between psychopathology with the Personality Assessment Screener (PAS) and childhood physical and sexual abuse and adult physical and sexual partner violence in a primary care sample of 98 urban-dwelling African American women. Patients completed the PAS, the Childhood Trauma Questionnaire, and the Conflict Tactics Scale. The PAS total score significantly correlated with all measures of childhood and adult abuse. Stepwise regression analyses revealed that PAS element scores of Suicidal Thinking and Hostile Control significantly predicted a history of childhood physical abuse; Suicidal Thinking, Hostile Control, and Acting Out significantly predicted a history of childhood sexual abuse; Suicidal Thinking, Negative Affect, and Alienation significantly predicted current adult partner physical violence; and Psychotic Features, Alcohol Problems, and Anger Control significantly predicted current adult sexual partner violence. The PAS appears to be a useful measure for fast-paced primary care settings for identifying patients who need a more thorough assessment for abuse. PMID:26374084

  3. 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),...

  4. 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

  5. A current look at the key performance measures considered critical by health care leaders.

    Science.gov (United States)

    Love, Dianne; Revere, Lee; Black, Ken

    2008-01-01

    The increased focus on health care quality is changing the face of performance measures. Traditional measures of financial performance are being complemented by indicators of satisfaction, medical error rates, infection control ,and more. This study surveyed health care executives to determine the performance indicators considered critical for organizational assessment and improvement. The findings suggest financial measures such as operating profit margin, days cash on hand, charity care, net profit margin, bad dept expense, and days in accounts receivable A/R continue to be critical for health care decision makers. These measures are complemented by non-financial indicators such as physician and employee satisfaction, hospital-acquired infection rates, surgical site infection rates, inpatient mortality, infection control outcomes, and medication error rates. The results of this study underscore the notion that health care administrators are concerned about delivering high-quality effective health care in which both customers and providers are satisfied and which is done in a strong financial environment. PMID:18468376

  6. Providers' Perspectives of Survivorship Care for Young Adult Survivors of Childhood Cancer.

    Science.gov (United States)

    Berg, Carla; Stratton, Erin; Esiashvili, Natia; Mertens, Ann; Vanderpool, Robin C

    2016-03-01

    We examined healthcare providers' perceptions of the goals of survivorship care and survivor programs, systems-level barriers and individual patient-level barriers to engaging patients in survivorship care, and potential resources for increasing engagement. In 2012, we recruited 21 healthcare providers of young adult survivors of childhood cancers from a children's hospital and a cancer center in the Southeastern USA to complete telephone-based semi-structured interviews. The sample was 45.95 years old (SD = 7.57) on average, 52.4 % female, and 81.0 % MDs. The major goals of survivorship programs identified were medical care management (e.g., addressing late and long-term effects, providing survivorship care plans (SCPs), assisting in transition of care) and holistic care including addressing psychosocial issues and promoting healthy lifestyles. Systems-level barriers to engagement in survivorship care included limited resources (e.g., time), role confusion (e.g., within cancer centers, from treatment team to survivorship care, role of primary care providers), communication challenges within the medical system (e.g., limited tracking of patients, lack of understanding of the role of survivorship clinic), communication challenges with patients (e.g., setting expectations regarding transition to survivorship care), and lack of insurance coverage. Perceived patient-level factors included psychological barriers (e.g., fear, avoidance), resistance to survivorship care, and physical barriers (e.g., distance from survivorship clinics). Resources to address these barriers included increased access to information, technology-based resources, and ensuring valuable services. There are several systems-level and patient-level barriers to survivorship care, thus requiring multilevel interventions to promote engagement in care among young adult survivors of childhood cancer. PMID:25943901

  7. 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.

  8. Should Cerebral Near-infrared Spectroscopy be Standard of Care in Adult Cardiac Surgery?

    Science.gov (United States)

    Bevan, Priscilla J W

    2015-06-01

    Near-infrared spectroscopy (NIRS) is non-invasive, easy to use, and offers real-time monitoring of the oxygen content of cerebral tissue. An effective and user-friendly method of cerebral monitoring stands to offer a significant advance in patient care during adult cardiac surgery, particularly for surgery in which the continuity of cerebral vessels may be compromised. While the current evidence does not definitively show improvement in neurological outcomes, it can be argued that the overall risk to benefit ratio falls on the side of NIRS. NIRS also gives information about the oxygenation of systemic tissues. It may be that in surgery that does not involve the aortic arch, the value of NIRS will be in increased individualisation of patient management and improved systemic perfusion, impacting general outcomes as much as neurological outcomes. This review will summarise the need for neuromonitoring and the principles of NIRS. It will examine the thresholds used to define desaturation, the evidence for clinical benefit from NIRS, and the criticisms and limitations of NIRS. It will also discuss the uses of NIRS beyond improving neurological outcomes alone. PMID:25735719

  9. Health of adults caring for orphaned children in an HIV endemic community in South Africa

    OpenAIRE

    Kuo, Caroline; Operario, Don

    2011-01-01

    In South Africa, an estimated 2.5 million children have been orphaned by AIDS and other causes of adult mortality. Although there is a growing body of research on the well-being of South African orphaned children, few research studies have examined the health of adult individuals caring for children in HIV endemic communities. The cross-sectional survey assessed prevalence of general health and functioning (based on Short-Form 36 version 2 scale), depression (based on Center for Epidemiologic...

  10. Self-Reported Sleep Difficulties and Self-Care Strategies Among Rural Older Adults

    OpenAIRE

    Sandberg, Joanne C.; Suerken, Cynthia K.; Quandt, Sara A.; Altizer, Kathryn P.; Bell, Ronny A.; Lang, Wei; Nguyen, Ha T.; Grzywacz, Joseph G.; Arcury, Thomas A.

    2013-01-01

    This study examined the use of self-care strategies to address difficulty sleeping among community-dwelling older adults. Data were collected from a series of 18 questionnaires administered to 195 rural African American and white older adults in North Carolina. Participants reported whether they had experienced difficulty sleeping and strategies used to respond to the symptom. The most widely used strategies included ignoring the symptom, staying in bed or resting, and praying. Herb and suppl...

  11. From pediatric to adult care: strategic evaluation of a transition program for patients with osteogenesis imperfecta

    OpenAIRE

    Dogba, Maman Joyce; Rauch, Frank; Wong, Trudy; Ruck, Joanne; Glorieux, Francis H; Bedos, Christophe

    2014-01-01

    Background Achieving a successful transition from pediatric to adult care for young adults with special needs, especially rare genetic diseases such as osteogenesis imperfecta (OI), is a prominent issue in healthcare research. This transition represents a challenge for patients with OI, their families, clinicians and healthcare managers because of the complex nature of the process and the lack of evaluation of existing transition programs. We evaluated a transition program for adolescents and...

  12. Preventive care delivered within Public Dental Service after caries risk assessment of young adults

    DEFF Research Database (Denmark)

    Hänsel Petersson, G; Ericson, E; Twetman, S

    2016-01-01

    OBJECTIVES: To study preventive care provided to young adults in relation to their estimated risk category over a 3-year period. METHODS: The amount and type of preventive treatment during 3 years was extracted from the digital dental records of 982 patients attending eight public dental clinics...... adults attending public dental service. Further research is needed how to reach those with the greatest need of primary and secondary prevention....

  13. 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...

  14. Perceived barriers to mental health care and goal setting among depressed, community-dwelling older adults

    Directory of Open Access Journals (Sweden)

    Mark I Weinberger

    2009-05-01

    Full Text Available Mark I Weinberger1, Camila Mateo2, Jo Anne Sirey11Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA; 2College of Public Health and Health Professions, University of Florida, Gainesville, FL, USAObjective: Older adults are particularly vulnerable to the deleterious effects of depression and tend to underutilize mental health services. The current study aims to characterize the perceived barriers to care and goal setting in a sample of depressed, community-dwelling older adults. Methods: We report on the association among perceived barriers to care, goal setting and accepting a mental health referral using a subset of data from a larger study. The Patient Health Questionnaire (PHQ-9 was used to assess depressive symptoms. Results: Forty-seven participants completed the study (Mean age = 82, SD = 7.8, 85% female. Accessing and paying for mental health treatment were the barriers most frequently cited by participants. Clinical improvement and improved socialization were most cited goals. In bivariate associations, participants who set goals (χ2 = 5.41, p = 0.02 and reported a logistic barrier (χ2 = 5.30, p = 0.02 were more likely to accept a mental health referral.Conclusion: Perceived barriers to care and goal setting appear to be central to accepting a mental health referral among community dwelling older, depressed adults. Developing interventions that can be used to increase mental health service utilization of older adults is necessary. Keywords: depression, older adults, community, perceived barriers to care

  15. 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...

  16. 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...

  17. 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…

  18. Mental health matrix support in Primary Care: a critical review (2000-2010

    Directory of Open Access Journals (Sweden)

    Karen Athié

    2013-02-01

    Full Text Available Objective: A critical review of articles published between 2000 and 2010 on the relation between mental health and primary care in Brazil in view of the practice of matrix support. Method: Review of virtual database in the period in question. The descriptors were “mental health”, “primary care”, “matrix support”, and the analysis categories were constructed from the reading of the articles. Results: We selected 86 articles, divided in three categories: the articulation analyzed from the Mental Health, the Primary Care Health, and experiences of matrix support. This analysis revealed the existence of different ways of describing the collaborative care. Conclusions: The Brazilian experience is in line with global recommendations towards decreasing the gap between the offer and treatment needs care. The construction of the integrated mental health network for Family Health Strategy is a new challenge for the Brazilian Psychiatric Reform.

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

    OpenAIRE

    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 app...

  20. Imported falciparum malaria among adults requiring intensive care: analysis of the literature.

    OpenAIRE

    Marks, M; Armstrong, M.; Walker, D.; Doherty, T.

    2014-01-01

    BACKGROUND Malaria is the most important imported tropical disease. Infection with Plasmodium falciparum is responsible for most of the morbidity and mortality. There are differences in both the epidemiology of imported malaria and in the facilities available to treat travellers with severe malaria between different parts of the world. There are limited data to guide clinicians caring for adults with imported malaria in an intensive care unit (ICU). Available data from the English-speaking li...

  1. 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...

  2. The Child and Adult Care Food Program and the Nutrition of Preschoolers

    OpenAIRE

    Korenman, Sanders; Abner, Kristin S.; Kaestner, Robert; Gordon, Rachel A.

    2013-01-01

    Children spend a considerable amount of time in preschools and child care centers. As a result, these settings may have an influence on their diet, weight, and food security, and are potentially important contexts for interventions to address nutritional health. The Child and Adult Care Food Program (CACFP) is one such intervention. No national study has compared nutrition-related outcomes of children in CACFP-participating centers to those of similar children in non-participating centers. We...

  3. Prevalence of Mental and Social Disorders in Adults Attending Primary Care Centers in Bosnia and Herzegovina

    OpenAIRE

    Broers, Teresa; Hodgetts, Geoffrey; Batić-Mujanović, Olivera; Petrović, Verica; Hasanagić, Melida; Godwin, Marshall

    2006-01-01

    Aim: To determine the prevalence of mental and social disorders in adults who attend primary care health centers in Bosnia and Herzegovina. Methods: Sixty-nine family physicians from the Primary Care Research Network in Bosnia and Herzegovina each invited 20 randomly selected patients from their practices to complete the Patient Health Questionnaire (PHQ), which consists of 26-58 questions about symptoms and signs of depression, anxiety, somatization disorder, eating disorders, and alcohol...

  4. 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

  5. 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.

  6. 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.

  7. The ethical dimension in published animal research in critical care: the dark side of our moon.

    Science.gov (United States)

    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 critical care research publications involving animal models.This may have a significant negative impact on the reliability of the results and on future funding for our research.The ability of septic shock animal models to translate into clinical studies has been a challenge. Therefore, every means to improve the quality of these models should be pursued. Animal welfare issues should be seen as an additional benefit to achieve this goal. It is therefore critical to draw conclusions from this study to improve the standard of animal welfare in critical care research. This has already been achieved in other fields of research, and we should follow their example. PMID:24886758

  8. Critical action research applied in clinical placement development in aged care facilities.

    Science.gov (United States)

    Xiao, Lily D; Kelton, Moira; Paterson, Jan

    2012-12-01

    The aim of this study was to develop quality clinical placements in residential aged care facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of people aged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is increasing for a nursing workforce competent in the care of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and five aged care organisations was utilised. A theoretical framework informed by Habermas' communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residential aged care facilities were developed to support 179 nursing students across three year-levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residential aged care facilities. PMID:23134277

  9. Clinical care of adult Turner syndrome--new aspects

    DEFF Research Database (Denmark)

    Trolle, Christian; Mortensen, Kristian Havmand; Hjerrild, Britta E;

    2012-01-01

    TS female enters adulthood it is less clear who should be the primary care giver. Morbidity and mortality is increased, especially due to the risk of dissection of the aorta and other cardiovascular diseases, as well as the risk of type 2 diabetes, hypertension, osteoporosis, thyroid disease and...... treatment for increasing height, are becoming well founded. Osteoporosis, diabetes, both type 1 and 2, hypothyroidism, obesity and a host of other endocrine diseases and conditions are seen more frequently in TS. Prevention, intervention and proper treatment is only just being recognized. Hypertension is...

  10. Mental Health Screening of Older Adults in Primary Care

    OpenAIRE

    Davis, Mary J.; Moye, Jennifer; Karel, Michele J.

    2002-01-01

    In an effort to document mental health outreach in our primary care clinic, 316 veterans (mean age 72) not currently in psychiatric treatment were screened for multiple mental health symptoms. Depressed mood was reported by 18% of the sample, insomnia by 26%, and morbid/suicidal ideation by 6.9% for at least several days during the past 2 weeks. Of those who experienced a loss over the past year (43%), 36% remained affected by the loss. Also reported were anxiety symptoms (29%) and PTSD sympt...

  11. 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

  12. 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

  13. Swimming without the water: a critical perspective on mental health experience for adult nursing students.

    Science.gov (United States)

    Barrett, Paul; Jackson, Andrew

    2013-11-01

    Adult nurses and adult field nursing students come into contact with a diverse range of other patient groups in their practice but perhaps none more so than those who have co-existing mental health issues. Consequently adult field student nurses must be equipped with the requisite knowledge and skills to competently care for their patients who also experience mental health problems. Given the pressure on placements many education providers have developed alternatives to direct mental health experiences. The authors review their own experience of some of the modalities that higher education institutes (HEI) use to instruct their students in this field. They argue that, ideally, there is no substitute for the practical experience of placements in the mental health sector, particularly if these include contact with mental health nursing. The paper concludes with some recommendations for nursing education and our professional body that could help equip adult field nursing students with the necessary experience and skills of mental health to support them into their future careers. PMID:23830557

  14. 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\

  15. 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…

  16. 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.…

  17. 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…

  18. 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...

  19. 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.

  20. Personalisation of Adult Social Care: Self-Directed Support and the Choice and Control Agenda

    Science.gov (United States)

    Kendall, Sophie; Cameron, Ailsa

    2014-01-01

    In 2007, "self-directed support" was introduced in adult social care in England to establish choice and control--in the assessment process itself and over service provision--for "all" service users. The personalisation agenda is underpinned by a range of ideologies, particularly a civil rights empowerment approach and…

  1. 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…

  2. 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…

  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. Fair equality of opportunity critically reexamined: the family and the sustainability of health care systems.

    Science.gov (United States)

    Engelhardt, H Tristram

    2012-12-01

    A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls's original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy. PMID

  5. 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,...

  6. Consensus statement on the management of the GH-treated adolescent in the transition to adult care

    DEFF Research Database (Denmark)

    Clayton, P E; Cuneo, R C; Juul, A; Monson, J P; Shalet, S M; Tauber, M

    2005-01-01

    The European Society for Paediatric Endocrinology held a consensus workshop in Manchester, UK in December 2003 to discuss issues relating to the care of GH-treated patients in the transition from paediatric to adult life. Clinicians experienced in the care of paediatric and adult patients on GH t...

  7. What is the Nature of Palliative Care for Patients Dying from Heart Failure on Acute Hospital Wards? A Critical Review.

    OpenAIRE

    Helme, Laura

    2008-01-01

    A critical review was conducted with an aim to explore the nature of palliative care for patients dying from heart failure. A thorough search of healthcare databases, specific journals and relevant websites produced the literature that provided the basis for this review. All literature was critically appraised and categorised into chapter topics. Key components of palliative care are providing pain relief, symptom control, holistic care and improving or maintaining a patient's quality of...

  8. 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

  9. 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

  10. Perceived job stress, job satisfaction, and psychological symptoms in critical care nursing.

    Science.gov (United States)

    Norbeck, J S

    1985-09-01

    This study tested the relationships among perceived job stress, job satisfaction, and psychological symptoms of critical care nurses. A self-administered questionnaire was sent to a sample of 180 critical care nurses from eight hospitals. The results supported the hypotheses that higher levels of perceived job stress are related to lower levels of job satisfaction (r = -.24, p = .001) and to higher levels of psychological symptoms (r = .33, p = .000). These effects remained even when years of experience in nursing and shift were controlled. Item analysis, however, showed that four of the five top-ranking stressors were not related to the outcome measures. A distinction between positive and negative stressors is proposed to explain the pattern of results. PMID:3852360

  11. 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. PMID:12682572

  12. 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

  13. [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

  14. 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

  15. Perceptions of the appropriateness of care in California adult intensive care units

    OpenAIRE

    Anstey, Matthew H; Adams, John L.; McGlynn, Elizabeth A

    2015-01-01

    Introduction Increased demand for expensive intensive care unit (ICU) services may contribute to rising health-care costs. A focus on appropriate use may offer a clinically meaningful way of finding the balance. We aimed to determine the extent and characteristics of perceived inappropriate treatment among ICU doctors and nurses, defined as an imbalance between the amount or intensity of treatments being provided and the patient’s expected prognosis or wishes. Methods This was a cross-section...

  16. 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...

  17. 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...

  18. 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

  19. 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...

  20. 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 ...

  1. 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...

  2. Deciding intensive care unit-admission for critically ill cancer patients

    OpenAIRE

    Thiery Guillaume; Darmon Michael; Azoulay Elie

    2007-01-01

    Over the last 15 years, the management of critically ill cancer patients requiring intensive care unit admission has substantially changed. High mortality rates (75-85%) were reported 10-20 years ago in cancer patients requiring life sustaining treatments. Because of these high mortality rates, the high costs, and the moral burden for patients and their families, ICU admission of cancer patients became controversial, or even clearly discouraged by some. As a result, the reluctance of i...

  3. The Chronic Responsibility: A Critical Discourse Analysis of Danish Chronic Care Policies.

    Science.gov (United States)

    Ravn, Iben M; Frederiksen, Kirsten; Beedholm, Kirsten

    2016-03-01

    This article reports on the results of a Fairclough-inspired critical discourse analysis aiming to clarify how chronically ill patients are presented in contemporary Danish chronic care policies. Drawing on Fairclough's three-dimensional framework for analyzing discourse, and using Dean's concepts of governmentality as an interpretative lens, we analyzed and explained six policies published by the Danish Health and Medicines Authority between 2005 and 2013. The analysis revealed that discourses within the policy vision of chronic care consider chronically ill patients' active role, lifestyle, and health behavior to be the main factors influencing susceptibility to chronic diseases. We argue that this discursive construction naturalizes a division between people who can actively manage responsible self-care and those who cannot. Such discourses may serve the interests of those patients who are already activated, while others remain subjugated to certain roles. For example, they may be labeled as "vulnerable." PMID:25662943

  4. 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

  5. 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

  6. 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.

  7. "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.

  8. Estimates of complications of medical care in the adult US population

    Directory of Open Access Journals (Sweden)

    Anderson Jeremy N

    2001-03-01

    Full Text Available Abstract Background Total US population estimates of complications of medical care have relied on extrapolations of state-specific estimates. Generalizability is suspect because findings are limited by geographical location or time. We describe the relationship between the annual prevalence of complications of medical care (CM and socio-demographic characteristics in the adult US population. Methods We used data from the National Health Interview Surveys, annual nationwide surveys of the resident, civilian, noninstitutionalized population of the United States. The main outcome of interest was self-reported conditions from CMs (ICD-9 996-999 and activity limitations that arise from such events. Univariate estimates and multivariably adjusted models accounting for selected socio-demographic characteristics and health status were derived. Results A total of 618,167 reports of conditions from 313,438 subjects 18 years and older from 1987 to 1994 were examined. In 1987, 830,386 adults reported complications of medical care, increasing by about 40% to 1,174,089 adults in 1994. Based on an extrapolation to the US adult population, rates increased by 25% from 558 to 678 per 100,000 during the same period. One-third reported onset a year prior to the interview; two-thirds visited a doctor six months prior; half experienced limitation in major activities; a quarter reported limitation in personal care activities. In the two weeks preceding the interview, complications of medical care caused an average of 1.72 days of restricted activity, 0.79 days spent in bed, and 0.58 days of work lost. Race modified the age-specific risk of these complications. Conclusions Complications of medical care impose heavier morbidity than previously considered with some indication that socio-demographic variables modify the risk for injuries.

  9. 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…

  10. 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

  11. 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

  12. Primary care physicians’ perceived barriers and facilitators to conservative care for older adults with chronic kidney disease: design of a mixed methods study

    OpenAIRE

    Tam-Tham, Helen; Hemmelgarn, Brenda; Campbell, David; Thomas, Chandra; Quinn, Robert; Fruetel, Karen; King-Shier, Kathryn

    2016-01-01

    Background Guideline committees have identified the need for research to inform the provision of conservative care for older adults with stage 5 chronic kidney disease (CKD) who have a high burden of comorbidity or functional impairment. We will use both qualitative and quantitative methodologies to provide a comprehensive understanding of barriers and facilitators to care for these patients in primary care. Objectives Our objectives are to (1) interview primary care physicians to determine t...

  13. 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.

  14. 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...

  15. 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

  16. 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...

  17. 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

  18. Reimagining care for adolescent and young adult cancer programs: Moving with the times.

    Science.gov (United States)

    Gupta, Abha A; Papadakos, Janet K; Jones, Jennifer M; Amin, Leila; Chang, Eugene K; Korenblum, Chana; Mina, Daniel Santa; McCabe, Lianne; Mitchell, Laura; Giuliani, Meredith E

    2016-04-01

    Literature regarding the development of adolescent and young adult (AYA) cancer programs has been dominantly informed by pediatric centers and practitioners. However, the majority of young adults are seen and treated at adult cancer centers, in which cancer volumes afford the development of innovative supportive care services. Although the supportive care services in adult cancer centers are helpful to AYAs, some of the most prominent and distinct issues faced by AYAs are not adequately addressed through these services alone. This article describes how the AYA Program at Princess Margaret Cancer Centre has collaborated with existing supportive care services in addition to supplying its own unique services to meet the comprehensive needs of AYAs in the domains of: symptom management (sexuality and fatigue), behavior modification (return to work and exercise), and health services (advanced cancer and survivorship). These collaborations are augmented by patient education interventions and timely referrals. The objective of this article was to assist other centers in expanding existing services to address the needs of AYA patients with cancer. Cancer 2016;122:1038-1046. © 2016 American Cancer Society. PMID:26848554

  19. 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

  20. 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.

  1. 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

  2. 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

  3. 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

  4. Conflicts in Learning to Care for Critically Ill Newborns: "It Makes Me Question My Own Morals".

    Science.gov (United States)

    Boss, Renee D; Geller, Gail; Donohue, Pamela K

    2015-09-01

    Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit (NICU) is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their "experience in the NICU." Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects. PMID:25656132

  5. 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...

  6. 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...

  7. 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

  8. 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

  9. 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.

  10. Sequential organ failure assessment score as prognostic marker in critically ill patients in a tertiary care intensive care unit

    Directory of Open Access Journals (Sweden)

    Charan Bale

    2013-07-01

    Full Text Available Introduction: Sepsis is one of the most important causes of mortality in the intensive care setting. An effective predictor of prognosis of sepsis is required to assess morbidity and mortality of this condition. In this study, sepsis in the intensive care unit (ICU of a tertiary care hospital was evaluated, with specific reference to clinical features and causative organisms. The sequential organ failure assessment (SOFA score was calculated to assess the severity of sepsis and multi-organ failure at presentation and after 48 h. The correlation of SOFA and mean SOFA scores with outcome was studied. Materials and Methods: This was a prospective, observational, cohort study carried out in a tertiary care teaching hospital. Forty consecutive cases of septicemia were studied. Detailed history, clinical features, and SOFA score was recorded to assess the disease severity at the time of presentation and after 48 h. Inclusion of patients in the study was performed using the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM definition of sepsis. Two sample t-test and 95% confidence interval (CI for difference of mean was applied. Results: When the SOFA score was <7, the mortality was 56%. It increased to 70% when the score was 8-15 (P = 0.0989, t value: 1.69, Mean difference: 2.12, 95% CI: 0.41-4.665. Patients with SOFA score <7 after 48 h had 52% mortality and it increased to 88% when the score was 8-15. The mean SOFA score at 48 h was 6.96 in patients who died and 2.5 in those who improved (P < 0.001, t value: 4.332, mean difference: 4.39, 95% CI: 2.34-6.44. Hence, the predictive value for mortality of SOFA score was better at 48 h than at presentation. Conclusions: Sequential assessment of organ dysfunction in ICU at presentation and at 48 h is a good indicator of prognosis. Both mean and highest SOFA scores are particularly useful predictors of outcome, independent of the initial score. A high SOFA score at 48 h of

  11. 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

  12. 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...

  13. Examining the trajectories of children providing care for adults in rural Kenya

    DEFF Research Database (Denmark)

    Skovdal, Morten

    2011-01-01

    Research on caregiving children tends to be limited to children's caregiving experiences of parents with a specific disease or disability. This has led to a common perception that children's caregiving is a single, uniform and often long-term experience. Whilst this is most certainly the case for...... family and community members for varying periods of time and intensities. Although their living arrangements and life circumstances often gave them little choice but to care, a social recognition of children's capacity to provide care for fragile adults, helped the children construct an identity, which...

  14. 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

  15. Screening for alcohol and drug use disorders among adults in primary care: a review

    Directory of Open Access Journals (Sweden)

    Pilowsky DJ

    2012-04-01

    Full Text Available Daniel J Pilowsky1, Li-Tzy Wu21Departments of Epidemiology and Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York City, NY, 2Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USABackground: The Patient Protection and Affordable Care Act of 2010 supports integration of substance abuse interventions and treatments into the mainstream health care system. Thus, effective screening and intervention for substance use disorders in health care settings is a priority.Objective: This paper reviews the prevalence of alcohol and drug use disorders (abuse or dependence in primary care settings and emergency departments, as well as current screening tools and brief interventions.Methods: MEDLINE was searched using the following keywords: alcohol use, alcohol use disorder, drug use, drug use disorder, screening, primary care, and emergency departments. Using the related-articles link, additional articles were screened for inclusion. This review focuses on alcohol and drug use and related disorders among adults in primary care settings.Conclusion: Screening, brief intervention, and referral for treatment are feasible and effective in primary care settings, provided that funding for screening is available, along with brief interventions and treatment facilities to which patients can be referred and treated promptly.Keywords: brief intervention, emergency departments

  16. A visit to the intensive cares unit: a family-centered culture change to facilitate pediatric visitation in an adult intensive care unit.

    Science.gov (United States)

    Hanley, Julie Boyer; Piazza, Julie

    2012-01-01

    To guide family adjustment, an effort was made to facilitate pediatric visitation in an adult intensive care unit (ICU). Goals were to improve customer satisfaction and to raise staff comfort level with child visitation. After implementing an open visitation policy, concerns around pediatric visitation in the ICU remained. Fears centered on risks to both patient and child. Literature was reviewed before a book was written entitled A Visit to the ICU. It contained information about what a child visiting the ICU would see, hear, and feel when visiting a loved one. The book provided reassurance for caregivers and children, informing them about what to expect when visiting. The goal of the book was to provide caregivers with a framework for age-appropriate education. Staff education was provided on developmental stages, including a child's understandings of illness and death. Nursing interventions were reviewed and resources provided. A survey demonstrated that the book increased staff comfort level with children visiting the unit, was a positive tool for patients and families, and eased fears among children while helping to facilitate coping mechanisms. The article will describe the practice change of pediatric visitation in an ICU and how it could be applied to other critical care settings. PMID:22157497

  17. 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

  18. Up against the System: A Case Study of Young Adult Perspectives Transitioning from Pediatric Palliative Care

    Directory of Open Access Journals (Sweden)

    Karen Cook

    2013-01-01

    Full Text Available Advances in pediatric care have not provided the interdisciplinary support services required by those young adults with pediatric life-threatening conditions (pedLTCs who live beyond childhood but have limited expectations to live past early adulthood. These young adults, the first generation to live into adulthood, face multiple challenges transitioning from a plethora of pediatric palliative services to scant adult health services. In a case study, using an innovative bulletin board focus group, we describe the complex interplay of the health, education, and social service sectors in this transition. Our descriptions include system deficits and strengths and the young adults’ resilience and coping strategies to overcome those deficits and move forward with their lives. Young adults with pedLTC need knowledgeable providers, coordinated and accessible services, being respected and valued, and services and supports that promote independence. We recommend implementation of multidisciplinary solutions that are focused on young adult priorities to ensure seamless access to resources to support these young adults’ health, educational, vocational, and social goals. The input and voice of young adults in the development of these services are imperative to ensure that multisystem services support their needs and life goals.

  19. 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

  20. 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.

  1. Concerns about usage of smartphones in operating room and critical care scenario.

    Science.gov (United States)

    Attri, J P; Khetarpal, R; Chatrath, V; Kaur, J

    2016-01-01

    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. PMID:26952181

  2. UTILIZATION OF HEALTH CARE SERVICES AMONG ADULTS ATTENDING A HEALTH FAIR IN SOUTH LOS ANGELES COUNTY

    OpenAIRE

    Macias, Eduardo P.; Morales, Leo S.

    2000-01-01

    A bilingual survey was developed to collect information regarding socio-demographics, access to medical and dental care, health insurance coverage, perceived health status, and use of folk medicine providers from 70 adults presenting to a health fair in South Los Angeles County. Ninety-seven percent of respondents were foreign-born. Seventy-nine percent reported having no health insurance during the year prior to survey. Of the uninsured, 61 percent lacked a doctor visit and 76 percent lacked...

  3. Adult safeguarding policy and law:a thematic chronology relevant to care homes and hospitals

    OpenAIRE

    Manthorpe, Jill; Stevens, Martin

    2014-01-01

    Elder abuse is a ‘social problem’, as illustrated by the production of policy documents and legislation that define and revise the scope and nature of the problem. This article synthesises and discusses the policy documents and legal changes that have taken place in England since 2000, when the first policy guidance to address adult safeguarding as a whole was produced. The focus of this article is on particular locations, namely care home and hospital settings, and the applicable policy and ...

  4. The Role of the Primary Care Physician in Helping Adolescent and Adult Patients Improve Asthma Control

    OpenAIRE

    Yawn, Barbara P.

    2011-01-01

    Many adolescents and adults with asthma continue to have poorly controlled disease, often attributable to poor adherence to asthma therapy. Failure to adhere to recommended treatment may result from a desire to avoid regular reliance on medications, inappropriate high tolerance of asthma symptoms, failure to perceive the chronic nature of asthma, and poor inhaler technique. Primary care physicians need to find opportunities and methods to address these and other issues related to poor asthma ...

  5. Abandonment Fears in Persons with Alzheimer's at Adult Day Care Centers

    OpenAIRE

    Judkins, Wayne A

    1999-01-01

    In my research, I examined abandonment fears in persons with Alzheimerâ s disease at the Salem Veterans Affairs adult day care center. I observed fifty hours at the center, and conducted open-ended interviews with two of the participants and their respective caregivers. These two participants (Ellen and Opel) at the center expressed abandonment fears much more frequently than any of the other participants. I found that most of the time, these two women would express their abandonment f...

  6. Drug incompatibilities in the adult intensive care unit of a university hospital

    OpenAIRE

    Marsilio, Naiane Roveda; da Silva, Daiandy; Bueno, Denise

    2016-01-01

    Objectives This study sought to identify the physical and chemical incompatibilities among the drugs administered intravenously to patients admitted to an adult intensive care unit. We also aimed to establish pharmaceutical guidelines for administering incompatible drugs. Methods This cross-sectional, prospective, and quantitative study was conducted from July to September 2015. Drug incompatibilities were identified based on an analysis of the patient prescriptions available in the hospital ...

  7. Perceived Need for Mental Health Care Among Community-Dwelling Older Adults

    OpenAIRE

    Garrido, Melissa M; Kane, Robert L; Kaas, Merrie; Kane, Rosalie A.

    2009-01-01

    Only half of older adults with a mental disorder use mental health services, and little is known about the causes of perceived need for mental health care (MHC). We used logistic regression to examine relationships among depression, anxiety, chronic physical illness, alcohol abuse and/or dependence, sociodemographics, and perceived need among a national sample of community-dwelling individuals 65 years of age and older (the Collaborative Psychiatric Epidemiology Surveys data set). Less than h...

  8. Regulatory focus and adherence to self-care behaviors among adults with type 2 diabetes.

    Science.gov (United States)

    Avraham, Rinat; Van Dijk, Dina; Simon-Tuval, Tzahit

    2016-09-01

    The aims of this study were, first, to test the association between regulatory focus of adults with type 2 diabetes and their adherence to two types of self-care behaviors - lifestyle change (e.g. physical activity and diet) and medical care regimens (blood-glucose monitoring, foot care and medication usage). Second, to explore whether a fit between the message framing and patients' regulatory focus would improve their intentions to adhere specifically when the type of behavior fits the patients' regulatory focus as well. A cross-sectional study was conducted among 130 adults with type 2 diabetes who were hospitalized in an academic medical center. The patients completed a set of questionnaires that included their diabetes self-care activities, regulatory focus, self-esteem and demographic, socioeconomic and clinical data. In addition, participants were exposed to either a gain-framed or a loss-framed message, and were then asked to indicate their intention to improve adherence to self-care behaviors. A multivariable linear regression model revealed that promoters reported higher adherence to lifestyle change behaviors than preventers did (B = .60, p = .028). However, no effect of regulatory focus on adherence to medical care regimens was found (B = .46, p = .114). In addition, preventers reported higher intentions to adhere to medical care behaviors when the message framing was congruent with prevention focus (B = 1.16, p = .023). However, promoters did not report higher intentions to adhere to lifestyle behaviors when the message framing was congruent with promotion focus (B = -.16, p = .765). These findings justify the need to develop tailor-made interventions that are adjusted to both patients' regulatory focus and type of health behavior. PMID:26576471

  9. Fisioterapia motora em pacientes adultos em terapia intensiva Motor physiotherapy in intensive care adult patients

    Directory of Open Access Journals (Sweden)

    Vanessa Marcos Borges

    2009-12-01

    ventilados mecanicamente é um procedimento seguro e viável, diminuindo o tempo de internação na unidade de terapia intensiva e hospitalar. Porém mais estudos se fazem necessário para se identificar o tipo de exercício, duração, intensidade e a repercussão da fisioterapia motora precoce em grupos específicos de pacientes.This study aimed to review the literature addressing motor physical therapy for intensive care unit adult patients. A literature search was conducted in the databases, PubMed, MedLine (International Literature and Health, LILACS (Latin American and Caribbean Health Sciences and Cochrane between 1995 and December 2008 using the keywords: physical therapy, mobilization and intensive care unit. For comparison purposes we selected randomized controlled trials and prospective studies, addressing the subject motor physical therapy for intensive care unit adult patients. Pediatric and experimental studies, systematic reviews and meta-analysis were excluded. Of the 121 articles identified, only 4 met the inclusion criteria. Among these, three focused early motor physical therapy in patients with a range of diagnoses, showing that these patients left the bed and walked earlier, and stayed shorter both in the intensive care unit and hospital. Furthermore, patients on early motor physical therapy had shorter mechanical ventilation duration. Another paper compares the use of electrical stimulation associated with physical therapy in chronic obstructive pulmonary disease patients, showing increased muscle strength and shorter time for these patients bed to chair transference as compared with those only receiving physiotherapy. The risks of immobilization in mechanically ventilated critically ill patients are not fully understood. However, it is clear that the survivors show impaired quality of life due to persistent weakness and fatigue. Early mobilization is a new area, with little evidence so far. However, recent studies have confirmed that mechanically

  10. Adult Patients’ Satisfaction with Inpatient Nursing Care and Associated Factors in an Ethiopian Referral Hospital, Northeast, Ethiopia

    OpenAIRE

    Haile Eyasu, Kokeb; Adane, Akilew Awoke; Amdie, Fisseha Zewdu; Getahun, Tesfaye Bisenebit; Biwota, Mulunesh Abuhay

    2016-01-01

    Introduction. Patient satisfaction with nursing care is considered as an important factor in explaining patients’ perceptions of service quality. Care assessed to be high quality according to clinical, economic, or other provider-defined criteria is far from ideal if as a result of that care the patient is unhappy or dissatisfied. Objective. The aim of this study was to assess adult patients’ satisfaction with inpatient nursing care and associated factors in Dessie Referral Hospital, Northeas...

  11. Adults ages 50-64 and the Affordable Care Act of 2010.

    Science.gov (United States)

    Collins, Sara R; Doty, Michelle M; Garber, Tracy

    2010-12-01

    The Patient Protection and Affordable Care Act, which will provide health insurance to nearly all U.S. citizens and improve the quality of health insurance, will particularly benefit adults ages 50 to 64, a group suffering from extended unemployment and a loss of employer health benefits. Several early provisions that go into effect in 2010, including preexisting condition insurance plans, will provide transitional assistance for adults who have struggled to gain health insurance. The biggest improvements will come in 2014 through a significant expansion in eligibility for Medicaid and the creation of health insurance exchanges with subsidized private insurance for people with low and moderate incomes. Of the 8.6 million adults ages 50 to 64 who were uninsured in 2009, up to 6.8 million may gain subsidized insurance through Medicaid and the exchanges and 1.4 million with higher incomes will have access to comprehensive health plans with new consumer protections. PMID:21155372

  12. Amniotic fluid and colostrum as potential diets in the critical care of preterm infants

    DEFF Research Database (Denmark)

    Støy, Ann Cathrine Findal; Viberg Østergaard, Mette; Torp Sangild, Per

    2015-01-01

    Amniotic fluid is the enteral “diet” of the developing fetus, while the first mammary gland secretion, colostrum, is the natural diet of the newborn mammal. Both diets contain nutrients but also growth factors, immune-modulating components, and antibacterial agents that support perinatal organ...... species independent, maybe allowing colostrum from one species (i.e., lactating cows) to be used as the first enteral diet for infants for whom mother’s milk is lacking. The use of amniotic fluid and bovine colostrum in the critical care of neonates is still at an experimental stage, but animal studies...

  13. 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...... 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. If...

  14. 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...

  15. 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...

  16. 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 ...

  17. 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...

  18. Merging person-centered care with translational research to improve the lives of older adults: creating community-based nursing research networks.

    Science.gov (United States)

    Hill, Nikki L; Penrod, Janice; Milone-Nuzzo, Paula

    2014-10-01

    Translational research is a leading trend in science with the aim of bridging the research-practice gap to significantly speed the implementation of effective interventions in clinical practice. Integrating the values and preferences of older adults and their families into this process is critical to the success of translational research. Engaging communities in meaningful research is an important part of advancing translational science in which older adults are partners in developing solutions to the health needs of individuals within communities. The current article describes one approach to developing an infrastructure (i.e., community-based nursing research network) to support patient-centered care within translational research. Nurses are uniquely poised and prepared to assume leadership roles in community-based research networks to support a true collaboration among stakeholders that prizes the voices of older adults and integrates them into practice efforts. PMID:25275784

  19. 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.

    Directory of Open Access Journals (Sweden)

    Peter Hodkinson

    Full Text Available 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.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 department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors.The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74% of children, and death prior to PICU admission was avoidable in 17/30 (56.7% of children.The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.

  20. Factors that limit access to dental care for adults with spinal cord injury.

    Science.gov (United States)

    Yuen, Hon K; Wolf, Bethany J; Bandyopadhyay, Dipankar; Magruder, Kathryn M; Selassie, Anbesaw W; Salinas, Carlos F

    2010-01-01

    This study investigated dental care service utilization among adults with spinal cord injury (SCI) and identified barriers and other factors affecting utilization among this population. There were 192 subjects with SCI who participated in the oral health survey assessing dental care service utilization and they were compared with subjects from the 2004 Behavioral Risk Factors Surveillance System (BRFSS). There was no significant difference in the proportion of subjects with SCI who visited the dentist for any reason in the past year compared to the general population (65.5% vs. 68.8%, p= .350). However, subjects with SCI were less likely to go to the dentist for a dental cleaning in the past year compared to the general population (54.6% vs. 69.4%, p dental care were cost (40.1%), physical barriers (22.9%), and dental fear (15.1%). Multivariate modeling showed that physical barriers and fear of dental visits were the two significant factors deterring subjects from dental visits in the past year. Physical barriers preventing access to dental facilities and dental fear are prevalent and significantly impede the delivery of dental health care to adults with SCI. Dentists should undertake necessary physical remodeling of their facilities to accommodate wheelchair users and implement appropriate strategies for the management of dental fear among patients with SCI. PMID:20618781