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Sample records for care organizations united

  1. [The organization of a post-intensive care rehabilitation unit].

    Science.gov (United States)

    Barnay, Claire; Luauté, Jacques; Tell, Laurence

    2015-01-01

    When a patient is admitted to a post-intensive care rehabilitation unit, the functional outcome is the main objective of the care. The motivation of the team relies on strong cohesion between professionals. Personalised support provides a heightened observation of the patient's progress. Listening and sharing favour a relationship of trust between the patient, the team and the families. PMID:26365639

  2. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices.

    Science.gov (United States)

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick

    2013-10-01

    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

  3. Children as donors: a national study to assess procurement of organs and tissues in pediatric intensive care units.

    Science.gov (United States)

    Siebelink, Marion J; Albers, Marcel J I J; Roodbol, Petrie F; Van de Wiel, Harry B M

    2012-12-01

    A shortage of size-matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol. A national retrospective cohort study was conducted in all eight Dutch pediatric intensive care units. Records of deceased children were analyzed by an independent donation officer. Seventy-four (11%) of 683 deceased children were found to be suitable for organ donation and 132 (19%) for tissue donation. Sixty-two (84%) potential organ donors had been correctly identified; the parental consent and effectuation rate was 42%. Sixty-three (48%) potential tissue donors had been correctly identified; the parental consent and effectuation rate was 27%. Correct identification increased with age (logistic regression, organs: P = .024; tissues: P = .011). Although an overall identification rate of 84% of potential organ donors may seem acceptable, the variation observed suggests room for improvement, as does the overall low rate of identification of pediatric tissue donors. Efforts to address the shortage of organs and tissues for transplantation in children should focus on identifying potential donors and on the reasons why parents do not consent.

  4. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

    Science.gov (United States)

    Dick, W

    1994-01-01

    Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency

  5. The influence of volume and intensive care unit organization on hospital mortality in patients admitted with severe sepsis: a retrospective multicentre cohort study.

    NARCIS (Netherlands)

    Peelen, L.; Keizer, N.F. de; Peek, N.; Scheffer, G.J.; Voort, P.H. van der; Jonge, E. de

    2007-01-01

    INTRODUCTION: The aim of the study was to assess the influence of annual volume and factors related to intensive care unit (ICU) organization on in-hospital mortality among patients admitted to the ICU with severe sepsis. METHODS: A retrospective cohort study was conducted using the database of the

  6. Initial Sequential Organ Failure Assessment score versus Simplified Acute Physiology score to analyze multiple organ dysfunction in infectious diseases in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Remyasri Nair

    2016-01-01

    Full Text Available Aims: To investigate initial Sequential Organ Failure Assessment (SOFA score of patients in Intensive Care Unit (ICU, who were diagnosed with infectious disease, as an indicator of multiple organ dysfunction and to examine if initial SOFA score is a better mortality predictor compared to Simplified Acute Physiology Score (SAPS. Materials and Methods: Hospital-based study done in medical ICU, from June to September 2014 with a sample size of 48. Patients aged 18 years and above, diagnosed with infectious disease were included. Patients with history of chronic illness (renal/hepatic/pulmonary/  cardiovascular, diabetes, hypertension, chronic obstructive pulmonary disease, heart disease, those on immunosuppressive therapy/chemoradiotherapy for malignancy and patients in immunocompromised state were excluded. Blood investigations were obtained. Six organ dysfunctions were assessed using initial SOFA score and graded from 0 to 4. SAPS was calculated as the sum of points assigned to each of the 17 variables (12 physiological, age, type of admission, and three underlying diseases. The outcome measure was survival status at ICU discharge. Results: We categorized infectious diseases into dengue fever, leptospirosis, malaria, respiratory tract infections, and others which included undiagnosed febrile illness, meningitis, urinary tract infection and gastroenteritis. Initial SOFA score was both sensitive and specific; SAPS lacked sensitivity. We found no significant association between age and survival status. Both SAPS and initial SOFA score were found to be statistically significant as mortality predictors. There is significant association of initial SOFA score in analyzing organ dysfunction in infectious diseases (P < 0.001. SAPS showed no statistical significance. There was statistically significant (P = 0.015 percentage of nonsurvivors with moderate and severe dysfunction, based on SOFA score. Nonsurvivors had higher SAPS but was not statistically

  7. Organizing Safe Transitions from Intensive Care

    OpenAIRE

    Marie Häggström; Britt Bäckström

    2014-01-01

    Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients’ transfers from high technological intensive care units (ICU) to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient’s care before, during, and after transfer...

  8. Primary Care Clinics and Accountable Care Organizations

    Directory of Open Access Journals (Sweden)

    Judith Ortiz PhD

    2015-10-01

    Full Text Available Background: The Accountable Care Organization (ACO is one of the new models of health care delivery in the United States. To date, little is known about the characteristics of health care organizations that have joined ACOs. We report on the findings of a survey of primary care clinics, the objective of which was to investigate the opinions of clinic management about participation in ACOs and the characteristics of clinic organizational structure that may contribute to joining ACOs or be willing to do so. Methods: A 27-item survey questionnaire was developed and distributed by mail in 3 annual waves to all Rural Health Clinics (RHCs in 9 states. Two dependent variables—participation in ACOs and willingness to join ACOs—were created and analyzed using a generalized estimating equation approach. Results: A total of 257 RHCs responded to the survey. A small percentage (5.2% of the respondent clinics reported that they were participating in ACOs. Rural Health Clinics in isolated areas were 78% less likely to be in ACOs (odds ratio = 0.22, P = .059. Nonprofit RHCs indicated a higher willingness to join an ACO than for-profit RHCs (B = 1.271, P = .054. There is a positive relationship between RHC size and willingness to join an ACO (B = 0.402, P = .010. Conclusion: At this early stage of ACO development, many RHC personnel are unfamiliar with the ACO model. Rural providers’ limited technological and human resources, and the lack of ACO development in rural areas, may delay or prevent their participation in ACOs.

  9. Dementia Special Care Units in Residential Care Communities: United States, 2010

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Dementia Special Care Units in Residential Care Communities: United ... Facilities Seventeen percent of residential care communities had dementia special care units. Figure 1. Number and percent ...

  10. Accountable Care Organizations: Will They Deliver?

    OpenAIRE

    Marsha Gold

    2010-01-01

    This brief examines accountable care organizations—groupings of diverse health care providers that care for a group of people and aim to create a cohesive framework, encourage accountability, and create incentives and rewards to providers that focus on the overall scope of patient care. It examines ACOs’ role in improving, integrating, and coordinating care delivered by multiple providers. It also places ACOs in the historical context of health care reform in the United States to draw les...

  11. Uptake of meningococcal conjugate vaccine among adolescents in large managed care organizations, United States, 2005: Demand, supply and seasonality

    Directory of Open Access Journals (Sweden)

    Wortley Pascale M

    2009-11-01

    Full Text Available Abstract Background In February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4 for routine use among 11- to 12-year-olds (at the preadolescent health-care visit, 14- to 15-year-olds (before high-school entry, and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds and non-target (13- plus 16-year-olds age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4 and tetanus diphtheria (Td vaccines. Methods We analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD. For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4. Results Coverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p Conclusion A surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005.

  12. Uptake of meningococcal conjugate vaccine among adolescents in large managed care organizations, United States, 2005: Demand, supply and seasonality

    Science.gov (United States)

    2009-01-01

    Background In February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4) for routine use among 11- to 12-year-olds (at the preadolescent health-care visit), 14- to 15-year-olds (before high-school entry), and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds) and non-target (13- plus 16-year-olds) age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4) and tetanus diphtheria (Td) vaccines. Methods We analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD). For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4. Results Coverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p < 0.001). Of the 64,272 MCV4 doses administered from March-December 2005, 73% were administered June-August. Fifty-nine percent of all MPSV4 doses and 38% of all Td doses were administered during June-August. Conclusion A surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005. PMID:19887009

  13. Pediatric Palliative Care in the Intensive Care Unit.

    Science.gov (United States)

    Madden, Kevin; Wolfe, Joanne; Collura, Christopher

    2015-09-01

    The chronicity of illness that afflicts children in Pediatric Palliative Care and the medical technology that has improved their lifespan and quality of life make prognostication extremely difficult. The uncertainty of prognostication and the available medical technologies make both the neonatal intensive care unit and the pediatric intensive care unit locations where many children will receive Pediatric Palliative Care. Health care providers in the neonatal intensive care unit and pediatric intensive care unit should integrate fundamental Pediatric Palliative Care principles into their everyday practice. PMID:26333755

  14. Sleep in intensive care unit

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Jennum, Poul; Nikolic, Miki;

    2016-01-01

    PURPOSE: To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients. MATERIALS AND METHODS: Randomized controlled trial, crossover design. The night intervention "quiet routine......" protocol was directed toward improving ICU environment between 10pm and 6am. Noise levels during control and intervention nights were recorded. Patients on mechanical ventilation and able to give consent were eligible for the study. We monitored sleep by PSG.The standard (American Association of Sleep...... Medicine) sleep scoring criteria were insufficient for the assessment of polysomnograms. Modified classification for sleep scoring in critically ill patients, suggested by Watson et al. (Crit Care Med 2013;41:1958-1967), was used. RESULTS: Sound level analysis showed insignificant effect...

  15. Organization theory. Analyzing health care organizations.

    Science.gov (United States)

    Cors, W K

    1997-02-01

    Organization theory (OT) is a tool that can be applied to analyze and understand health care organizations. Transaction cost theory is used to explain, in a unifying fashion, the myriad changes being undertaken by different groups of constituencies in health care. Agency theory is applied to aligning economic incentives needed to ensure Integrated Delivery System (IDS) success. By using tools such as OT, a clearer understanding of organizational changes is possible. PMID:10164970

  16. Organizing Rural Health Care

    DEFF Research Database (Denmark)

    Bunkenborg, Mikkel

    2012-01-01

    The liberalization of health care in the course of three decades of ‘reform and opening up’ has given people in rural China access to a diverse range of treatment options, but the health care system has also been marred by accusations of price hikes, fake pharmaceuticals, and medical malpractice....... This chapter offers an ethnographic description of health as an issue in a Hebei township and it focuses on a popular and a statist response to the perceived inadequacy of the rural health care system. The revival of religious practices in rural China is obviously motivated by many factors, but in the township...... roads to healing. The recent introduction of new rural cooperative medicine in the township represents an attempt to bring the state back in and address popular concern with the cost and quality of health care. While superficially reminiscent of the traditional socialist system, this new state attempt...

  17. Children as donors : a national study to assess procurement of organs and tissues in pediatric intensive care units

    NARCIS (Netherlands)

    Siebelink, Marion J.; Albers, Marcel J. I. J.; Roodbol, Petrie F.; Van de Wiel, Harry B. M.

    2012-01-01

    A shortage of size-matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol.

  18. Donor Care in Intensive Care Unit

    OpenAIRE

    Erdoğan, Ayşen

    2013-01-01

    Organ transplantation has been increasing day by day. However, there has been still a huge discrepancy between the numbers of potential organ donor and patients candidate for transplant recipient. Therefore, it is most important to gain organ donor pool. A potential organ donor is defined by the presence of either brain death or a catastrophic injury to the brain. It is mandatory to retrieve organs that offer the greatest likelihood of successful outcomes for the recipients. This strategy nec...

  19. Organizing Safe Transitions from Intensive Care

    Directory of Open Access Journals (Sweden)

    Marie Häggström

    2014-01-01

    Full Text Available Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients’ transfers from high technological intensive care units (ICU to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient’s care before, during, and after transfer from intensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment. Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach.

  20. United Network for Organ Sharing

    Science.gov (United States)

    ... phase of COIIN (the Collaborative Innovation and Improvement Network), a three-year project intended to increase kidney ... Google+ Google+ E-news E-news © 2015 United Network for Organ Sharing , a non-profit 501(c)( ...

  1. Current physiotherapy approaches in intensive care units

    OpenAIRE

    Yurdalan, S. Ufuk

    2011-01-01

    Physiotherapy is a part of the multidisciplinary treatment in different intensive care units. Respiratory, cardiovascular and neuromusculoskeletal- focused physiotherapy programmes and prevention of the respiratory, neuromuscular complications which may be possible, developing the exercise capacity related to inspiratory muscle function in critically patients internalized and postoperative cases in intensive care unit are clinical targets. It is known that physiotherapy initiated early is rel...

  2. ASSESSMENT OF BIOFILM FORMATION BY THE CAUSATIVE ORGANISMS OF VENTILATOR ASSOCIATED PNEUMONIA AT INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Mulla Summaiya A

    2012-02-01

    Full Text Available Introduction: The endotracheal tube participates in the pathogenesis of ventilator-associated pneumonia by the elimination of natural defense mechanisms, thereby allowing the entry of bacteria by the aspiration of subglottic secretions and ultimately these all will play role in the formation of biofilm on the endotracheal tube. Aims and objectives: Present study was done to assess biofilm formation by bacterial clinical isolates from endotracheal tube of ventilator associated pneumonia patients and to assess drug resistance in association with biofilm. Material and method: All isolates are identified by standard biochemical reaction and antibiotic susceptibility testing was done as per CLSI guidelines. Detection of biofilm is done by using tissue culture plate method. Results: Total 56 isolates are recovered from 42 patients of ventilator associated pneumonia; from it 34 (65.4% isolates are strongly positive by tissue culture plate method. Most common organisms isolated which producing strong biofilm are Pseudomonas aeruginosa and Acinetobacter spp. Conclusion: The presence of an endotracheal tube in the airway, although critical for the management of the mechanically ventilated patient, also contributes to the development of ventilator associated pneumonia by disrupting normal protective mechanism which is associated with the intraluminal formation of biofilm by multidrug resistant organisms. [National J of Med Res 2012; 2(1.000: 15-18

  3. Nosocomial Infections in Neonatal Intensive Care Units

    OpenAIRE

    Ioanna Paulopoulou; Christina Nanou

    2013-01-01

    Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific ...

  4. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.

    1999-01-01

    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring facilit

  5. The Living, Dynamic and Complex Environment Care in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Marli Terezinha Stein Backes

    2015-06-01

    Full Text Available OBJECTIVE: to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care.METHOD: Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units.RESULTS: built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions; "Providing a suitable environment" and "having relatives with concern" (context; "Mediating facilities and difficulties" (intervenienting conditions; "Organizing the environment and managing the dynamics of the unit" (strategy and "finding it difficult to accept and deal with death" (consequences.CONCLUSION: confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  6. Nursing management and organizational ethics in the intensive care unit.

    Science.gov (United States)

    Wlody, Ginger Schafer

    2007-02-01

    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth. PMID:17242604

  7. Frequency of candidemias in a tertiary care intensive care unit

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of fungal infections in intensive care unit (ICU) of Military Hospital, Rawalpindi, a tertiary care health facility. Study Design: Cross sectional study. Place and Duration of Study: Intensive Care Department of Military Hospital Rawalpindi from 01 Jan 2012 to 30 Jun 2012. Methodology: A total of 89 patients were screened with stay of more than 5 days in intensive care unit. Thirty cases were enrolled in the study for investigation of fungal infections that had fever even after 05 days of being on broad spectrum antibiotics. Culture was done on blood, urine and catheter tip samples as per clinical condition of a patient. Results: Candida infection was found in 23.4% of study cases. The mean age of study patients was 41.2 +- 20.0 years while 63.4% were female patients as compared to 36.7% males. Conclusion: Fungal infections especially candidemias are quite frequent in the intensive care units. (author)

  8. Hyperglycemia in the Intensive Care Unit

    OpenAIRE

    Rainer Lenhardt; Ozan Akca

    2014-01-01

    Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without d...

  9. Performance and burnout in intensive care units

    NARCIS (Netherlands)

    Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit p

  10. Family-Centered Care in Neonatal Intensive Care Unit: A Concept Analysis

    Science.gov (United States)

    Ramezani, Tahereh; Hadian Shirazi, Zahra; Sabet Sarvestani, Raheleh; Moattari, Marzieh

    2014-01-01

    Background: The concept of family- centered care in neonatal intensive care unit has changed drastically in protracted years and has been used in various contexts differently. Since we require clarity in our understanding, we aimed to analyze this concept. Methods: This study was done on the basis of developmental approach of Rodgers’s concept analysis. We reviewed the existing literature in Science direct, PubMed, Google Scholar, Scopus, and Iran Medex databases from 1980 to 2012. The keywords were family-centered care, family-oriented care, and neonatal intensive care unit. After all, 59 out of 244 English and Persian articles and books (more than 20%) were selected. Results: The attributes of family-centered care in neonatal intensive care unit were recognized as care taking of family (assessment of family and its needs, providing family needs), equal family participation (participation in care planning, decision making, and providing care from routine to special ones), collaboration (inter-professional collaboration with family, family involvement in regulating and implementing care plans), regarding family’s respect and dignity (importance of families’ differences, recognizing families’ tendencies), and knowledge transformation (information sharing between healthcare workers and family, complete information sharing according to family learning style). Besides, the recognized antecedents were professional and management-organizational factors. Finally, the consequences included benefits related to neonate, family, and organization. Conclusion: The findings revealed that family centered-care was a comprehensive and holistic caring approach in neonatal intensive care. Therefore, it is highly recommended to change the current care approach and philosophy and provide facilities for conducting family-centered care in neonatal intensive care unit.  PMID:25349870

  11. NOSOCOMIAL ACINETOBACTER INFECTIONS IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Nwadike V. Ugochukwu

    2013-01-01

    Full Text Available Acinetobacter plays an important role in the infection of patients admitted to hospitals. Acinetobacter are free living gram-negative coccobacilli that emerge as significant nosocomial pathogens in the hospital setting and are responsible for intermittent outbreaks in the Intensive Care Unit. The aim of this study was to determine the prevalence of Acinetobacter in patients admitted into the Intensive Care Unit and determine their role in infections in the ICU. A total of one hundred patients were recruited for the study, catheter specimen urine, tracheal aspirate and blood culture were collected aseptically from the patients. The specimens were cultured on blood and MacConkey and the organisms identified using Microbact 12E (0xoid. The Plasmid analysis was done using the TENS miniprep method. Fourteen (14% of the 100 patients recruited into the study, developed Acinetobacter infection. Acinetobacter spp constituted 9% of the total number of isolates. Twelve (86% of the isolates were recovered from tracheal aspirate, 1(7% from urine and 1(7% from blood. All of the isolates harbor plasmids of varying molecular sizes. Ten of the fourteen Acinetobacter were isolated at about the same period of time in the ICU with 6(42.7% having plasmid size in the 23.1kb band and all showed similar pattern revealing that the isolates exhibit some relatedness. The clonal nature of the isolates suggest that strict infection control practices must be adopted in ICU, also an antibiotic policy must be developed for the ICU to prevent abuse of antibiotics that may lead to selection of resistant bacteria.

  12. Nosocomial Infections in Neonatal Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Ioanna Paulopoulou

    2013-10-01

    Full Text Available Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific journals during the period 2004-2013. As a main tool of retraction of bibliography was used the internet. Specific web sites and library databases: PubMed, Cinahl and Google scholar with key-words: "prevent nosocomial infections", "infection control", "neonatal care", "nursing care prematurity", "neonates nosocomial infections", "neonatal intensive care unit" (NICU. Methodology was applied thematic content analysis, which provides a careful reading of the material and recording the recurring risk factors Neonatal Neonatal Unit. Results: All researchers agree that nosocomial infections of hospitalized infants are a result of interaction of intrinsic and extrinsic factors risk. The intrinsic factors predisposing to infection is the immaturity of the immune system, the barriers of the skin and mucous membranes. Furthermore, multiple external factors contribute to the development of infection, such as low birth weight, underlying disease, broad-spectrum antibiotics, prolonged hospitalization, invasive techniques, parenteral nutrition, numerical insufficiency of staff, and poor compliance with medical professionals on hand hygiene. In recent years, the use of protocols and guidelines for each intervention in newborns has dramatically reduce the incidence of nosocomial infections. Conclusions: Nosocomial infections constitute serious threat to the population of the Neonatal Intensive Care Unit. Surveillance of infections and the use of protocols will help control

  13. A model for integrating independent physicians into accountable care organizations.

    Science.gov (United States)

    Shields, Mark C; Patel, Pankaj H; Manning, Martin; Sacks, Lee

    2011-01-01

    The Affordable Care Act encourages the formation of accountable care organizations as a new part of Medicare. Pending forthcoming federal regulations, though, it is unclear precisely how these ACOs will be structured. Although large integrated care systems that directly employ physicians may be most likely to evolve into ACOs, few such integrated systems exist in the United States. This paper demonstrates how Advocate Physician Partners in Illinois could serve as a model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs, and be held accountable for the results. The partnership has signed its first commercial ACO contract effective January 1, 2011, with the largest insurer in Illinois, Blue Cross Blue Shield. Other commercial contracts are expected to follow. In a health care system still dominated by small, independent physician practices, this may constitute a more viable way to push the broader health care system toward accountable care. PMID:21163804

  14. Sleep in the Intensive Care Unit measured by polysomnography

    DEFF Research Database (Denmark)

    Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard

    2013-01-01

    Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep-frien...

  15. Fighting antibiotic resistance in the intensive care unit using antibiotics

    NARCIS (Netherlands)

    Plantinga, Nienke L.; Wittekamp, Bastiaan H J; Van Duijn, Pleun J.; Bonten, Marc J M

    2015-01-01

    Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to cl

  16. Prevalence of Hospital Acquired Infections in Anesthesiology Intensive Care Unit

    OpenAIRE

    ÇELİK, İlhami; İNCİ, Nuran; Denk, Affan; SEVİM, Erol; YAŞAR, Demet; YAŞAR, M. Akif

    2005-01-01

    Objectives: To determine the prevalence of infections, predominant organisms and their resistance pattern. Materials and Methods: Prospective cohort study. All patients over 16 years old were occupying an intensive care unit bed over a 24-hour period. All patients admitted to the unit were evaluated on a daily basis for nosocomial infections in compliance with National Nosocomial Infections Surveillance System (NNISS) methodology. Infection site definitions were in agreement with Center fo...

  17. Intensive care unit nurses' opinions about euthanasia.

    Science.gov (United States)

    Kumaş, Gülşah; Oztunç, Gürsel; Nazan Alparslan, Z

    2007-09-01

    This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011).

  18. Interdisciplinary communication in the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, R; Mearns, Kathryn; Cuthbertson, Brian H

    2007-01-01

    Background. Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. Methods. Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. Results. A sample o...

  19. Factors Affecting Intensive Care Units Nursing Workload

    OpenAIRE

    Mohammadkarim BAHADORI; RAVANGARD, Ramin; Raadabadi, Mehdi; Mosavi, Seyed Masod; Gholami Fesharaki, Mohammad; Mehrabian, Fardin

    2014-01-01

    Background: The nursing workload has a close and strong association with the quality of services provided for the patients. Therefore, paying careful attention to the factors affecting nursing workload, especially those working in the intensive care units (ICUs), is very important. Objectives: This study aimed to determine the factors affecting nursing workload in the ICUs of the hospitals affiliated to Tehran University of Medical Sciences. Materials and Methods: This was a cross-sectional a...

  20. Hyperglycemia in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Rainer Lenhardt

    2014-12-01

    Full Text Available Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without diabetes and has a strong association with increased mortality in the intensive care unit patients. Insulin is the drug of choice to treat hyperglycemia in the intensive care unit. In patients with moderate hyperglycemia a basal–bolus insulin concept can be used. Close glucose monitoring is of paramount importance throughout the intensive care unit stay of the patient. In the guidelines for glycemic control based on meta-analyses it was shown that a tight glycemic control does not have a significant mortality advantage over conventional treatment. Given the controversy about optimal blood glucose goals in the intensive care unit setting, it seems reasonable to target a blood glucose level around 140 mg/dL to avoid episodes of hypoglycemia and minimize glycemic variability. The closed loop system with continuous glucose monitoring and algorithm based insulin application by an infusion pump is a promising new concept with the potential to further reduce mortality and morbidity due to hyperglycemia, hypoglycemia and glycemic variability. The goal of this review was to give a brief overview about pathophysiology of hyperglycemia and to summarize current guidelines for glycemic control in critically ill patients.

  1. VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Syed Ali

    2015-12-01

    Full Text Available BACKGROUND Knowledge of the incidence of ventilator-associated pneumonia (VAP and its associated risk factors is imperative for the development and use of more effective preventive measures. METHODOLOGY We conducted a prospective cohort study over a period of 12 months to determine the incidence and the risk factors for development of VAP in critically ill adult patients admitted in intensive care units (ICUs in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, we included 150 patients, on mechanical ventilation for more than 48 hours. VAP was diagnosed according to the current diagnostic criteria. RESULTS The study cohort comprised of 150 patients of various cases of cerebrovascular accident, poisoning, neurological disorders, sepsis and others. VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. The mean age of the patients was 40 years. Of the 150 patients, 28 patients developed VAP during the ICU stay. The incidence of VAP in our study was 18.8%. The risk factor in our study was decrease in the PaO2/FiO2 ratio, duration of mechanical ventilation, impaired consciousness, tracheostomy, re-intubation, emergency intubation, nasogastric tube, emergency intubation and intravenous sedatives were found to be the specific risk factors for early onset VAP, while tracheostomy and re-intubation were the independent predictors of late-onset VAP, The most predominant organisms in our study was Pseudomonas (39.2%. CONCLUSIONS Knowledge of these risk factors may be useful in implementing simple and effective preventive measures. Precaution during emergency intubation, minimizing the occurrence of reintubation, avoidance of tracheostomy as far as possible, and minimization of sedation. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to

  2. Fighting antibiotic resistance in the intensive care unit using antibiotics.

    Science.gov (United States)

    Plantinga, Nienke L; Wittekamp, Bastiaan H J; van Duijn, Pleun J; Bonten, Marc J M

    2015-01-01

    Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to classical infection prevention protocols and surveillance programs, counterintuitive interventions, such as selective decontamination with antibiotics and antibiotic rotation have been applied and investigated to control the emergence of antibiotic resistance. This review provides an overview of selective oropharyngeal and digestive tract decontamination, decolonization of methicillin-resistant Staphylococcus aureus and antibiotic rotation as strategies to modulate antibiotic resistance in the intensive care unit.

  3. Fast Hugs with Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nimet Şenoğlu

    2014-12-01

    Full Text Available Mnemonics are commonly used in medical procedures as cognitive aids to guide clinicians all over the world. The mnemonic ‘FAST HUG’ (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glycemic control was proposed almost ten years ago for patient care in intensive care units and have been commonly used worldwide. Beside this, new mnemonics were also determined for improving routine care of the critically ill patients. But none of this was accepted as much as “FAST HUGS”. In our clinical practice we delivered an another mnemonic as FAST HUGS with ICU (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Stress ulcer prevention, and Glucose control, Water balance, Investigation and Results, Therapy, Hypo-hyper delirium, Invasive devices, Check the daily infection parameters, Use a checklist for checking some of the key aspects in the general care of intensive care patients. In this review we summarized these mnemonics.

  4. Performance and burnout in intensive care units

    OpenAIRE

    Keijsers, G.J.; Schaufeli, W.B.; LeBlanc, P; Zwerts, C.; Miranda, D.R.

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit performance. Subjective performance measures relate negatively to burnout levels of nurses, whereas an objective performance measure relates positively to burnout. Furthermore, subjectively assessed...

  5. Probiotics in the intensive care unit.

    Science.gov (United States)

    Morrow, Lee E; Gogineni, Vijaya; Malesker, Mark A

    2012-04-01

    Probiotics are living microorganisms that, when ingested in adequate amounts, provide benefits to the host. The benefits include either a shortened duration of infections or decreased susceptibility to pathogens. Proposed mechanisms of beneficial effects include improving gastrointestinal barrier function, modification of the gut flora by inducing host cell antimicrobial peptides and/or local release of probiotic antimicrobial factors, competition for epithelial adherence, and immunomodulation. With increasing intensive care unit (ICU) antibacterial resistance rates and fewer new antibiotics in the research pipeline, focus has been shifted to non-antibiotic approaches for the prevention and treatment of nosocomial infections. Probiotics offer promise to ICU patients for the prevention of antibiotic-associated diarrhea, Clostridium difficile infections, multiple organ dysfunction syndrome, and ventilator-associated pneumonia. Our current understanding of probiotics is confounded by inconsistency in probiotic strains studied, optimal dosages, study durations, and suboptimal sample sizes. Although probiotics are generally safe in the critically ill, adverse event monitoring must be rigorous in these vulnerable patients. Delineation of clinical differences of various effective probiotic strains, their mechanisms of action, and optimal dosing regimens will better establish the role of probiotics in various disorders. However, probiotic research will likely be hindered in the future given a recent ruling by the U.S. Food and Drug Administration.

  6. Acinetobacter septicemia in neonates admitted to intensive care units

    Directory of Open Access Journals (Sweden)

    Vishal B Shete

    2009-01-01

    Results: A total of 26 Acinetobacter septicemia cases were identified by blood culture. Acb complex strains predominated. Institutional birth and preterm birth were identified as the most frequent significant risk factors. 11.3% mortality rate was recorded. Acb complex strains exhibited a multi-drug resistant pattern. No carbapenem resistance was observed. Conclusion: Acinetobacter should be added to the list of organisms causing severe nosocomial infection in neonatal intensive care units. Continuous bacteriological surveillance, implementation of infection control policies, careful disinfection of intensive care equipment, and rational antibiotic use are required for control of such infections.

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

    Science.gov (United States)

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

    2009-01-01

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

  8. Perception of nurses regarding risk classification in emergency care units

    Directory of Open Access Journals (Sweden)

    Carmen Lúcia Mottin Duro

    2014-09-01

    Full Text Available This study aimed to assess nurses’ perception regarding the risk classification in emergency care units. It is a descriptive study that used a qualitative approach and that was conducted with 55 nurses from emergency care units in the south of Brazil. Data were collected between July and October, 2011, through open questions, answered in writing. The data collected were submitted to the thematic analysis technique. Results indicate that the risk classification contributes to the organization of the service flow provided to patients, intervening in severe cases and preventing sequelae. Difficulties were described, such as: inadequate physical installations, overcrowding, disagreement in the definition of priorities among doctors and nurses and lack of articulation between the emergency care network and basic health care. It is highlighted the need to improve the physical structure, the quantity of human resources and the implementation of public policies to overcome these challenges.

  9. [Primary care in the United Kingdom].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-03-01

    The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's. PMID:26412408

  10. [Primary care in the United Kingdom].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-03-01

    The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's.

  11. Burnout in the intensive care unit professionals

    Directory of Open Access Journals (Sweden)

    Kalpalatha K Guntupalli

    2014-01-01

    Full Text Available Background: Professional burnout has been widely explored in health care. We conducted this study in our hospital intensive care unit (ICU in United States to explore the burnout among nurses and respiratory therapists (RT. Materials and Methods: A survey consisting of two parts was used to assess burnout. Part 1 addressed the demographic information and work hours. Part 2 addressed the Maslach Burnout Inventory-Human Service Survey. Results: The analysis included 213 total subjects; Nurses 151 (71% and RT 62 (29%. On the emotional exhaustion (EE scale, 54% scored "Moderate" to "High" and 40% scored "Moderate" to "High" on the depersonalization (DP scale. Notably 40.6% scored "Low" on personal accomplishment (PA scale. Conclusion: High level of EE, DP and lower PAs were seen among two groups of health care providers in the ICUs.

  12. Neonatal intensive care unit nosocomial bacterial infections

    Directory of Open Access Journals (Sweden)

    Ghazvini

    2008-08-01

    Full Text Available Background: Nosocomial infections increase patients' morbidity, mortality and length of hospital stay especially in neonatal intensive care units (NICUs and have become a matter of major concern. Controlling and preventing nosocomial infections need enough information about epidemiology of these infections. This study aims at estimating the incidence rate and the most frequent bacteria which cause these infections in neonatal intensive care unit of Ghaem university hospital, Mashhad. Methods: In this study which is performed during a twelve month period in 2004 and 2005 at neonatal intensive care unit of Ghaem hospital, 971 hospitalized neonates were studied. Data were collected considering the standard surveillance protocols. Early onset neonatal nosocomial infections and late onset neonatal infections were defined as illness appearing from birth to seven days and from eight to twenty-eight days postnatal age respectively. Statistical analysis was performed using the χ2 test. Results: In this study 32 cases of nosocomial infections were identified so the incidence rate of nosocomial infection in this ward was 3.29%. Fifteen babies identified with early onset neonatal nosocomial infection and the rest have presented with late onset neonatal infections. In order of frequency, the sites of infection were: primary bloodstream (84.4% and pneumonia (15.62%. Coagulase negative staphylococci were the most common bacteria (43.74% isolated in these patients. Other isolated bacteria were Klebsiella pneumonia (31.42% and other gram negative bacilli such as E.coli, Pseudomonas aeroginosa and Acintobacter spp. The mechanical ventilation and umbilical catheter were associated with nosocomial infections as risk factors in our study (p<0.01. Conclusion: Our findings show that the neonatal intensive care unit of Ghaem hospital has low rate of nosocomial infections. However, as neonatal intensive care unit is an area of great concern in terms of nosocomial

  13. 29 CFR 103.30 - Appropriate bargaining units in the health care industry.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Appropriate bargaining units in the health care industry... Appropriate Bargaining Units § 103.30 Appropriate bargaining units in the health care industry. (a) This... such by either Joint Committee on Accreditation of Healthcare Organizations or by Commission...

  14. Benefitting From Monitorization in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mois Bahar

    2011-12-01

    Full Text Available The most essential matter about following a patient in intensive care unit is a fine and correct monitorization. While benefitting from monitorization is the main objective of every intensive care physician, it should be discussed how successful we are when we do not take monitorization as a subject of interest sufficiently. This physicians who are both performing medical care and education has a very important role regarding the matter: To question and confirm the correctness of the parameters that are being followed and to use this data for choosing the treatment type. The vital parameters that are found necessary to be followed usually do not present us the sufficient utility. For purpose, implementing monitorization in a way of whole perspective including Examining, Questioning, Reading (Observing, Repeating, Recalling will maintain to receive consequences for the benefit of the patient. (Journal of the Turkish Society Intensive Care 2011; 9: 110-5

  15. Job satisfaction in health-care organizations

    OpenAIRE

    Kavita Bhatnagar; Kalpana Srivastava

    2012-01-01

    Job satisfaction among health-care professionals acquires significance for the purpose of maximization of human resource potential. This article is aimed at emphasizing importance of studying various aspects of job satisfaction in health-care organizations.

  16. Organizational Learning in Health Care Organizations

    OpenAIRE

    Savithiri Ratnapalan; Elizabeth Uleryk

    2014-01-01

    The process of collective education in an organization that has the capacity to impact an organization’s operations, performance and outcomes is called organizational learning. In health care organizations, patient care is provided through one or more visible and invisible teams. These teams are composed of experts and novices from diverse backgrounds working together to provide coordinated care. The number of teams involved in providing care and the possibility of breakdowns in communication...

  17. Nosocomial Infections in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Emine Parlak

    2013-04-01

    Full Text Available Introduction: Nosocomial infections are one of the important mortality and morbidity reasons among newborns. For this reason recognition of infection factors and the resistance to antimicrobials in intensive care unit is very important in terms of rational antibiotic use. Materials and Methods: Nosocomial infections seen in our neonatal intensive care unit between 2009 and 2011 were retrospectively analyzed. Isolated strains, antibiotic sensitivities, the use of invasive tool, infectious species and infection rates were determined according to the data provided by National Nosocomial Infections Surveillance Control Unit. Results: A total of 4258 patients were observed for 34625 patient days, 6536 ventilator days, 98 urinary catheter days, 601 central venous catheter days and 590 umbilical catheter days. The infection rate was 3.26% (139/4258 and the incident density was 4.01‰. Pneumonia was on the first rank (61; 43% and it was in ventilator association form. 36 strains were isolated as the infectious agents. The rates of gram negative factors was 23 (63.88%, gram positive factors was 8 (22.22% and Candida spp. was 5 (13.88 %. The most frequently isolated gram negative strains were Klebsiella spp. (7; 19.4% and Pseudomonas spp. (7; 19.4 %. The most effective antibiotics in Enterobactericeae spp. were meropenem and imipenem. In enteric gram-negative rods, extended-spectrum beta-lactamase positivity was 63.64%. In the neonatal intensive care unit, ventilator-associated pneumonia rate was 6.73% and the ventilator use ratio was 19%. Conclusions: In conclusion, each intensive care unit should determne the factors and follow antimicrobial resistant patterns. Empiric antibiotic treatment strategy should be established. Decreasing or totally preventing hospital infections would be possible by active surveillance system, adoption infection control guidelines, limitation of instrument use and rational antibiotic use rules. (The Jo­ur­nal of Cur

  18. Sedation in neurological intensive care unit

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    Birinder S Paul

    2013-01-01

    Full Text Available Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives.

  19. Reflecting on healthcare and self-care in the Intensive Care Unit: our story

    Directory of Open Access Journals (Sweden)

    Allan Peterkin

    2014-12-01

    Full Text Available Health care professionals working in Intensive Care Units (ICUs are exposed to high levels of stress-provoking stimuli. Some may unconsciously employ negative coping skill s which may contribute to burnout and negatively affect patient care. We chose to explore ways of facilitating and encouraging self-reflective practice in an effort to increase empathic traits and enhance communication. A narrative medicine series, which included six sessions that were focused on different narrative approaches, was organized for staff of an academic teaching hospital. Totally, 132 interdisciplinary ICU staff attended the sessions. They were generally open to exploring the selected approaches and discussing their reflections within the interdisciplinary environment. The narrative medicine series provided tools for health care professionals to enhance self-reflective skills utilizing a team-based learning approach. The anticipated outcomes were improved self-care, increased empathy and communication skills, enhanced team functioning, which all contribute to better patient care at the bedside.

  20. Pharmacists belong in accountable care organizations and integrated care teams.

    Science.gov (United States)

    Smith, Marie; Bates, David W; Bodenheimer, Thomas S

    2013-11-01

    Effective health care workforce development requires the adoption of team-based care delivery models, in which participating professionals practice at the full extent of their training in pursuit of care quality and cost goals. The proliferation of such new models as medical homes, accountable care organizations, and community-based care teams is creating new opportunities for pharmacists to assume roles and responsibilities commensurate with their capabilities. Some challenges to including pharmacists in team-based care delivery models, including the lack of payment mechanisms that explicitly provide for pharmacist services, have yet to be fully addressed by policy makers and others. Nevertheless, evolving models and strategies reveal a variety of ways to draw on pharmacists' expertise in such critical areas as medication management for high-risk patients. As Affordable Care Act provisions are implemented, health care workforce projections need to consider the growing number of pharmacists expected to play an increasing role in delivering primary care services.

  1. Hospital infections in neonatal intensive care units

    OpenAIRE

    Đurišić Jasna; Marković-Denić Ljiljana N.; Ilić Slobodanka; Ramadani Ruždi

    2005-01-01

    Introduction Sick newborn babies in the neonatal intensive care units (NICU) are al increased risk for hospital-acquired infections (HI). The aim of our study was to determine the incidence and localization of neonatal hospital infections in NICU. Material and methods A prospective, six-month study was carried out in a NICU. All patients hospitalized in NICU longer then 48 hours were examined according to their basic descriptive-epidemiological characteristics and the incidence of all hospita...

  2. Diarrhea in neonatal intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Annalisa; Passariello; Gianluca; Terrin; Maria; Elisabetta; Baldassarre; Mario; De; Curtis; Roberto; Paludetto; Roberto; Berni; Canani

    2010-01-01

    AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years.The main anamnesis and demographic characteristics,etiology and characteristics of diarrhea,nutritional and therapeutic management,clinical outcomes were evaluated.RESULTS:Thirty-nine cases of diarrhea(36 acute,3 chronic) were identified.The occurrence rate of diarrhea was 6.72 per 1000 hosp...

  3. Music Inside an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ana Maria Loureiro De Souza Delabary

    2004-07-01

    Full Text Available This paper reports on the music therapy work performed in the intensive care unit of a university hospital. Clinical practice is inserted with in the hospital psychology department and acts jointly with some of the other health departments in the same hospital. The text presents the employed methodology, techniques, and repertoire, along with some considerations, comments, and observations on the practical side of the treatment. Music therapy imposes itself as a valuable element for the health area and becomes particularly meaningful as a part of the hospital's humanization program which is being developed in the institution. Striving for care quality, all the while it helps integrating all involved personnel interacting with the patients, music can be a powerful stimulus for the improvement of health care, particularly in the reception and support of the difficult situations terminal patients are faced with.

  4. [Intermediate care units and noninvasive ventilation].

    Science.gov (United States)

    Becker, Heinrich F; Schönhofer, Bernd; Vogelmeier, Claus

    2006-04-15

    Intermediate care units (IMC) have been introduced to provide optimal patient management according to disease severity and to bridge the gap between intensive care (ICU) and general wards. Most patients that are referred to an IMC need monitoring and intensive analgetic treatment. Over the past years noninvasive ventilation (NIV) and weaning have emerged as important new forms of active treatment in the IMC. Most studies that have been published so far demonstrate that an IMC improves patient outcome and lowers costs, although randomized controlled trials are missing. NIV reduces mortality, the need for intubation as well as ICU and hospital length of stay in patients with chronic obstructive pulmonary disease (COPD) and other disorders that cause respiratory failure. In many cases NIV can be performed in the IMC, a fact that reduces the number of ICU admissions, lowers costs and improves patient care. The high prevalence of pulmonary diseases and NIV emphasizes the importance of pneumologists as directors of both ICU and IMC.

  5. Dermatology in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2012-10-01

    Full Text Available Introduction: The intensive care unit (ICU represents a special environment for patients. We analyzed patients in the ICU/ high care unit (HCU with respect to dermatology counselling and skin problems.Setting: Academic Teaching Hospital over a 10 month period.Methods: The total number of patients of the ICU was 1,208 with a mean stay of 4.1 days. In the HCU the mean stay was 16 days. Diagnosis leading to admission were analyzed. All files of dermatological counselling were evaluated in detail.Results: Fifty-five patients with dermatologic problems were identified: 19 women and 26 males. The age ranged from 22 to 90 years of life (mean ± standard deviation: 67.2 ± 17.4 years. The total number of consultations were 85. The range of repeated dermatological consultation ranged from two to ten. The major reasons were skin and soft tissue infections, adverse drug reactions, chronic wounds including pressure sores and skin irritation or dermatitis. Pre-existing skin conditions may complicate the treatment and care during ICU/HCU stay.Conclusion: A tight collaboration between of the medical staff of ICU/HCU and dermatology department will ensure a rapid diagnosis and treatment of various skin conditions in the ICU, without increasing the costs significantly. Interdisciplinary education of nursing staff contributes to improved skin care in the ICU/HCU and helps to prevent acute skin failure.

  6. Rehabilitation starts in the intensive care unit.

    Science.gov (United States)

    Rozeboom, Nathan; Parenteau, Kathy; Carratturo, Daniel

    2012-01-01

    Each year between 10 000 and 12 000 spinal cord injuries occur in the United States. Once injured, many of these patients will receive a portion of their care in an intensive care unit (ICU), where their treatment will begin. Harborview Medical Center in Seattle, Washington, provides comprehensive care to approximately 60 to 70 cervical spinal cord injuries each year. Because of many factors such as hemodynamic instability, pulmonary complications, and risk of infection, patients with cervical spinal cord injuries can spend up to 2 or more weeks in the ICU before they transfer to a rehabilitation unit. To achieve optimal outcomes, it is imperative that members of the interdisciplinary team work together in a consistent, goal-oriented, collaborative manner. This team includes physicians, nurses, respiratory therapists, physical and occupational therapists, speech pathologists, dieticians, and rehabilitation psychologists. An individual plan is developed for each patient and rehabilitation starts in the ICU as soon as the patient is medically stable. This article will highlight the management strategies used in the neuroscience ICU at Harborview Medical Center and will include a case study as an example of the typical experience for our patients with high cervical cord injury.

  7. How the United States exports managed care to developing countries.

    Science.gov (United States)

    Waitzkin, H; Iriart, C

    2001-01-01

    As their expansion slows in the United States, managed care organizations will continue to enter new markets abroad. Investors view the opening of managed care in Latin America as a lucrative business opportunity. As public-sector services and social security funds are cut back, privatized, and reorganized under managed care, with the support of international lending agencies such as the World Bank, the effects of these reforms on access to preventive and curative services will hold great importance throughout the developing world. Many groups in Latin America are working on alternative projects that defend health as a public good, and similar movements have begun in Africa and Asia. Increasingly, this organizing is being recognized not only as part of a class struggle but also as part of a struggle against economic imperialism--which has now taken on the new appearance of rescuing less developed countries from rising health care costs and inefficient bureaucracies through the imposition of neoliberal managed-care solutions exported from the United States. PMID:11562002

  8. Health care data in the United States.

    Science.gov (United States)

    Rice, D P

    1983-06-01

    This article serves as an introduction to the following article, An Inventory of U.S. Health Care Data Bases. As an introduction, this article-reviews the characteristics of U.lS. Health Care Data. These characteristics include a lack of common definition and uniformity of reporting of observations, systems that are sometimes duplicative, and a resistance to data sharing on the part of collecting agencies, arising from the pluralistic American health care economy. Yet federal, state, and local governments as well as private organizations need health data to operate and evaluate their programs. Moreover, recent shifts to block grants and cutbacks in federal funding without accountability requirements will adversely affect our ability to adequately monitor the impact of these programs on the nation's health. The article discusses these data issues, but also emphasizes the need for coordination between the government and private sectors. PMID:10261971

  9. Families' experiences of intensive care unit quality of care

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty;

    2015-01-01

    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess relevance and understandability of each question. Validation also included test-retest reliability and construct...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test...

  10. A taxonomy of nursing care organization models in hospitals

    Directory of Open Access Journals (Sweden)

    Dubois Carl-Ardy

    2012-08-01

    Full Text Available Abstract Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs and assistive staff (orderlies to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an

  11. Managing mechanistic and organic structure in health care organizations.

    Science.gov (United States)

    Olden, Peter C

    2012-01-01

    Managers at all levels in a health care organization must organize work to achieve the organization's mission and goals. This requires managers to decide the organization structure, which involves dividing the work among jobs and departments and then coordinating them all toward the common purpose. Organization structure, which is reflected in an organization chart, may range on a continuum from very mechanistic to very organic. Managers must decide how mechanistic versus how organic to make the entire organization and each of its departments. To do this, managers should carefully consider 5 factors for the organization and for each individual department: external environment, goals, work production, size, and culture. Some factors may push toward more mechanistic structure, whereas others may push in the opposite direction toward more organic structure. Practical advice can help managers at all levels design appropriate structure for their departments and organization.

  12. Comparison of PCR/Electron spray Ionization-Time-of-Flight-Mass Spectrometry versus Traditional Clinical Microbiology for active surveillance of organisms contaminating high-use surfaces in a burn intensive care unit, an orthopedic ward and healthcare workers

    Directory of Open Access Journals (Sweden)

    Yun Heather C

    2012-10-01

    Full Text Available Abstract Background Understanding nosocomial pathogen transmission is restricted by culture limitations. Novel platforms, such as PCR-based electron spray ionization-time-of-flight-mass spectrometry (ESI-TOF-MS, may be useful as investigational tools. Methods Traditional clinical microbiology (TCM and PCR/ESI-TOF-MS were used to recover and detect microorganisms from the hands and personal protective equipment of 10 burn intensive care unit (ICU healthcare workers providing clinical care at a tertiary care military referral hospital. High-use environmental surfaces were assessed in 9 burn ICU and 10 orthopedic patient rooms. Clinical cultures during the study period were reviewed for pathogen comparison with investigational molecular diagnostic methods. Results From 158 samples, 142 organisms were identified by TCM and 718 by PCR/ESI-TOF-MS. The molecular diagnostic method detected more organisms (4.5 ± 2.1 vs. 0.9 ± 0.8, p S. aureus in 13 samples vs. 21 by PCR/ESI-TOF-MS. Gram-negative organisms were less commonly identified than gram-positive by both methods; especially by TCM. Among all detected bacterial species, similar percentages were typical nosocomial pathogens (18-19% for TCM vs. PCR/ESI-TOF-MS. PCR/ESI-TOF-MS also detected mecA in 112 samples, vanA in 13, and KPC-3 in 2. MecA was associated (p S. aureus. No vanA was codetected with enterococci; one KPC-3 was detected without Klebsiella spp. Conclusions In this pilot study, PCR/ESI-TOF-MS detected more organisms, especially gram-negatives, compared to TCM, but the current assay format is limited by the number of antibiotic resistance determinants it covers. Further large-scale assessments of PCR/ESI-TOF-MS for hospital surveillance are warranted.

  13. Rehabilitation in the intensive care unit.

    Science.gov (United States)

    Rochester, Carolyn L

    2009-12-01

    Critical illness has many devastating sequelae, including profound neuromuscular weakness and psychological and cognitive disturbances that frequently result in long-term functional impairments. Early rehabilitation begun in the intensive care unit (ICU) is emerging as an important strategy both to prevent and to treat ICU-acquired weakness, in an effort to facilitate and improve long-term recovery. Rehabilitation may begin with range of motion and bed mobility exercise, then may progress when the patient is fully alert and able to participate actively to include sitting and posture-based exercise, bed to chair transfers, strength and endurance exercises, and ambulation. Electrical muscle stimulation and inspiratory muscle training are additional techniques that may be employed. Studies conducted to date suggest that such ICU-based rehabilitation is feasible, safe, and effective for carefully selected patients. Further research is needed to identify the optimal patient candidates and procedures and for providing rehabilitation in the ICU.

  14. Ethical issues in neonatal intensive care units.

    Science.gov (United States)

    Liu, Jing; Chen, Xin-Xin; Wang, Xin-Ling

    2016-07-01

    On one hand, advances in neonatal care and rescue technology allow for the healthy survival or prolonged survival time of critically ill newborns who, in the past, would have been non-viable. On the other hand, many of the surviving critically ill infants have serious long-term disabilities. If an infant eventually cannot survive or is likely to suffer severe disability after surviving, ethical issues in the treatment process are inevitable, and this problem arises not only in developed countries but is also becoming increasingly prominent in developing countries. In addition, ethical concerns cannot be avoided in medical research. This review article introduces basic ethical guidelines that should be followed in clinical practice, including respecting the autonomy of the parents, giving priority to the best interests of the infant, the principle of doing no harm, and consent and the right to be informed. Furthermore, the major ethical concerns in neonatal intensive care units (NICUs) in China are briefly introduced. PMID:26382713

  15. Factors influencing nursing care in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Raj John

    2006-01-01

    Full Text Available Context: The total time spent in nursing care depends on the type of patient and the patient′s condition. We analysed factors that influenced the time spent in nursing a patient. Aims : To analyse the factors in a patient′s condition that influenced time spent in nursing a patient. Materials and Methods: This study was performed in the Surgical Intensive Care Unit of a tertiary referral centre, over a period of one month. The total time spent on a patient in nursing care for the first 24 hours of admission, was recorded. This time was divided into time for routine nursing care, time for interventions, time for monitoring and time for administering medications. Statistical analysis used: A backward stepwise linear regression analysis using the age, sex, diagnosis, type of admission and ventilatory status as variables, was done. Results: Patients admitted after elective surgery required less time (852.4 ± 234.1 minutes, than those admitted after either emergency surgery (1069.5 ± 187.3 minutes, or directly from the ward or the emergency room (1253.7 ± 42.1 minutes. Patients who were ventilated required more time (1111.5 ± 132.5 minutes, than those brought on a T-piece (732.2 ± 134.8 minutes or extubated (639.5 ± 155.6 minutes. The regression analysis showed that only the type of admission and the ventilatory status significantly affected the time. Conclusions : This study showed that the type of admission and ventilatory status significantly influenced the time spent in nursing care. This will help optimal utilization of nursing resources.

  16. [Nosocomial infections in intensive care units].

    Science.gov (United States)

    Zaragoza, Rafael; Ramírez, Paula; López-Pueyo, María Jesús

    2014-05-01

    Nosocomial infections (NI) still have a high incidence in intensive care units (ICUs), and are becoming one of the most important problems in these units. It is well known that these infections are a major cause of morbidity and mortality in critically ill patients, and are associated with increases in the length of stay and excessive hospital costs. Based on the data from the ENVIN-UCI study, the rates and aetiology of the main nosocomial infections have been described, and include ventilator-associated pneumonia, urinary tract infection, and both primary and catheter related bloodstream infections, as well as the incidence of multidrug-resistant bacteria. A literature review on the impact of different nosocomial infections in critically ill patients is also presented. Infection control programs such as zero bacteraemia and pneumonia have been also analysed, and show a significant decrease in NI rates in ICUs.

  17. 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.

  18. Applying Lean Six Sigma for innovative change to the post-anesthesia care unit.

    Science.gov (United States)

    Haenke, Roger; Stichler, Jaynelle F

    2015-04-01

    Many healthcare organizations are building or renovating patient care facilities. Using Lean Six Sigma methods, nurse leaders can eliminate unnecessary waste and improve work and patient care environments. Starting with a key department like the post-anesthesia care unit is a good way to expose staff and leaders to the potential of Lean.

  19. Variation in the use of alternative levels of hospital care for newborns in a managed care organization.

    OpenAIRE

    Roblin, D. W.; Richardson, D K; Thomas, E; Fitzgerald, F; Veintimilla, R.; Hulac, P.; Bemis, G.; Leon, L.

    2000-01-01

    OBJECTIVE(S): To assess the extent to which variation in the use of neonatal intensive care resources in a managed care organization is a consequence of variation in neonatal health risks and/or variation in the organization and delivery of medical care to newborns. STUDY DESIGN: Data were collected on a cohort of all births from four sites in Kaiser Permanente by retrospective medical chart abstraction of the birth admission. Likelihood of admission into a neonatal intensive care unit (NICU)...

  20. How Health Care Organizations Are Using Data on Patients' Race and Ethnicity to Improve Quality of Care

    OpenAIRE

    Thorlby, Ruth; Jorgensen, Selena; Siegel, Bruce; Ayanian, John Z.

    2011-01-01

    Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encounte...

  1. How to achieve care coordination inside health care organizations

    DEFF Research Database (Denmark)

    Prætorius, Thim; C. Becker, Markus

    2015-01-01

    Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from...... the contribution of, e.g., routines like those guided by care pathways or of artefacts like displays. The coordination insights are also discussed as regards inter-organizational care coordination....... organization theory, where coordination is a central research topic. The article focuses on intra-organizational coordination, which is challenging especially across boundaries such as departments or professions. It provides an overview of the classic coordination mechanisms, e.g., standardization of work...

  2. Organizational Learning in Health Care Organizations

    Directory of Open Access Journals (Sweden)

    Savithiri Ratnapalan

    2014-02-01

    Full Text Available The process of collective education in an organization that has the capacity to impact an organization’s operations, performance and outcomes is called organizational learning. In health care organizations, patient care is provided through one or more visible and invisible teams. These teams are composed of experts and novices from diverse backgrounds working together to provide coordinated care. The number of teams involved in providing care and the possibility of breakdowns in communication and coordinated care increases in direct proportion to sophisticated technology and treatment strategies of complex disease processes. Safe patient care is facilitated by individual professional learning; inter-professional team learning and system based organizational learning, which encompass modified context specific learning by multiple teams and team members in a health care organization. Organizational learning in health care systems is central to managing the learning requirements in complex interconnected dynamic systems where all have to know common background knowledge along with shared meta-knowledge of roles and responsibilities to execute their assigned functions, communicate and transfer the flow of pertinent information and collectively provide safe patient care. Organizational learning in health care is not a onetime intervention, but a continuing organizational phenomenon that occurs through formal and informal learning which has reciprocal association with organizational change. As such, organizational changes elicit organizational learning and organizational learning implements new knowledge and practices to create organizational changes.

  3. Nutrition in the neurocritical care unit

    Directory of Open Access Journals (Sweden)

    Swagata Tripathy

    2015-01-01

    Full Text Available The aim of intensive care is to support the physiology of the body till the treatment or the reparative process of the body kicks in to the rescue. Maintaining an adequate nutrition during this period is of vital importance to counteract the catabolic effect of the critical disease process. The guidelines for nutritional care in the neuro intensive care unit (ICU are sparse. This article collates the current evidence and best practice recommendations as applicable to the critically ill patient in the neuro ICU. The use of screening tests to identify patients at a risk of malnutrition and related complications is presently recommended for all patients with an emphasis on early initiation of caloric support. Over-aggressive feeding in an attempt to revert the catabolic effects of critical illness have not proven beneficial, just as the attempts to improve patient outcomes by altering the routes of nutrition administration. Special patient population such as traumatic brain injury, stroke, subarachnoid haemorrhage or spinal cord injury may have varying nutritional requirements; individualised approach in the neurocritical ICU with the help of the intensivist, nutritionist and pharmacology team may be of benefit.

  4. Accountable care organizations: back to the future?

    Science.gov (United States)

    Burns, Lawton R; Pauly, Mark V

    2012-01-01

    Accountable Care Organizations (ACOs) are networks of providers that assume risk for the quality and total cost of the care they deliver. Public policymakers and private insurers hope that ACOs will achieve the elusive "triple aim" of improving quality of care, improving population health, and reducing costs. The model is still evolving, but the premise is that ACOs will accomplish these aims by coordinating care, managing chronic disease, and aligning financial incentives for hospitals and physicians. If this sounds familiar, it may be because the integrated care networks of the 1990s tried some of the same things, and mostly failed in their attempts. This Issue Brief summarizes the similarities and differences between the new ACOs and the integrated delivery networks of the 1990s, and presents the authors' analysis of the likely success of these new organizations in affecting the costs and quality of health care. PMID:23610793

  5. Structure and Function: Planning a New Intensive Care Unit to Optimize Patient Care

    Directory of Open Access Journals (Sweden)

    Jozef Kesecioğlu

    2014-08-01

    Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.

  6. Health care organization drug testing.

    Science.gov (United States)

    Brooks, J P; Dempsey, J

    1992-09-01

    Health care managers are being required to respond to the growing concerns of the public about alcohol and drug use in the health care workplace. To this end, the following recommendations are offered. A drug testing policy should be developed with input from and support of employees and unions. "For cause" testing should be used because it results in more definitive results and better employee acceptance. Unless there are compelling reasons for random testing, "for cause" testing is the preferable method. All levels of employees and the medical staff should be subject to the drug-testing policy. Rehabilitation rather than punishment should be emphasized in dealing with employees with alcohol and drug problems.

  7. [The organization of burn care].

    Science.gov (United States)

    Latarjet, Jacques

    2002-12-15

    In 2002, the organisation of burn care is confronted to a great deficiency in burn epidemiological datas. The main mechanisms of hospitalized burns are somehow wellknown in industrialized countries: about 60% scalds and 30% flame burns; as well as the place of occurrence (60% at home, and 20% at work), and the risk groups (3 times more important for the age group 0-4 years old). The incidence of burns needing medical care (all levels) (250/100,000 inh/yr) or hospitalization (15-20/100,000 inh/yr) is much more uncertain. The statistics of Diagnosis Related Groups (DRG), for hospitalized patients will allow in France very shortly to know more about the most rational ways of dispatching and treating them. They already show that only 30% of hospitalized burned patients are treated in specialized facilities.

  8. Nurses' experiences of futile care at intensive care units: a phenomenological study.

    Science.gov (United States)

    Yekefallah, Leili; Ashktorab, Tahereh; Manoochehri, Houman; Hamid, Alavi Majd

    2015-01-01

    The concept and meaning of futile care depends on the existing culture, values, religion, beliefs, medical achievements and emotional status of a country. We aimed to define the concept of futile care in the viewpoints of nurses working in intensive care units (ICUs). In this phenomenological study, the experiences of 25 nurses were explored in 11 teaching hospitals affiliated to Social Security Organization in Ghazvin province in the northwest of Iran. Personal interviews and observations were used for data collection. All interviews were recorded as well as transcribed and codes, subthemes and themes were extracted using Van Manen's analysis method. Initially, 191 codes were extracted. During data analysis and comparison, the codes were reduced to 178. Ultimately, 9 sub-themes and four themes emerged: uselessness, waste of resources, torment, and aspects of futility.Nurses defined futile care as "useless, ineffective care giving with wastage of resources and torment of both patients and nurses having nursing and medical aspects" As nurses play a key role in managing futile care, being aware of their experiences in this regard could be the initial operational step for providing useful care as well as educational programs in ICUs. Moreover, the results of this study could help nursing managers adopt supportive approaches to reduce the amount of futile care which could in turn resolve some of the complications nurses face at these wards such as burnout, ethical conflicts, and leave. PMID:25946928

  9. Intensive Care Unit Infections and Antibiotic Use

    Directory of Open Access Journals (Sweden)

    Ayşegül Yeşilkaya

    2011-07-01

    Full Text Available Burn wound infections is the leading cause of morbidity and mortality in burn trauma patients. Although burn wound is sterile at the beginning, because of risk factors such as prolonged hospital stay, immunesuppression and burn affecting large body surface area, colonisation firstly with Staphylococcus aureus and then Pseudomonas aeruginosa will occur later. Delay in wound closure and treatment with broad-spectrum antibiotic will result wound colonisation with antibiotic-resistant bacteria. To control colonization and to prevent burn wound infection topical antimicrobial dressings are used. The criteria used for the diagnosis of sepsis and wound infections are different in burn victims. Surface swabs from burn wounds must be cultured for the early assestment of infection. Although histopathological examination and quantitative culture of wound tissue biopsy has been known as the gold standard for the verification of invasive burn wound infection, many burn centers cannot do histopathological examination. When the traditional treatment modalities such as debridement of necrotic tissue, cleaning of wound and topical antimicrobial dressing application fails in the management of burn patient, cultures must be taken from possible foci of infection for the early diagnosis. After specimen collection, empirical bactericidal systemic antibiotic treatment should be started promptly. Inappropriate utilization of antibiotics may cause selection of resistant bacteria in the flora of the patient and of the burn unit which facilitates an infection or an outbreak at the end. Infection control in the burn unit includes surveillance cultures, cohort patient care staff, standard isolation precautions, strict hand hygiene compliance and appropariate antibiotic utilization. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 55-61

  10. Sleep in the intensive care unit.

    Science.gov (United States)

    Pisani, Margaret A; Friese, Randall S; Gehlbach, Brian K; Schwab, Richard J; Weinhouse, Gerald L; Jones, Shirley F

    2015-04-01

    Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes. Basic and clinical research has documented the important role circadian rhythm plays in biologic function. Critical illness is a time of extreme vulnerability for patients, and the important role sleep may play in recovery for intensive care unit (ICU) patients is just beginning to be explored. This concise clinical review focuses on the current state of research examining sleep in critical illness. We discuss sleep and circadian rhythm abnormalities that occur in ICU patients and the challenges to measuring alterations in circadian rhythm in critical illness and review methods to measure sleep in the ICU, including polysomnography, actigraphy, and questionnaires. We discuss data on the impact of potentially modifiable disruptors to patient sleep, such as noise, light, and patient care activities, and report on potential methods to improve sleep in the setting of critical illness. Finally, we review the latest literature on sleep disturbances that persist or develop after critical illness.

  11. Medical imaging and alternative health care organizations

    International Nuclear Information System (INIS)

    Imaging is not easy to measure in economic terms for France to day. The impact of innovation process is no more clear and especially the substitutions expected between different techniques. Nevertheless, these new techniques could provoque big changes in medical practices and health care organizations. They should probably increase the proportion of ambulatory patients in total examinations and encourage the development of extra-hospital health care. But, in France, alternative health care organizations (day hospital, home care, etc...) are under developed because of many non technical factors (behavioural managerial and institutional). Perhaps major potential change shall come from imaging networks. But can imaging development contribute to moderate health expanses growth rate. Economic evaluations of each new technique are difficult and ambiguous but necessary to maximize health care system efficiency

  12. Unit 051 - Information Organization and Data Structure

    OpenAIRE

    055, CC in GIScience; Yeung, Albert K.

    2000-01-01

    This unit presents an overview of the terminology and concepts pertaining to information organization and data structure in the context of information science and management. The aim is to provide a general but articulate introduction to the principles and methods of information organization, with special reference to geographic information, that serves as a prerequisite for more advanced studies of data models and database in subsequent units.

  13. Introduction of a team-based care model in a general medical unit

    OpenAIRE

    Hastings, Stephanie E.; Suter, Esther; Bloom, Judy; Sharma, Krishna

    2016-01-01

    Background Alberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban ...

  14. Assessment of brain death in the neurocritical care unit.

    Science.gov (United States)

    Hwang, David Y; Gilmore, Emily J; Greer, David M

    2013-07-01

    This article reviews current guidelines for death by neurologic criteria and addresses topics relevant to the determination of brain death in the intensive care unit. The history of brain death as a concept leads into a discussion of the evolution of practice parameters, focusing on the most recent 2010 update from the American Academy of Neurology and the practice variability that exists worldwide. Proper transition from brain death determination to possible organ donation is reviewed. This review concludes with a discussion regarding ethical and religious concerns and suggestions on how families of patients who may be brain dead might be optimally approached. PMID:23809039

  15. Insurance coverage for male infertility care in the United States.

    Science.gov (United States)

    Dupree, James M

    2016-01-01

    Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws. PMID:27030084

  16. Insurance coverage for male infertility care in the United States

    Directory of Open Access Journals (Sweden)

    James M Dupree

    2016-01-01

    Full Text Available Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws.

  17. Withholding or withdrawing therapy in intensive care units

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Erlandsen, Mogens;

    2011-01-01

    The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU).......The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU)....

  18. The future of managed care organization.

    Science.gov (United States)

    Robinson, J C

    1999-01-01

    This paper analyzes the transformation of the central organization in the managed care system: the multiproduct, multimarket health plan. It examines vertical disintegration, the shift from ownership to contractual linkages between plans and provider organizations, and horizontal integration--the consolidation of erstwhile indemnity carriers, Blue Cross plans, health maintenance organizations (HMOs), and specialty networks. Health care consumers differ widely in their preferences and willingness to pay for particular products and network characteristics, while providers differ widely in their willingness to adopt particular organization and financing structures. This heterogeneity creates an enduring role for health plans that are diversified into multiple networks, benefit products, distribution channels, and geographic regions. Diversification now is driving health plans toward being national, full-service corporations and away from being local, single-product organizations linked to particular providers and selling to particular consumer niches. PMID:10091427

  19. [DEVELOPMENTAL CARE IN THE NEONATAL INTENSIVE CARE UNIT ACCORDING TO NEWBORN INDIVIDUALIZED DEVELOPMENTAL CARE AND ASSESSMENT PROGRAM (NIDCAP)].

    Science.gov (United States)

    Silberstein, Dalia; Litmanovitz, Ita

    2016-01-01

    During hospitalization in the neonatal intensive care unit (NICU), the brain of the preterm infant undergoes a particularly vulnerable and sensitive period of development. Brain development might be negatively influenced by direct injury as well as by complications of prematurity. Over the past few years, stress has come to be increasingly recognized as a potential risk factor. The NICU environment contains numerous stress factors due to maternal deprivation and over-stimulation, such as light, sound and pain, which conflict with the brain's developmental requirements. Developmental care is a caregiving approach that addresses the early developmental needs of the preterm infant as an integral component of quality neonatal care. NIDCAP (Newborn Individualized Developmental Care and Assessment Program) is a comprehensive program that aims to reduce environmental stress, to support the infant's neuro-behavioral maturation and organization, and to promote early parent-infant relationships. The implementation of developmental care based on NIDCAP principles is a gradual, in-depth systems change process, which affects all aspects of care in the NICU. This review describes the theoretical basis of the NIDCAP approach, summarizes the scientific evidence and addresses some of the implications of the transition from a traditional to a developmental care NICU.

  20. Costing of consumables: use in an intensive care unit.

    Science.gov (United States)

    Mann, S A

    1999-08-01

    In 1991, the Intensive Care Unit (ICU) at Middlemore Hospital manually costed the treatment and care of asthmatic patients. This was long-winded and labour-intensive, but provided hard data to support anecdotal beliefs that intensive care patients are more expensive than was currently believed or accepted. It is a known problem that funder and provider organizations see a huge disparity on the funding issue. With additional accurate information on the actual cost of individual patients, which can be grouped into disease categories, funding applications can be backed with accurate, up-to-date quantitative data. After a long preparation time, we are now costing individual patient stays in the ICU. Each individual resource was established, costed and entered into an MS ACCESS computerized database. Schedules have been prepared for updating prices, as these change. The final report available gives a detailed list of resource use within certain categories. Some items proved to be impractical to cost on an individual patient basis, and these have been grouped together, costed, and divided by the number of patient days for the last year, and assigned to each individual patient as an hourly unit cost. Believed to be a world-first, this information now forms the basis for variance reporting and pricing. PMID:10786509

  1. Roy in the postanesthesia care unit.

    Science.gov (United States)

    Jackson, D A

    1990-06-01

    The adaptation model developed by Sister Callista Roy, RN, PhD, was used as the organizing framework for developing a preoperative assessment tool for PACU nurses. The purpose of preoperative assessment of a surgical patient by a PACU nurse is to determine the patient's location on the health-illness continuum. This is done by analyzing data regarding the patient's biopsychosocial needs, evaluating the data, and determining from that information what problems need intervention. Roy's theory advocates assessing the patient's biopsychosocial needs using four different adaptive modes: self-concept, physiological function, role function, and interdependence (level I assessment). After completing the PACU preoperative assessment tool, each mode in level I assessment is identified as either positive (adaptive) or negative (maladaptive) depending on the patient's behavior identified by the tool. If a maladaptive behavior is identified during the preoperative assessment, a level II assessment is made to collect data regarding focal, contextual, and residual stimuli. A nursing diagnosis, expected outcomes, nursing interventions, and evaluation are listed on the patient care plan based on the data obtained from the assessment.

  2. Strange and scary memories of the intensive care unit

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Egerod, Ingrid; Dreyer, Pia

    2016-01-01

    of the Intensive Care Unit. CONCLUSIONS: Analysis based on Ricoeurian phenomenological hermeneutics provided insights into themes in intensive care unit patients' memories of delusions. More studies are needed to understand the meaning of memories of delusions, the commonality of themes and the association between...

  3. Glucose variability is associated with intensive care unit mortality

    NARCIS (Netherlands)

    J. Hermanides; T.M. Vriesendorp; R.J. Bosman; D.F. Zandstra; J.B. Hoekstra; J.H. DeVries

    2010-01-01

    OBJECTIVE: Mounting evidence suggests a role for glucose variability in predicting intensive care unit (ICU) mortality. We investigated the association between glucose variability and intensive care unit and in-hospital deaths across several ranges of mean glucose. DESIGN: Retrospective cohort study

  4. Inpatient Transfers to the Intensive Care Unit

    Science.gov (United States)

    Young, Michael P; Gooder, Valerie J; McBride, Karen; James, Brent; Fisher, Elliott S

    2003-01-01

    OBJECTIVE To examine if delayed transfer to the intensive care unit (ICU) after physiologic deterioration is associated with increased morbidity and mortality. DESIGN Inception cohort. SETTING Community hospital in Ogden, Utah. PATIENTS Ninety-one consecutive inpatients with noncardiac diagnoses at the time of emergent transfer to the ICU. We determined the time when each patient first met any of 11 pre-specified physiologic criteria. We classified patients as “slow transfer” when patients met a physiologic criterion 4 or more hours before transfer to the ICU. Patients were followed until discharge. INTERVENTIONS None. MEASUREMENTS In-hospital mortality, functional status at hospital discharge, hospital resources. MAIN RESULTS At the time when the first physiologic criterion was met on the ward, slow- and rapid-transfer patients were similar in terms of age, gender, diagnosis, number of days in hospital prior to ICU transfer, prehospital functional status, and APACHE II scores. By the time slow-transfer patients were admitted to the ICU, they had significantly higher APACHE II scores (21.7 vs 16.2; P = .002) and were more likely to die in-hospital (41% vs 11%; relative risk [RR], 3.5; 95% confidence interval [95% CI], 1.4 to 9.5). Slow-transfer patients were less likely to have had their physician notified of deterioration within 2 hours of meeting physiologic criteria (59% vs 31%; P = .001) and less likely to have had a bedside physician evaluation within the first 3 hours after meeting criteria (23% vs 83%; P = .001). CONCLUSIONS Slow transfer to the ICU of physiologically defined high-risk hospitalized patients was associated with increased risk of death. Slow response to physiologic deterioration may explain these findings. PMID:12542581

  5. Repertoire of intensive care unit pneumonia microbiota.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs. During a three-year period, we tested the bronchoalveolar lavage (BAL of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls. Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93. Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.

  6. Communication skills and error in the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, Rhona; Cuthbertson, Brian H

    2007-01-01

    Purpose of review: Poor communication in critical care teams has been frequently shown as a contributing factor to adverse events. There is now a strong emphasis on identifying the communication skills that can contribute to, or protect against, preventable medical errors. This review considers communication research recently conducted in the intensive care unit and other acute domains. Recent findings: Error studies in the intensive care unit have shown good communication to be crucial for e...

  7. Nursing workload in a trauma intensive care unit

    OpenAIRE

    Luana Loppi Goulart; Roberta Nazário Aoki; Camila Fernanda Lourençon Vegian; Edinêis de Brito Guirardello

    2014-01-01

    Severely injured patients with multiple and conflicting injuries present themselves to nursing professionals at critical care units faced with care management challenges. The goal of the present study is to evaluate nursing workload and verify the correlation between workload and the APACHE II severity index. It is a descriptive study, conducted in the Trauma Intensive Care Unit of a teaching hospital. We used the Nursing Activities Score and APACHE II as instruments. The sample comprised 32 ...

  8. Care of the newborn in perinatal units in New Brunswick

    OpenAIRE

    Stephen, David L.

    1986-01-01

    A survey of 23 perinatal units in New Brunswick hospitals was conducted by means of a mailed questionnaire to determine the type of care provided to newborns. The results showed various degrees of conformity with published guidelines for the care of newborns. Deficiencies were noted in several areas of care: failing to give or improperly giving vitamin K1 prophylaxis (in 7 of the units), flushing the eyes after silver nitrate prophylaxis (in 10), using hexachlorophene to bathe newborns (in 11...

  9. The anatomy of health care in the United States.

    Science.gov (United States)

    Moses, Hamilton; Matheson, David H M; Dorsey, E Ray; George, Benjamin P; Sadoff, David; Yoshimura, Satoshi

    2013-11-13

    Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7% of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3% per year, exceeds any other industry and GDP overall. Government funding increased from 31.1% in 1980 to 42.3% in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91% of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and (3) chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources

  10. The anatomy of health care in the United States.

    Science.gov (United States)

    Moses, Hamilton; Matheson, David H M; Dorsey, E Ray; George, Benjamin P; Sadoff, David; Yoshimura, Satoshi

    2013-11-13

    Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7% of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3% per year, exceeds any other industry and GDP overall. Government funding increased from 31.1% in 1980 to 42.3% in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91% of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and (3) chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources

  11. [Organs shortage in the United States].

    Science.gov (United States)

    Hattori, Masahiro; Iwaki, Yuichi

    2005-11-01

    Since the law pertaining to deceased transplantation was legalized in October 1997 in Japan, 140 cases of deceased transplants have been performed through March 2005. Patients on waiting lists, however, are increasing every year. Meanwhile patients traveling abroad in desperations to require donors also increase. In the United States, over 25,000 transplantations are performed annually. The number of patients on waiting list exceeded 86,000 in 2003. Organ shortages are a serious problem, even in the United States. Expanded criteria donor(ECD) and Model for endstage liver disease (MELD) scoring systems were implemented to improve some problems in kidney and liver allocation systems, respectively in 2002. Utilization of donated organs for non-citizens is limited in the United States. Japan must independently increase deceased donor transplantations. PMID:16277249

  12. Accountable care organizations: financial advantages of larger hospital organizations.

    Science.gov (United States)

    Camargo, Rodrigo; Camargo, Thaisa; Deslich, Stacie; Paul, David P; Coustasse, Alberto

    2014-01-01

    Accountable care organizations (ACOs) are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of this study suggest that ACOs based in a larger hospital organization are more likely to meet Centers for Medicare and Medicaid Services criteria for formation because of financial and structural assets of those entities.

  13. Care of the gut in the surgical intensive care unit: fact or fashion?

    Science.gov (United States)

    Steinmetz, O K; Meakins, J L

    1991-06-01

    The traditional approach to the care of the gastrointestinal tract in the intensive care unit has been one of neglect. However, recent evidence has linked enteric flora to the generation of clinical sepsis in the absence of other infectious foci. The role of the bowel as an efficient barrier to the invasion of its own flora is addressed in this paper. A variety of insults disrupt the integrity of the barrier function of the gut, allowing the entry of bowel organisms or endotoxins, or both, into the portal and systemic circulatory systems. In animal and early clinical studies, a number of interventions, aimed at altering the enteric flora and enhancing the bowel's barrier function, have been shown to modulate the host's resistance to different insults and may even improve clinical outcome. Such interventions include maintenance of enteral feeding, glutamine supplementation of hyperalimentation solutions and selective bacterial decontamination of the bowel.

  14. Knowledge management: organizing nursing care knowledge.

    Science.gov (United States)

    Anderson, Jane A; Willson, Pamela

    2009-01-01

    Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the "know-how" of clinical experience. This "know-how" knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical "know-how" and investigational (evidence-based) knowledge culminate into the "knowledge of caring" that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.

  15. Health Care Indicators for the United States

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Levit, Katharine R.

    1992-01-01

    Contained in this regular feature of the journal is a section on each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.

  16. Sustainable competitive advantage for accountable care organizations.

    Science.gov (United States)

    Macfarlane, Michael Alex

    2014-01-01

    In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value. PMID:25154124

  17. Sustainable competitive advantage for accountable care organizations.

    Science.gov (United States)

    Macfarlane, Michael Alex

    2014-01-01

    In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value.

  18. Direct and indirect nursing care time in an Intensive Care Unit1

    OpenAIRE

    Luciana Emi Kakushi; Yolanda Dora Martinez Évora

    2014-01-01

    OBJECTIVE: to identify the direct and indirect nursing care time in an Intensive Care Unit. METHOD: a descriptive/exploratory study conducted at a private hospital. The Nursing Activities Score classification system was used to estimate the direct care time, and electronic health records were used to estimate the indirect care time. The data were collected from March to June 2011. RESULTS: the findings indicate that the average nursing care time was 29.5 hours, consisting of 27.4 hou...

  19. [Neonatal intensive care unit--therapeutical success and what next?].

    Science.gov (United States)

    Swietliński, Janusz; Sitko-Rudnicka, Magdalena; Maruniak-Chudek, Iwona

    2004-01-01

    The increasing number of successfully treated newborns with disturbances of the adaptive period can measure effectiveness of neonatal intensive care units (NICU). The authors summarized some health problems of the former NICU patients. Central nervous system (CNS) of the premature, especially low (LBW) and very low birth weight (VLBW) infant, is in serious danger of improper development. The lack of neurological disturbances in early infancy does not exclude further pathological events and such patients require long-term observation and follow-up. High-risk newborns are of great need of precise imaging and diagnosis of CNS, which should be performed before discharge. Early stimulation and developmental care program are the crucial points in the management of newborns with neurological abnormalities. Sensorial problems, especially the rate of vision and hearing impairments, can be significantly reduced when prophylactic schedule is applied. Both, etiological factors leading to respiratory insufficiency and some iatrogenic effects of the therapy, can influence respiratory system. Symptoms of different intensity--from sneezing caused by nasal mucous membrane edema to the severe forms of bronchopulmonary dysplasia (BPD)--may last for a long time and influence the child's general condition. The surgical closure of Botall's duct (persistent ductus arteriosus--PDA) usually normalizes the circulatory system. In serious heart defects or isolated shunt-type defects, the compensation of the circulatory system can easily be disturbed. Digestive tract problems belong to the two main groups: first--connected with the prematurity and immature interstitial functioning (necrotizing enterocolitis, digestive and absorption abnormalities, hepatic cholestasis), and second--caused by congenital defects requiring immediate surgical intervention. Despite different types of the diseases, the treatment and care have to be focused on necessary for the growing organism, optimal nutrients and

  20. Reducing medication errors in the neonatal intensive care unit

    OpenAIRE

    Simpson, J.; Lynch, R; Grant, J; Alroomi, L

    2004-01-01

    Background: Medication errors are common in the neonatal intensive care unit (NICU). Various strategies to reduce errors have been described in adult and paediatric patients but there are few published data on their effect in the NICU.

  1. Infants in a neonatal intensive care unit: parental response

    OpenAIRE

    Carter, J; Mulder, R; Bartram, A; Darlow, B

    2005-01-01

    Objective: To compare the psychosocial functioning of the parents (mother and father) of infants admitted to a neonatal intensive care unit (NICU) with the parents of infants born at term and not admitted to the NICU.

  2. Mental health care in the accountable care organization.

    Science.gov (United States)

    Maust, Donovan T; Oslin, David W; Marcus, Steven C

    2013-09-01

    The Centers for Medicare and Medicaid Services (CMS) is promoting formation of accountable care organizations (ACOs). In these population-based models, CMS aligns a Medicare beneficiary population to an ACO with associated expenditure and quality targets, transitioning away from purely volume-based revenue of fee-for-service Medicare. Patients with mental illness are among high-cost Medicare beneficiaries, but this population has received little attention in ACO implementation. Although the ACO goals of providing chronic and preventive care in a coordinated, patient-centered manner are consistent with what some mental health providers have long advocated, the population-based orientation may be unfamiliar. In addressing the needs of high-cost, high-risk patients to meet quality and expenditure targets, an ACO should examine the quality of mental health care it provides as well as medical quality for patients with mental illness. In addition, federal agencies should invest to ensure understanding of the impact of population-based initiatives on patients with mental illness. PMID:23771432

  3. Burn unit care of Stevens Johnson syndrome/toxic epidermal necrolysis: A survey.

    Science.gov (United States)

    Le, Hong-Gam; Saeed, Hajirah; Mantagos, Iason S; Mitchell, Caroline M; Goverman, Jeremy; Chodosh, James

    2016-06-01

    Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a systemic disease that can be associated with debilitating acute and chronic complications across multiple organ systems. As patients with acute SJS/TEN are often treated in a burn intensive care unit (BICU), we surveyed burn centers across the United States to determine their approach to the care of these patients. The goal of our study was to identify best practices and possible variations in the care of patients with acute SJS/TEN. We demonstrate that the method of diagnosis, use of systemic therapies, and involvement of subspecialists varied significantly between burn centers. Beyond supportive care provided to every patient, our data highlights a lack of standardization in the acute care of patients with SJS/TEN. A comprehensive guideline for the care of patients with acute SJS/TEN is indicated. PMID:26810444

  4. Implementation of an electronic logbook for intensive care units.

    OpenAIRE

    Wallace, Carrie J.; Stansfield, Dennis; Gibb Ellis, Kathryn A.; Clemmer, Terry P.

    2002-01-01

    Logbooks of patients treated in acute care units are commonly maintained; the data may be used to justify resource use, analyze patient outcomes, and encourage clinical research. We report herein the conversion of a paper-based logbook to an electronic logbook in three hospital intensive care units. The major difference between the paper logbook and electronic logbook data was the addition of clinician-entered data to the electronic logbook. Despite extensive computerization of patient inform...

  5. Pathophysiology of intensive care unit-acquired anemia

    OpenAIRE

    Fink, Mitchell P.

    2004-01-01

    The formation of red blood cells (RBCs) in the bone marrow is regulated by erythropoietin in response to a cascade of events. Anemia in the intensive care unit can be caused by a host of factors. Patients in the intensive care unit may have decreased RBC production and a blunted response to erythropoietin. Administration of recombinant human erythropoietin may stimulate erythropoiesis, increase hematocrit levels and hemoglobin concentration, and reduce the need for RBC transfusions.

  6. BURNOUT MIDWIVES WORKING IN NEONATAL INTESIVE CARE UNIT

    OpenAIRE

    Nanou, Christina; Gourounti, Kleanthi; Palaska, Ermioni; Mallidou, Anastasia; Sarantaki, Antigoni

    2015-01-01

    Abstract  Introduction: The considerably low proportion of midwives in closed wards in Greek hospitals in combination with the highly stressful environment may lead to burnout syndrome (BS).  Aim: It was to explore burnout syndrome (BS) that experience midwives working in Neonatal Intensive Care Units (NICU) and the factors associated with its' occurrence.  Methods: The sample studied consisted of midwives working in Νeonatal Intensive Care Unit in hospitals ...

  7. Respiratory virology and microbiology in intensive care units

    DEFF Research Database (Denmark)

    Østby, Anne-Cathrine; Gubbels, Sophie; Baake, Gerben;

    2013-01-01

    Our aim was to determine the frequency of 12 common respiratory viruses in patients admitted to intensive care units with respiratory symptoms, evaluate the clinical characteristics and to compare the results to routine microbiological diagnostics. Throat swabs from 122 intensive care-patients >18...

  8. Physical Therapy Intervention in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Garber, June

    2013-01-01

    This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert…

  9. [The difficulties of staff retention in neonatal intensive care units].

    Science.gov (United States)

    Deparis, Corinne

    2015-01-01

    Neonatal intensive care units attract nurses due to the technical and highly specific nature of the work. However, there is a high turnover in these departments. Work-related distress and the lack of team cohesion are the two main causes of this problem. Support from the health care manager is essential in this context. PMID:26183101

  10. Perceptions of Appropriateness of Care Among European and Israeli Intensive Care Unit Nurses and Physicians

    NARCIS (Netherlands)

    Piers, Ruth D.; Azoulay, Elie; Ricou, Bara; Ganz, Freda DeKeyser; Decruyenaere, Johan; Max, Adeline; Michalsen, Andrej; Maia, Paulo Azevedo; Owczuk, Radoslaw; Rubulotta, Francesca; Depuydt, Pieter; Meert, Anne-Pascale; Reyners, Anna K.; Aquilina, Andrew; Bekaert, Maarten; Van den Noortgate, Nele J.; Schrauwen, Wim J.; Benoit, Dominique D.

    2011-01-01

    Context Clinicians in intensive care units (ICUs) who perceive the care they provide as inappropriate experience moral distress and are at risk for burnout. This situation may jeopardize patient quality of care and increase staff turnover. Objective To determine the prevalence of perceived inappropr

  11. Environmental Design for Patient Families in Intensive Care Units

    OpenAIRE

    Rashid, Mahbub

    2010-01-01

    The purpose of this paper is to define the role of environmental design in improving family integration with patient care in Intensive Care Units (ICUs). It argues that it is necessary to understand family needs, experience and behavioral responses in ICUs to develop effective models for family integration. With its two components—the “healing culture” promoting effective relationships between caregivers and care seekers, and the “environmental design” supporting the healing culture—a “healin...

  12. Management practices and the quality of care in cardiac units

    OpenAIRE

    McConnell, K. John; Lindrooth, Richard C; Wholey, Douglas R; Maddox, Thomas M.; Bloom, Nicholas

    2013-01-01

    Importance:- To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance. Objectives:- To describe the variation in management practices among a large sample of hospital cardiac care units; asses...

  13. (Dis) connections between management and care in a surgical intensive care unit

    OpenAIRE

    Borges, Maria Cristina Leite Araujo; Silva, Lucilane Maria Sales da

    2013-01-01

    Objective: The objective was to understand the perception of the nursing team on the (dis)connections between management actions and care performed by nurses in a surgical intensive care unit. Method: Exploratory research with qualitative approach carried out in a surgical intensive care unit of a hospital in the public net of Fortaleza-CE, Brazil. Data was collected between March and July 2011, through semi-structured interviews and systematic observations, with 20 nursing ...

  14. Nutrition in the intensive care unit

    OpenAIRE

    Weissman, Charles

    1999-01-01

    Nutritional support has become a routine part of the care of the critically ill patient. It is an adjunctive therapy, the main goal of which is to attenuate the development of malnutrition, yet the effectiveness of nutritional support is often thwarted by an underlying hostile metabolic milieu. This requires that these metabolic changes be taken into consideration when designing nutritional regimens for such patients. There is also a need to conduct large, multi-center studies to acquire more...

  15. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  16. Medicare Accountable Care Organizations: Beneficiary Assignment Update.

    Science.gov (United States)

    Vaughn, Thomas; MacKinney, A Clinton; Mueller, Keith J; Ullrich, Fred; Zhu, Xi

    2016-06-01

    This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services (CMS) Accountable Care Organization (ACO) regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Overall, the regulatory changes are intended to (1) encourage ACOs to participate in two-sided risk contracts, (2) increase the likelihood that beneficiaries are assigned to the physician (and ACO) from whom they receive most of their primary care services, and (3) make it easier for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to participate in ACOs. Understanding ACO beneficiary assignment policies is critical for ACO in managing their panel of ACO providers and beneficiaries. PMID:27416650

  17. Medicare Accountable Care Organizations: Beneficiary Assignment Update.

    Science.gov (United States)

    Vaughn, Thomas; MacKinney, A Clinton; Mueller, Keith J; Ullrich, Fred; Zhu, Xi

    2016-06-01

    This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services (CMS) Accountable Care Organization (ACO) regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Overall, the regulatory changes are intended to (1) encourage ACOs to participate in two-sided risk contracts, (2) increase the likelihood that beneficiaries are assigned to the physician (and ACO) from whom they receive most of their primary care services, and (3) make it easier for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to participate in ACOs. Understanding ACO beneficiary assignment policies is critical for ACO in managing their panel of ACO providers and beneficiaries.

  18. Prevalence rates of infection in intensive care units of a tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Toufen Junior Carlos

    2003-01-01

    Full Text Available OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP, a teaching and tertiary hospital, were eligible to participate in the study. PATIENTS: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports. MAIN OUTCOME MEASURES: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates. RESULTS: A total of 126 patients were studied. Eighty-seven patients (69% received antimicrobials on the day of study, 72 (57% for treatment, and 15 (12% for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%, non- intensive care unit nosocomial infection in 24 (33.3%, and intensive care unit-acquired infection in 22 patients (30.6%. Eleven patients (15.3% had no defined type. The most frequently reported infections were respiratory (58.5%. The most frequently isolated bacteria were Enterobacteriaceae (33.8%, Pseudomonas aeruginosa (26.4%, and Staphylococcus aureus (16.9%; [100% resistant to methicillin]. Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age > 60 years (p = 0.007, use of a nasogastric tube (p = 0.017, and postoperative status (p = 0.017. At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p=0.088. CONCLUSION: The rate of nosocomial infection is high in intensive care

  19. Intensive care unit telemedicine: review and consensus recommendations.

    Science.gov (United States)

    Cummings, Joseph; Krsek, Cathleen; Vermoch, Kathy; Matuszewski, Karl

    2007-01-01

    Intensive care unit telemedicine involves nurses and physicians located at a remote command center providing care to patients in multiple, scattered intensive care units via computer and telecommunication technology. The command center is equipped with a workstation that has multiple monitors displaying real-time patient vital signs, a complete electronic medical record, a clinical decision support tool, a high-resolution radiographic image viewer, and teleconferencing for every patient and intensive care unit room. In addition to communication functions, the video system can be used to view parameters on ventilator screens, infusion pumps, and other bedside equipment, as well as to visually assess patient conditions. The intensivist can conduct virtual rounds, communicate with on-site caregivers, and be alerted to important patient conditions automatically via software-monitored parameters. This article reviews the technology's background, status, significance, clinical literature, financial effect, implementation issues, and future developments. Recommendations from a University HealthSystem Consortium task force are also presented. PMID:17656728

  20. Aerosol from Organic Nitrogen in the Southeast United States

    Science.gov (United States)

    Biogenic volatile organic compounds (BVOCs) contribute significantly to organic aerosol in the southeastern United States. During the Southern Oxidant and Aerosol Study (SOAS), a portion of ambient organic aerosol was attributed to isoprene oxidation and organic nitrogen from BVO...

  1. Glucose control in the intensive care unit: a roller coaster ride or a swinging pendulum?

    Science.gov (United States)

    Comi, Richard J

    2009-06-01

    Many studies of tight control of blood glucose in critically ill patients are associated with poor outcomes. However, randomized studies of tight glucose control in patients admitted to coronary care or surgical intensive care units showed a reduction in mortality rates; supported by recommendations from professional organizations, many intensive care units implemented protocols for tight glucose control. More recent studies in medical intensive care units did not confirm the benefits of tight control, however, and the most recent study suggests that tight control increases mortality rates. Furthermore, tight control significantly increases episodes of hypoglycemia. The sum of the recent literature suggests that a degree of glucose control lies between the extremes of the adverse outcomes related to poor glucose control and those related to overly aggressive glucose control. PMID:19487715

  2. Modeling Safety Outcomes on Patient Care Units

    Science.gov (United States)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  3. Parental involvement and kangaroo care in European neonatal intensive care units

    DEFF Research Database (Denmark)

    Pallás-Alonso, Carmen R; Losacco, Valentina; Maraschini, Alice;

    2012-01-01

    To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out.......To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out....

  4. Measurement of muscle strength in the intensive care unit.

    Science.gov (United States)

    Bittner, Edward A; Martyn, Jeevendra A; George, Edward; Frontera, Walter R; Eikermann, Matthias

    2009-10-01

    Traditional (indirect) techniques, such as electromyography and nerve conduction velocity measurement, do not reliably predict intensive care unit-acquired muscle weakness and its clinical consequences. Therefore, quantitative assessment of skeletal muscle force is important for diagnosis of intensive care unit-acquired motor dysfunction. There are a number of ways for assessing objectively muscle strength, which can be categorized as techniques that quantify maximum voluntary contraction force and those that assess evoked (stimulated) muscle force. Important factors that limit the repetitive evaluation of maximum voluntary contraction force in intensive care unit patients are learning effects, pain during muscular contraction, and alteration of consciousness.The selection of the appropriate muscle is crucial for making adequate predictions of a patient's outcome. The upper airway dilators are much more susceptible to a decrease in muscle strength than the diaphragm, and impairment of upper airway patency is a key mechanism of extubation failure in intensive care unit patients. Data suggest that the adductor pollicis muscle is an appropriate reference muscle to predict weakness of muscles that are typically affected by intensive care unit-acquired weakness, i.e., upper airway as well as extremity muscles. Stimulated (evoked) force of skeletal muscles, such as the adductor pollicis, can be assessed repetitively, independent of brain function, even in heavily sedated patients during high acuity of their disease. PMID:20046117

  5. A Review of Visiting Policies in Intensive Care Units.

    Science.gov (United States)

    Khaleghparast, Shiva; Joolaee, Soodabeh; Ghanbari, Behrooz; Maleki, Majid; Peyrovi, Hamid; Bahrani, Naser

    2016-01-01

    Admission to intensive care units is potentially stressful and usually goes together with disruption in physiological and emotional function of the patient. The role of the families in improving ill patients' conditions is important. So this study investigates the strategies, potential challenges and also the different dimensions of visiting hours' policies with a narrative review. The search was carried out in scientific information databases using keywords "visiting policy", "visiting hours" and "intensive care unit" with no time limitation on accessing the published studies in English or Farsi. Of a total of 42 articles, 22 conformed to our study objectives from 1997 to 2013. The trajectory of current research shows that visiting in intensive care units has, since their inception in the 1960s, always considered the nurses' perspectives, patients' preferences and physiological responses, and the outlook for families. However, little research has been carried out and most of that originates from the United States, Europe and since 2010, a few from Iran. It seems that the need to use the research findings and emerging theories and practices is necessary to discover and challenge the beliefs and views of nurses about family-oriented care and visiting in intensive care units. PMID:26755480

  6. Anaesthesia for procedures in the intensive care unit.

    Science.gov (United States)

    Chollet-Rivier, M; Chioléro, R L

    2001-08-01

    Taking in charge severely ill patients in the intensive care environment to manage complex procedures is a performance requiring highly specific knowledge. Close collaboration between anaesthetists and intensive care specialists is likely to improve the safety and quality of medical care. Three forms of anaesthetic care should be considered in clinical practice: sedation and analgesia; monitored anaesthetic care; and general anaesthesia or conduction block anaesthesia. Even in the field of sedation and analgesia, the anaesthesiologist can offer expertise on new anaesthetic techniques like: the most recent concepts of balanced anaesthesia in terms of pharmacokinetics and dynamics, favouring the use of short-acting agents and of sedative-opioid combinations. New modes of administration and monitoring intravenous anaesthesia have been developed, with potential application in the intensive care unit. These include the use of target-controlled administration of intravenous drugs, and of electroencephalographic signals to monitor the level of sedation.

  7. Transfusional profile in different types of intensive care units

    Directory of Open Access Journals (Sweden)

    Ilusca Cardoso de Paula

    2014-06-01

    Full Text Available Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49% and active bleeding (32%. The median number of units transfused per episode was 2 (1-2 and the median storage time was 14 (7-21 days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

  8. [Antibiotic multiresistance in critical care units].

    Science.gov (United States)

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

    2011-01-01

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

  9. Measuring technical efficiency of output quality in intensive care units.

    Science.gov (United States)

    Junoy, J P

    1997-01-01

    Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients management in respect of quality performance of health services. Conventional knowledge of health economics points out that critically ill patients are responsible for increased use of technological resources and that they receive a high proportion of health care resources. Attempts to answer, from the point of view of microeconomics, the question: how do we measure comparative efficiency in the management of intensive care units? Analyses this question through data from an international empirical study using micro-economic measures of productive efficiency in public services (data envelopment analysis). Results show a 28.8 per cent level of technical inefficiency processing data from 25 intensive care units in the USA. PMID:10169231

  10. Neonatal intensive care unit lighting: update and recommendations.

    Science.gov (United States)

    Rodríguez, Roberto G; Pattini, Andrea E

    2016-08-01

    Achieving adequate lighting in neonatal intensive care units is a major challenge: in addition to the usual considerations of visual performance, cost, energy and aesthetics, there appear different biological needs of patients, health care providers and family members. Communicational aspects of light, its role as a facilitator of the visual function of doctors and nurses, and its effects on the newborn infant physiology and development were addressed in order to review the effects of light (natural and artificial) within neonatal care with a focus on development. The role of light in regulating the newborn infant circadian cycle in particular and the therapeutic use of light in general were also reviewed. For each aspect, practical recommendations were specified for a proper well-lit environment in neonatal intensive care units. PMID:27399015

  11. Developing a team performance framework for the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, Rhona; Mearns, Kathryn; Cuthbertson, Brian H

    2009-01-01

    Objective: There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. Data Sources: Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. Study Selection: Studies i...

  12. Symptomatic and asymptomatic candidiasis in a pediatric intensive care unit

    OpenAIRE

    Arslankoylu Ali Ertug; Kuyucu Necdet; Yilmaz Berna; Erdogan Semra

    2011-01-01

    Abstract Introduction This study aimed to examine the incidence, epidemiology, and clinical characteristics of symptomatic and asymptomatic candidiasis in a pediatric intensive care unit (PICU), and to determine the risk factors associated with symptomatic candidiasis. Methods This retrospective study included 67 patients from a 7-bed PICU in a tertiary care hospital that had Candida-positive cultures between April 2007 and July 2009. Demographic and clinical characteristics of the patients, ...

  13. Integrated patient unit care in schizophrenia population vs a non-integrated patient unit care

    Directory of Open Access Journals (Sweden)

    Waago-Hansen C

    2013-01-01

    Full Text Available Background: Several studies have described the benefits of integrated care in chronic conditions. Keeping the patients out of hospital is considered to increase value to the patient and is also benefit to the society and the healthcare provider.As we have an increase in the treatment options, costs, age and demand, an optimized treatment model is required if we want to maintain or obtain a sustainable system. The objective of this study was to describe how costs of treatment and value to the patient, to the hospital and the society differs in a non integrated patient unit (IPU vs an IPU system.Methods: Contact data of schizophrenic patients (n=51 from the hospital's electronic medical records (EMRs was accessed (from October 2010 till March 2012 and analyzed. All financial data was obtained from the finance department. Time driven activity based costing (TDABC as used to calculate the costs.Results: The study examined 1,149 out-patient consultations and 4,386 days of occupancy. By adopting an IPU approach, the costs were significantly reduced compared to the non-IPU approach. Increased complexity benefitted significantly from IPU. These patients had a higher frequency of contact but lower degrees of admission, whilst the non-IPU had significantly higher admission rates and duration of stay.Conclusions: This study shows a striking difference in the resources used on patients treated with an IPU vs a non-IPU approach. In almost every aspect, the IPU approach is by far superior to the non-IPU approach.

  14. The case against segregation in "specialized" care units.

    Science.gov (United States)

    Lines, R

    Canadian public officials are demanding that prisons segregate HIV-positive individuals and require mandatory HIV testing similar to the procedures used in correctional institutions in the United States. These measures have been consistently rejected as ineffective and punitive in Canada. The commissioner of the Correctional Service of Canada (CSC) does not consider forced testing or segregation as a useful part of their HIV/AIDS strategy. The issue raises concerns about prisoners' rights. Proponents of segregation say that creating specialized care units in some Federal institutions would guarantee state-of-the-art care; others charge that it is an admission of substandard care throughout the system. Voluntary segregation forces prisoners to choose between health care and proximity to family. It also deters voluntary testing, as some prisoners will decline testing if they do not want to be moved to another facility. Segregation stigmatizes everyone associated with an institution that has a specialized care unit. There are also problems associated with combining prisoners of varying security levels in the same unit. Compassionate release is preferable to segregation. PMID:11365291

  15. Economic analysis of the cost of Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mazetas D.

    2014-04-01

    Full Text Available The cost of Intensive Care Units has the greatest impact on overall medical costs and the overall cost for the health of a country and an increasing number of studies from around the world presenting the quantification of these costs. Aim: Review of the Economic Analysis of the Cost of Intensive Care Units. Method: Search was made in the SCOPUS, MEDLINE and CINAHL databases using the key-words “Intensive Care Units (ICU”, “Cost”, “Cost Analysis”, “Health Care Costs”, “Health Resources”, “ICU resources”. The study was based on articles published in English from 2000 to 2011 investigating the Economic Analysis of the Cost of Intensive Care Units. Results: The cost of ICU is a significant percentage of gross domestic product in developed countries. Most cost analysis studies that relate to plans that include the study of staff costs, duration of stay in the ICU, the clinical situations of hospitalized patients, engineering support, medications and diagnostic tests costing scales and in relation to the diagnostic criteria. Conclusions: most studies conclude that the remuneration of staff, particularly nurses, in the ICU is the largest cost of ICU, while for the duration of stay in the ICU results are conflicting. The analysis on the cost-effectiveness of ICU can help to better apply these findings to the therapeutic context of ICU.

  16. Oral care in patients on mechanical ventilation in intensive care unit: literature review

    Directory of Open Access Journals (Sweden)

    Selma Atay

    2014-06-01

    Full Text Available intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care and rdquo; between the years of 2000- 2012. Inclusion criteria for the studies were being performed in adult intensive care unit patients on mechanical ventilation, published in peer-reviewed journals in English between the years of 2000-2012, included oral care practice and presence of a nurse among researchers. A total of 304 articles were identified. Six descriptive evaluation studies, three randomised controlled trials, four literature reviews, three meta-Analysis randomized clinical trials, one qualitative study and one semi-experimental study total 18 papers met all of the inclusion criteria. Oral care is emphasized as an infection control practice for the prevention of Ventilator-Associated Pneumonia (VAP. In conclusion, we mention that oral care is an important nursing practice to prevent VAP development in intensive care unit patients; however, there is no standard oral evaluation tool and no clarity on oral care practice frequency, appropriate solution and appropriate material. It can be recommended that the study projects on oral care in intensive care patients to have high proof level and be experimental, and longitudinal. [Int J Res Med Sci 2014; 2(3.000: 822-829

  17. Education of trainees in the intensive care unit.

    Science.gov (United States)

    Croley, W Christopher; Rothenberg, David M

    2007-02-01

    The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage in U.S. urban intensive care units. There is, therefore, a need for more novel approaches in educating trainees in critical care medicine to better prepare future physicians to manage acutely ill patients and improve patient safety. This article will review methods to improve educational designs in teaching critical care medicine to medical students, residents, and fellows, including the use of simulation technology to enhance cognition and procedural skills. PMID:17242600

  18. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review.

    Science.gov (United States)

    Gasperino, James

    2011-10-01

    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States.

  19. "Where Withstanding is Difficult, and Deserting Even More": Head Nurses’ Phenomenological Description of Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Roghieh Nazari

    2016-01-01

    Full Text Available Introduction: The intensive care unit is one of the specialized units in hospitals where head nurses are responsible for both motivating the personnel and providing high quality care. Understanding of the lived experiences of head nurses could help develop new assumptions of the ICU. The present study was therefore conducted to describe the lived experiences of head nurses working in ICU. Methods: In this phenomenological study, data were collected through unstructured in-depth interviews with 5 ICU head nurses in Northern Iran and then analyzed using 7 steps Colaizzi’s method. Results: Despite the "distressing atmosphere of the ICU", the "difficulty of managing the ICU" and the "difficulty of communication in the ICU", which encourages the "desire to leave the unit" among ICU head nurses, the "desire to stay in the unit" is stronger and head nurses are highly motivated to stay in the unit because the unit "develops a feeling of being extraordinary", "creates an interest in providing complicated care to special patients", "facilitates the spiritual bond", "develops a professional dynamism" and "creates an awareness about the nature of intensive care" among them. Conclusion: According to the result, ICU head nurses are still inclined to work in the unit and achieve success in spite of the problems that persist in working in the ICU. As the individuals’ motivation can be the backbone of organizations, and given that individuals with a high enthusiasm for success are productive, hospital managers can take advantage of this strength in choosing their head nurses.

  20. Healthcare organization-education partnerships and career ladder programs for health care workers.

    Science.gov (United States)

    Dill, Janette S; Chuang, Emmeline; Morgan, Jennifer C

    2014-12-01

    Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization. PMID:25441318

  1. Caregiver distress. Related to disruptive behaviors on special care units versus traditional long-term care units.

    Science.gov (United States)

    Middleton, J I; Stewart, N J; Richardson, J S

    1999-03-01

    The link between staff stress and exposure to disruptive behaviors is an important issue in long-term care settings. This study compared the perceptions of two groups of formal caregivers (staff) regarding their distress from the behaviors of residents in their care. Staff on special care units for dementia were less distressed with disruptive behaviors than comparable staff on traditional units, although they reported higher exposure to these behaviors. These results were related to different perceptions of intent to harm and expectations of physical aggression as "part of the job." Implications for nursing include education and support for staff to enhance the quality of life for residents and staff on units where disruptive behaviors occur. PMID:10362970

  2. Multinational corporations and health care in the United States and Latin America: strategies, actions, and effects.

    Science.gov (United States)

    Jasso-Aguilar, Rebeca; Waitzkin, Howard; Landwehr, Angela

    2004-01-01

    In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institutions and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector

  3. Human-centered environment design in intensive care unit

    NARCIS (Netherlands)

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; Xiao, D.; Jakimowicz, J.J.

    2013-01-01

    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland ba

  4. Importance of recognizing and managing delirium in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    XIE Guo-hao; FANG Xiang-ming

    2009-01-01

    @@ Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors.

  5. Pet Care Teaching Unit: 1st-3rd Grades.

    Science.gov (United States)

    Peninsula Humane Society, San Mateo, CA.

    Activities in this unit are designed to familiarize primary grade students with the responsibilities involved in pet ownership. Teaching plans are provided for a total of 12 lessons involving social studies, language arts, math, and health sciences. Activities adaptable for readers and non-readers focus on pet overpopulation, care of pets when…

  6. [Benefits of aromatherapy in dementia special care units].

    Science.gov (United States)

    Bilien, Corinne; Depas, Nathalie; Delaporte, Ghislaine; Baptiste, Nathalie

    2016-01-01

    Aromatherapy is classed as a non-pharmacological treatment, recognised as a therapy for certain disorders. This practice was the subject of a study in a special care unit for patients with dementia. The objective was to demonstrate the benefit of aromatherapy diffusion on major behavioural disorders. PMID:27173630

  7. Glucocorticoid-induced myopathy in the intensive care unit

    DEFF Research Database (Denmark)

    Eddelien, Heidi Shil; Hoffmeyer, Henrik Westy; Lund, Eva Charlotte Løbner;

    2015-01-01

    Glucocorticoids (GC) are used for intensive care unit (ICU) patients on several indications. We present a patient who was admitted to the ICU due to severe respiratory failure caused by bronchospasm requiring mechanical ventilation and treated with methylprednisolone 240 mg/day in addition to ant......, and muscle strength gradually returned. The patient made full recovery from the quadriplegia a few months later....

  8. Increasing fungal infections in the intensive care unit

    NARCIS (Netherlands)

    Pauw, B.E. de

    2006-01-01

    BACKGROUND: Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing. METHOD: Review of the pertinent English-language literature. RESULTS: Most factors promoting an inva

  9. Significance of scientific evidence in organizing care processes.

    Science.gov (United States)

    Hasson, Henna; Blomberg, Staffan; Dunér, Anna; Sarvimäki, Anneli

    2016-06-20

    Purpose - The purpose of this paper is to analyze how staff and managers in health and social care organizations use scientific evidence when making decisions about the organization of care practices. Design/methodology/approach - Document analysis and repeated interviews (2008-2010) with staff (n=39) and managers (n=26) in health and social care organizations. The respondents were involved in a randomized controlled study about testing a continuum of care model for older people. Findings - Scientific evidence had no practical function in the social care organization, while it was a prioritized source of information in the health care organization. This meant that the decision making regarding care practices was different in these organizations. Social care tended to rely on ad hoc practice-based information and political decisions when organizing care, while health care to some extent also relied in an unreflected manner on the scientific knowledge. Originality/value - The study illustrates several difficulties that might occur when managers and staff try to consider scientific evidence when making complicated decisions about care practices. PMID:27296881

  10. Review of noise in neonatal intensive care units - regional analysis

    Energy Technology Data Exchange (ETDEWEB)

    Alvarez Abril, A [National Technological University, Regional Bioengineering Institute, Mendoza (Argentina); Terron, A; Boschi, C [National Technological University, Regional Bioengineering Institute, Mendoza (Argentina); Gomez, M [National Technological University, La Rioja (Argentina)

    2007-11-15

    This work is about the problem of noise in neonatal incubators and in the environment in the neonatal intensive care units. Its main objective is to analyse the impact of noise in hospitals of Mendoza and La Rioja. Methodology: The measures were taken in different moments in front of higher or lower severity level in the working environment. It is shown that noise produces severe damages and changes in the behaviour and the psychological status of the new born babies. Results: The noise recorded inside the incubators and the neonatal intensive care units together have many components but the noise of motors, opening and closing of access gates have been considered the most important ones. Values above 60 db and and up to 120 db in some cases were recorded, so the need to train the health staff in order to manage the new born babies, the equipment and the instruments associated with them very carefully is revealed.

  11. Affordable Care Organizations and Bundled Pricing: A New Philosophy of Care.

    Science.gov (United States)

    Barinaga, Gonzalo; Chambers, Monique C; El-Othmani, Mouhanad M; Siegrist, Richard B; Saleh, Khaled J

    2016-10-01

    Under the Patient Protection and Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services' Innovation was chartered to develop new models of health care delivery. The changes meant a drastic need to restructure the health care system. To minimize costs and optimize quality, new laws encourage continuity in health care delivery within an integrated system. Affordable care organizations provided a model of high-quality care while reducing costs. Bundled payments can have a substantial effect on the national expenditures. This article examines new developments in bundle payments, affordable care organizations, and gainsharing agreements as they pertain to arthroplasty. PMID:27637657

  12. Implementation of an electronic logbook for intensive care units.

    Science.gov (United States)

    Wallace, Carrie J.; Stansfield, Dennis; Gibb Ellis, Kathryn A.; Clemmer, Terry P.

    2002-01-01

    Logbooks of patients treated in acute care units are commonly maintained; the data may be used to justify resource use, analyze patient outcomes, and encourage clinical research. We report herein the conversion of a paper-based logbook to an electronic logbook in three hospital intensive care units. The major difference between the paper logbook and electronic logbook data was the addition of clinician-entered data to the electronic logbook. Despite extensive computerization of patient information extant in the participating units, there was considerable reluctance to replace the paper-based logbook. The project's success can be attributed to the use of feedback from the clinical users in the development and implementation process to create accessible, high quality data. These data provide clinicians with the capability to monitor trends in a variety of patient groups. Advantages of the electronic logbook include more efficient data access, higher data quality and increased ability to conduct quality improvement and clinical research activities. PMID:12463943

  13. Sri Lanka's Health Unit Program: A Model of "Selective" Primary Health Care

    Directory of Open Access Journals (Sweden)

    Soma Hewa

    2011-12-01

    Full Text Available This paper argues that the health unit program developed in Sri Lanka in the early twentieth century was an earlier model of selective primary health care promoted by the Rockefeller Foundation in the 1980s in opposition to comprehensive primary health care advocated by the Alma-Ata Declaration of the World Health Organization. A key strategy of the health unit program was to identify the most common and serious infectious diseases in each health unit area and control them through improved sanitation, health education, immunization and treatment with the help of local communities. The health unit program was later introduced to other countries in South and Southeast Asia as part of the Rockefeller Foundation's global campaign to promote public health.

  14. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

    NARCIS (Netherlands)

    Kett, D.H.; Azoulay, E.; Echeverria, P.M.; Vincent, J.L.; Pickkers, P.

    2011-01-01

    OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the I

  15. Intensive care unit research ethics and trials on unconscious patients.

    Science.gov (United States)

    Gillett, G R

    2015-05-01

    There are widely acknowledged ethical issues in enrolling unconscious patients in research trials, particularly in intensive care unit (ICU) settings. An analysis of those issues shows that, by and large, patients are better served in units where research is actively taking place for several reasons: i) they do not fall prey to therapeutic prejudices without clear evidential support, ii) they get a chance of accessing new and potentially beneficial treatments, iii) a climate of careful monitoring of patients and their clinical progress is necessary for good clinical research and affects the care of all patients and iv) even those not in the treatment arm of a trial of a new intervention must receive best current standard care (according to international evidence-based treatment guidelines). Given that we have discovered a number of 'best practice' regimens of care that do not optimise outcomes in ICU settings, it is of great benefit to all patients (including those participating in research) that we are constantly updating and evaluating what we do. Therefore, the practice of ICU-based clinical research on patients, many of whom cannot give prospective informed consent, ticks all the ethical boxes and ought to be encouraged in our health system. It is very important that the evaluation of protocols for ICU research should not overlook obvious (albeit probabilistic) benefits to patients and the acceptability of responsible clinicians entering patients into well-designed trials, even though the ICU setting does not and cannot conform to typical informed consent procedures and requirements.

  16. Circumstances surrounding dying in the paediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Plötz Frans B

    2006-08-01

    Full Text Available Abstract Background Death is inevitable in the paediatric intensive care unit (PICU. We aimed to describe the circumstances surrounding dying in a PICU. Method The chart records of all patients less than 18 years of age who died at the PICU between January first 2000 and July first 2005 were retrospectively analyzed. Information regarding sex, age, length of stay, admission, diagnosis, and the way a patient died was registered. Post mortem information regarding natural versus unnatural death, autopsy and donation was obtained. Non-survivors were allocated in five groups: do-not-resuscitate (DNR, withholding and/or withdrawal of therapy (W/W, failed cardiopulmonary resuscitation (failed CPR, brain death (BD, and terminal organ failure (TOF. Results During the study period 87 (4.4% of the 1995 admitted patients died. Non-survivors were more often admitted during the day (54% and the week (68%. W/W was found in 27.6%, TOF in 26.4%, BD in 23.0%, failed CPR in 18.4%, and DNR in 4.6%. Forty-three percent died in the first two days, of which BD (40.5% and failed CPR (37.8% were most common. Seventy-five children (86% died due to a natural cause. Autopsy permission was obtained in 19 of 54 patients (35%. The autopsies confirmed the clinical diagnosis in 11 patients, revealed new information in 5 patients, and in 3 patients the autopsy did not provide additional information. Nine patients were medically suitable for organ donation and 24 patients for tissue donation, whereas consent was only obtained in 2 cases in both groups. Conclusion We observed that 43% of the patients died within the first two days of admission due to BD and failed CPR, whereas after 4 days most patients died after W/W. Autopsy remains an useful tool to confirm clinical diagnoses or to provide new information. Only a small percentage of the deceased children is suitable for organ donation.

  17. The role of managed care organizations in obesity management.

    Science.gov (United States)

    Schaecher, Kenneth L

    2016-06-01

    In the United States, obesity is characterized as this century's greatest healthcare threat. The American Medical Association and several other large organizations now classify obesity as a disease. Several federal initiatives are in the planning stages, have been approved, or are being implemented to address the disease. Obesity poses challenges for all healthcare stakeholders. Diet and exercise often are insufficient to create the magnitude of change patients and their attending healthcare providers need. Managed care organizations (MCOs) have 3 tools that can help their members: health and wellness programs focusing on lifestyle changes, prescription weight-loss drugs, and bariatric surgical interventions. MCOs are addressing changes with national requirements and are responding to the availability of new weight-loss drugs to help their members achieve better health. A number of factors either deter or stimulate the progress of weight loss therapy. Understanding how MCOs are key to managing obesity at the local level is important for healthcare providers. It can help MCOs and individual healthcare providers develop and coordinate strategies to educate stakeholders and better manage overall care.

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

    Science.gov (United States)

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

    1999-04-01

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

  19. Status of neonatal intensive care units in India.

    Directory of Open Access Journals (Sweden)

    Fernandez A

    1993-04-01

    Full Text Available Neonatal mortality in India accounts for 50% of infant mortality, which has declined to 84/1000 live births. There is no prenatal care for over 50% of pregnant women, and over 80% deliver at home in unsafe and unsanitary conditions. Those women who do deliver in health facilities are unable to receive intensive neonatal care when necessary. Level I and Level II neonatal care is unavailable in most health facilities in India, and in most developing countries. There is a need in India for Level III care units also. The establishment of neonatal intensive care units (NICUs in India and developing countries would require space and location, finances, equipment, staff, protocols of care, and infection control measures. Neonatal mortality could be reduced by initially adding NICUs at a few key hospitals. The recommendation is for 30 NICU beds per million population. Each bed would require 50 square feet per cradle and proper climate control. Funds would have to be diverted from adult care. The largest expenses would be in equipment purchase, maintenance, and repair. Trained technicians would be required to operate and monitor the sophisticated ventilators and incubators. The nurse-patient ratio should be 1:1 and 1:2 for other infants. Training mothers to work in the NICUs would help ease the problems of trained nursing staff shortages. Protocols need not be highly technical; they could include the substitution of radiant warmers and room heaters for expensive incubators, the provision of breast milk, and the reduction of invasive procedures such as venipuncture and intubation. Nocosomial infections should be reduced by vacuum cleaning and wet mopping with a disinfectant twice a day, changing disinfectants periodically, maintaining mops to avoid infection, decontamination of linen, daily changing of tubing, and cleaning and sterilizing oxygen hoods and resuscitation equipment, and maintaining an iatrogenic infection record book, which could be used to

  20. Conflicts between managed care organizations and emergency departments in California.

    OpenAIRE

    Johnson, L. A.; Derlet, R W

    1996-01-01

    To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care...

  1. Procalcitonin use in a pediatric intensive care unit.

    Science.gov (United States)

    Cies, Jeffrey J; Chopra, Arun

    2014-09-01

    We evaluated whether procalcitonin (PCT) might aid diagnosing serious bacterial infections in a general pediatric intensive care unit population. Two-hundred and one patients accounted for 332 PCT samples. A PCT ≥1.45 ng/mL had a positive predictive value of 30%, a negative predictive value of 93% and a sensitivity of 72% and a specificity of 75%. These data suggest PCT can assist in identifying patients without serious bacterial infections and limit antimicrobial use.

  2. Intensive Care Unit Acquired Weakness: Under or Overdiagnosed?

    OpenAIRE

    Morgado, S; Moura, S.

    2010-01-01

    Intensive care unit-acquired weakness (ICU-AW) is recognized as an important and common clinical problem, associated with an increased morbidity in critical ill patients. This muscle weakness has been described in a wide range of clinical settings and therefore, has many different terminologies such as “critical illness myopathy – CIM”, “critical illness polyneuropathy - CIP”, “acute quadriplegic myopathy”, among others. Nowadays, these designations are considered somewhat restric...

  3. Human-centered environment design in intensive care unit

    OpenAIRE

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; D. Xiao; Jakimowicz, J.J.

    2013-01-01

    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland based on related standards. We also premeditate the indoor environment from planning perspective, analyze patients, their families, medical staff and space requirement to conduct research in ICU desi...

  4. Post-traumatic pulmonary embolism in the intensive care unit

    OpenAIRE

    Mabrouk Bahloul; Anis Chaari; Hassen Dammak; Fatma Medhioub; Leila Abid; Hichem Ksibi; Sondes Haddar; Hatem Kallel; Hedi Chelly; Chokri Ben Hamida; Mounir Bouaziz

    2011-01-01

    Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE) admitted in the intensive care unit (ICU). Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients ...

  5. Causes Of Microbial Carriers During Admission To Intensive Care Unit

    OpenAIRE

    Panagiotopoulou, Efthymia; Nteves, Ioannis; Kadda, Olga; Kapadohos, Theodore; Vasilopoulos, Georgios; Marvaki, Christina

    2016-01-01

    Introduction: The recording of microbial agent upon patients admission in the Intensive Care Unit (ICU) can be useful for the prevention and reduction of dispersion, forecasting new colonization or infection respectively bacteria and guide empirical antimicrobial therapy. Aim: The aim of the present study was to investigate the factors associated with microbial colonization of patients admitting to ICU. Material and Method: The studied sample consisted of 72 patients admitted to the I...

  6. Bedside Neonatal Intensive Care Unit Surgery- Myth or Reality!

    OpenAIRE

    Shandip Kumar Sinha; Sujoy Neogi

    2013-01-01

    Neonatal transport is associated with complications, more so in sick and unstable neonates who need immediate emergency surgery. To circumvent these problems, surgery in Neonatal intensive care unit (NICU) is proposed for these neonates. This article reviews the literature regarding feasibility of this novel concept and based on the generated evidence, suggest the NICU planners to always include infrastructure for this. Also neonatal surgical team can be developed that could be transported.

  7. Nutritional support of children in the intensive care unit.

    OpenAIRE

    Seashore, J. H.

    1984-01-01

    Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. A method of estimating the nutritional requirements of children is presented. The techniques of nutritional su...

  8. Mobility decline in patients hospitalized in an intensive care unit

    Science.gov (United States)

    de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz

    2016-01-01

    Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406

  9. Renal replacement therapy in the intensive care unit

    OpenAIRE

    Pannu, Neesh; Gibney, RT Noel

    2005-01-01

    Acute renal failure is a common complication in the intensive care unit (ICU). Over the last 25 years, there have been significant technological advances in the delivery of renal replacement therapy, particularly as it pertains to the critically ill patient population. Despite these advances, acute renal failure in critically ill patients continues to carry a poor prognosis. In this article, we review the current literature about timing and initiation of renal replacement therapy in the ICU a...

  10. Non-invasive respiratory monitoring in paediatric intensive care unit.

    OpenAIRE

    Nadkarni U; Shah A; Deshmukh C

    2000-01-01

    Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU), as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2) and transcutaneous PCO2 (PtcCO2) using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Cons...

  11. Physiotherapy practices in Intensive Care Units across Maharashtra

    OpenAIRE

    Ujwal Lakshman Yeole; Ankita Ramesh Chand; Nandi, Biplab B.; Pravin P Gawali; Adkitte, Roshan G.

    2015-01-01

    Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU) across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of t...

  12. What Does Change with Nutrition Team in Intensive Care Unit?

    OpenAIRE

    Ahmet Fatih Yılmaz; Ertuğrul Kılıç; Sema Gürsel; Nazlı Tiryaki

    2016-01-01

    Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU), the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Hea...

  13. Eye injury treatment in intensive care unit patients

    OpenAIRE

    L. K. Moshetova; S. A. Kochergin; A. S. Kochergin

    2015-01-01

    Aim. To describe eye injuries in intensive care unit (ICU) patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes) with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative...

  14. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, Morten Brøgger; Perner, A; Wetterslev, J;

    2013-01-01

    Stress ulcer prophylaxis (SUP) is regarded as standard of care in the intensive care unit (ICU). However, recent randomized, clinical trials (RCTs) and meta-analyses have questioned the rationale and level of evidence for this recommendation. The aim of the present systematic review was to evaluate...... Grading of Recommendations Assessment, Development, and Evaluation, and risk of random errors in cumulative meta-analyses was assessed with trial sequential analysis. A total of 57 studies were included in the review. The literature on SUP in the ICU includes limited trial data and methodological weak...... intervention?; (4) Do intensive care patients benefit from SUP with proton pump inhibitors as compared with other SUP interventions? Systematic reviews of possible interventions and well-powered observational studies and RCTs are needed....

  15. Postpartum depression on the neonatal intensive care unit: current perspectives

    Directory of Open Access Journals (Sweden)

    Tahirkheli NN

    2014-11-01

    Full Text Available Noor N Tahirkheli,1 Amanda S Cherry,1 Alayna P Tackett,2 Mary Anne McCaffree,3 Stephen R Gillaspy11Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; 2Department of Psychology, Oklahoma State University, Stillwater, OK, USA; 3Section of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USAAbstract: As the most common complication of childbirth affecting 10%–15% of women, postpartum depression (PPD goes vastly undetected and untreated, inflicting long-term consequences on both mother and child. Studies consistently show that mothers of infants in the neonatal intensive care unit (NICU experience PPD at higher rates with more elevated symptomatology than mothers of healthy infants. Although there has been increased awareness regarding the overall prevalence of PPD and recognition of the need for health care providers to address this health issue, there has not been adequate attention to PPD in the context of the NICU. This review will focus on an overview of PPD and psychological morbidities, the prevalence of PPD in mothers of infants admitted to NICU, associated risk factors, potential PPD screening measures, promising intervention programs, the role of NICU health care providers in addressing PPD in the NICU, and suggested future research directions.Keywords: neonatal intensive care unit, postpartum depression, mothers

  16. Primary nursing in Intensive Care Unit: measuring nurses' attitudes

    Directory of Open Access Journals (Sweden)

    Zetta, S.

    2010-07-01

    Full Text Available Intensive Care Units have been identified as having advantages for the use of primary nursing. Nursing staff play an important role οn the successful implementation of primary nursing. It is important to know in advance of the implementation plan the attitudes and opinions of the nurses. Such knowledge would adequately inform the management and enable them to use the right approaches to achieve successful implementation. Aim and Method The current study is a non-experimental, cross-sectional descriptive research design aiming to identify nurses’ attitudes towards primary nursing. The study was conducted in an 8-beded Intensive Care Unit (ICU part of a University Hospital in Scotland. The sample consisted of all 38 registered and enrolled nurse working at the unit at the time. Results Results indicated that nurses were aware and identified benefits and shortcomings of primary nursing which have been seen in the primary care literature. Nurses’ attitudes towards implementation of primary nursing were positive and appeared to agree with the positive impact of primary nursing to the patients either in term of patient satisfaction or patient autonomy. Conclusions Primary nursing advocates a shift away from the traditional system of hierarchical task allocation. Nurses are willing to change and want to learn more in order to improve patients’ outcomes.

  17. [Nurses' perspective on interprofessional communication on an intensive care unit].

    Science.gov (United States)

    Knoll, Martin; Lendner, Ilka

    2008-10-01

    The aim of this qualitative study was to explore experience in nurses' interdisciplinary/interprofessional communication on an intensive care unit. The structure of communication and influencing factors were shown and interpreted from the perspective of the nurses. Nurses working on an internal medical intensive care unit at a teaching facility in central Germany were questioned by means of semi-structured interviews. One main result was that for nurses the culture of communication in the investigation unit was characterized primarily by hierarchical structures imposed by the physicians. This dominance was identified in all nursing activities resulting in a considerable adverse effect on the flow of information concerning the patient between nurses and physicians. Especially within the context of daily rounds nurses were confronted with barriers to participate actively with their knowledge and professional competence in the process of decision-making. The problems described are well known in everyday nursing practice and have been dealt with in the English research literature. However, this study's aim is to present and summarize the gained insights and to transfer them in a practice-oriented way into a selected field of work. Possible solutions for the problems of inter-professional communication are suggested in subsequent work steps in order to optimize patient care. PMID:18850538

  18. Volume, outcome, and the organization of intensive care.

    Science.gov (United States)

    Kahn, Jeremy M

    2007-01-01

    Increasing evidence suggests that high case volume is associated with improved outcomes in the intensive care unit (ICU). Potential explanations for the volume-outcome relationship include selective referral, clinical experience and organizational factors common to high-volume ICUs. Distinguishing between these explanations has important health policy implications, because outcomes at low-volume ICUs could be improved either by exporting best practices found at high-volume centers or by regionalizing adult critical care - two very different care strategies. Future research efforts should be directed at better characterizing the process of care in high-volume ICUs and exploring the feasibility of creating a regionalized system of care. PMID:17493293

  19. Leadership-organizational culture relationship in nursing units of acute care hospitals.

    Science.gov (United States)

    Casida, Jesus; Pinto-Zipp, Genevieve

    2008-01-01

    The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence. PMID:18389837

  20. The underlying theories of health care reform in the United States--strategy implications for hospitals.

    Science.gov (United States)

    McLaughlin, Daniel B; Militello, Jack

    2011-01-01

    The United State Health Reform (Affordable Care Act) presents health provides with the goals that should be achieved in the reformed health care environment and rationale for those goals. Developing strategies to implement the act's policies by any health care organization must take into account the underlying theories of the act: managed change though payment design and funds flow. Market place competition. To execute strategy effective internal organizational management is a must and can be facilitated through a strong alignment between mission and opperating factors. The mission must relate to the organization's markets. Markets are best addressed through a local perspective where the ACA goals can be applied within a specific community or culture. The systems approach brings as many participants in the system to define their mutual success as it relates to reform. PMID:22235723

  1. Retrenchment in health care organizations: theory and practice.

    Science.gov (United States)

    Fottler, M D; Smith, H L; Muller, H J

    1986-01-01

    This paper analyzes retrenchment in health care organizations in terms of prescriptions in the literature and the actual responses of health care executives to retrenchment. Case studies of five organizations indicate that the range of coping strategies is much more limited than the range of possibilities suggested in the literature. Constraints within the culture of the organization are suggested as an explanation for this disparity.

  2. Maternal near miss in the intensive care unit: clinical and epidemiological aspects

    OpenAIRE

    Oliveira, Leonam Costa; da Costa, Aurélio Antônio Ribeiro

    2015-01-01

    Objective To analyze the epidemiological clinical profile of women with maternal near miss according to the new World Health Organization criteria. Methods A descriptive crosssectional study was conducted, in which the records of patients admitted to the obstetric intensive care unit of a tertiary hospital in Recife (Brazil) over a period of four years were analyzed. Women who presented at least one near miss criterion were included. The variables studied were age, race/color, civil status, e...

  3. Family, caring and ageing in the United Kingdom.

    Science.gov (United States)

    Gilbert, Tony; Powell, Jason L

    2005-03-01

    This paper provides a critical exploration of the assumptions and narratives underpinning the development of social policy initiatives targeting caring relationships based upon family ties. Using a narrative approach attention is drawn to the ways in which family identities are open to a far greater range of negotiation than is assumed by policy. Drawing on the United Kingdom as a case example, questions are posed about intergenerational relations and the nature of late life citizenship. The comparatively recent invention of narratives supporting 'informal care' and the link with neo-liberal and 'third way' notions of active citizenship are explored. As is the failure of policy developments to take into account the diversity of care giving styles and the complexity of caring relationships. It is argued that the uneven and locally specific ways in which policy develops enables the co-existence of a complex range of narratives about family, caring and ageing which address diverse aspects of the family life of older people in often contradictory ways.

  4. Core competencies of the entrepreneurial leader in health care organizations.

    Science.gov (United States)

    Guo, Kristina L

    2009-01-01

    The purpose of this article is to discuss core competencies that entrepreneurial health care leaders should acquire to ensure the survival and growth of US health care organizations. Three overlapping areas of core competencies are described: (1) health care system and environment competencies, (2) organization competencies, and (3) interpersonal competencies. This study offers insight into the relationship between leaders and entrepreneurship in health care organizations and establishes the foundation for more in-depth studies on leadership competencies in health care settings. The approach for identifying core competencies and designing a competency model is useful for practitioners in leadership positions in complex health care organizations, so that through the understanding and practice of these 3 areas of core competencies, they can enhance their entrepreneurial leadership skills to become more effective health care entrepreneurial leaders. This study can also be used as a tool by health care organizations to better understand leadership performance, and competencies can be used to further the organization's strategic vision and for individual improvement purposes. PMID:19225332

  5. Core competencies of the entrepreneurial leader in health care organizations.

    Science.gov (United States)

    Guo, Kristina L

    2009-01-01

    The purpose of this article is to discuss core competencies that entrepreneurial health care leaders should acquire to ensure the survival and growth of US health care organizations. Three overlapping areas of core competencies are described: (1) health care system and environment competencies, (2) organization competencies, and (3) interpersonal competencies. This study offers insight into the relationship between leaders and entrepreneurship in health care organizations and establishes the foundation for more in-depth studies on leadership competencies in health care settings. The approach for identifying core competencies and designing a competency model is useful for practitioners in leadership positions in complex health care organizations, so that through the understanding and practice of these 3 areas of core competencies, they can enhance their entrepreneurial leadership skills to become more effective health care entrepreneurial leaders. This study can also be used as a tool by health care organizations to better understand leadership performance, and competencies can be used to further the organization's strategic vision and for individual improvement purposes.

  6. Managed care, deficit financing, and aggregate health care expenditure in the United States: a cointegration analysis.

    Science.gov (United States)

    Murthy, N R; Okunade, A A

    2000-09-01

    We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960-96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good.

  7. Managed care, deficit financing, and aggregate health care expenditure in the United States: a cointegration analysis.

    Science.gov (United States)

    Murthy, N R; Okunade, A A

    2000-09-01

    We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960-96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good. PMID:11105414

  8. 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

  9. Confronting youth gangs in the intensive care unit.

    Science.gov (United States)

    Akiyama, Cliff

    2015-01-01

    Youth gang violence has continued its upward trend nationwide. It was once thought that gangs convened only in selected areas, which left churches, schools, and hospitals as "neutral" territory. Unfortunately, this is a fallacy. The results of gang violence pour into hospitals and into intensive care units regularly. The media portrays California as having a gang violence problem; however, throughout the United States, gang violence has risen more than 35% in the past year. Youth gang violence continues to rise dramatically with more and more of our youth deciding to join gangs each day. Sadly, every state has gangs, and the problem is getting much worse in areas that would never have thought about gangs a year ago. These "new generation" of gang members is younger, much more violent, and staying in the gang longer. Gangs are not just an urban problem. Gang activity is a suburban and rural problem too. There are more than 25 500 gangs in the United States, with a total gang membership of 850 000. Ninety-four percent of gang members are male and 6% are female. The ethnic composition nationwide includes 47% Latino, 31% African American, 13% White, 7% Asian, and 2% "mixed," according to the Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice. As a result of the ongoing proliferation of youth street gangs in our communities, it is imperative that critical care nurses and others involved with the direct care become educated about how to identify gang members, their activities, and understand their motivations. Such education and knowledge will help provide solutions to families and the youth themselves, help eradicate the problem of gang violence, and keep health care professionals safe.

  10. Confronting youth gangs in the intensive care unit.

    Science.gov (United States)

    Akiyama, Cliff

    2015-01-01

    Youth gang violence has continued its upward trend nationwide. It was once thought that gangs convened only in selected areas, which left churches, schools, and hospitals as "neutral" territory. Unfortunately, this is a fallacy. The results of gang violence pour into hospitals and into intensive care units regularly. The media portrays California as having a gang violence problem; however, throughout the United States, gang violence has risen more than 35% in the past year. Youth gang violence continues to rise dramatically with more and more of our youth deciding to join gangs each day. Sadly, every state has gangs, and the problem is getting much worse in areas that would never have thought about gangs a year ago. These "new generation" of gang members is younger, much more violent, and staying in the gang longer. Gangs are not just an urban problem. Gang activity is a suburban and rural problem too. There are more than 25 500 gangs in the United States, with a total gang membership of 850 000. Ninety-four percent of gang members are male and 6% are female. The ethnic composition nationwide includes 47% Latino, 31% African American, 13% White, 7% Asian, and 2% "mixed," according to the Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice. As a result of the ongoing proliferation of youth street gangs in our communities, it is imperative that critical care nurses and others involved with the direct care become educated about how to identify gang members, their activities, and understand their motivations. Such education and knowledge will help provide solutions to families and the youth themselves, help eradicate the problem of gang violence, and keep health care professionals safe. PMID:25463004

  11. Different Nursing Care Methods for Prevention of Keratopathy Among Intensive Care Unit Patients

    Science.gov (United States)

    Kalhori, Reza Pourmirza; Ehsani, Sohrab; Daneshgar, Farid; Ashtarian, Hossein; Rezaei, Mansour

    2016-01-01

    Background: Patients with reduced consciousness level suffer from eye protection disorder and Keratopathy. This study was conducted to compare effect of three eye care techniques in prevention of keratopathy in the patients hospitalized in intensive care unit of Kermanshah. Methods: This clinical trial was conducted in 2013 with sample size of 96 persons in three random groups. Routine care included washing of eyes with normal saline and three eye care methods were conducted with poly ethylene cover, liposic ointment, and artificial tear drop randomly on one eye of each sample and a comparison was made with the opposite eye as the control. Eyes were controlled for 5 days in terms of keratopathy. Data collection instrument was keratopathy severity index. Data statistical analysis was performed with SPSS-16 software and chi-squared test, Fisher’s exact test, ANOVA and Kruskal–Wallis one-way analysis of variance. Findings: The use of poly ethylene cover (0.59±0.665) was significantly more effective in prevention of keratopathy than other methods (P=0.001). There was no statistically significant difference between two care interventions of liposic ointment and artificial tear drop (P=0.844) but the results indicated the more effective liposic ointment (1.13±0.751) than the artificial tear drop (1.59±0.875) in prevention of corneal abrasion (Phospitalized in intensive care unit.

  12. Organization of Nursing work regarding the integration of family care for hospitalized children

    OpenAIRE

    Janaína Lopes da Silva; Emelynne Gabrielly de Oliveira Santos; Cintia Capistrano Teixeira Rocha; Cecília Nogueira Valença; Osvaldo de Góes Bay Júnior

    2016-01-01

    Objective: to discuss the organization of Nursing technician’s work in the interface of the care of family members of hospitalized children and to identify their perception of the insertion of family in caring for this child. Methods: this is an exploratory descriptive study with a qualitative approach, undertaken in the pediatric inpatient unit of a university hospital with six Nursing technicians, through semi-structured interviews. Results: professionals realized the importance of the fami...

  13. Oregon's Coordinated Care Organizations Increased Timely Prenatal Care Initiation And Decreased Disparities.

    Science.gov (United States)

    Muoto, Ifeoma; Luck, Jeff; Yoon, Jangho; Bernell, Stephanie; Snowden, Jonathan M

    2016-09-01

    Policies at the state and federal levels affect access to health services, including prenatal care. In 2012 the State of Oregon implemented a major reform of its Medicaid program. The new model, called a coordinated care organization (CCO), is designed to improve the coordination of care for Medicaid beneficiaries. This reform effort provides an ideal opportunity to evaluate the impact of broad financing and delivery reforms on prenatal care use. Using birth certificate data from Oregon and Washington State, we evaluated the effect of CCO implementation on the probability of early prenatal care initiation, prenatal care adequacy, and disparities in prenatal care use by type of insurance. Following CCO implementation, we found significant increases in early prenatal care initiation and a reduction in disparities across insurance types but no difference in overall prenatal care adequacy. Oregon's reforms could serve as a model for other Medicaid and commercial health plans seeking to improve prenatal care quality and reduce disparities. PMID:27605642

  14. Israeli breast care nurses as a learning organization

    OpenAIRE

    Ilana Kadmon; Livia Kislev

    2015-01-01

    This article will look at the theory of a Learning Organization as described by Senge and the Israeli Breast Care Nurses as an example. A description of the theory of a Learning Organization, the role of the Breast Care Nurses in Israel and the relation between the two will be described. Since 1996, the role of the Breast Care Nurse was founded in Israel. At that time, the role with its importance was very hard to be recognized by the health care team and other professionals of the multidisci...

  15. Insurance coverage for male infertility care in the United States

    OpenAIRE

    James M Dupree

    2016-01-01

    Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of h...

  16. Platelet counts and outcome in the pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Agrawal Shruti

    2008-01-01

    Full Text Available Objectives: Thrombocytopenia is commonly observed in critically ill patients. This study was undertaken to evaluate the variation in platelet counts and the risk factors associated with thrombocytopenia and mortality in pediatric intensive care patients. In addition, prognostic value of platelet counts for outcome in pediatric intensive care unit was studied. Study Design: Prospective, observational cohort analysis. Setting: 8- bedded pediatric intensive care unit of a tertiary care teaching hospital. Patients: All consecutively admitted patients (n=138 staying in the pediatric intensive care unit (PICU for at least 48h over a 7 months period were studied. Measurements and Main Results: Thrombocytopenia was defined as platelet counts < 150.0/nL. Median 1 st day Pediatric Risk of Mortality Score (PRISM was 5 (range 0-30 and median ICU stay was 4 days (range 2-98 days. Twenty five percent patients had at least one episode of thrombocytopenia during the stay. Twenty percent of these patients had thrombocytopenia on admission and rest (80% developed it during the PICU stay. Seventy one percent (19 of the patients developed thrombocytopenia by fourth day of admission. Patients with PICU acquired thrombocytopenia had statistically significant lower baseline, nadir and 4th day platelet counts and a significantly higher drop in platelet counts (56% vs. 6% P< 0.001 as compared to non thrombocytopenic patients. PRISM score, long PICU stay, sepsis, coagulopathy, and creatinine levels were significantly associated with occurrence of thrombocytopenia. Patients with thrombocytopenia had higher probability of bleeding (34% vs. 15%, P=0.01. Higher platelet counts on admission were associated with significantly reduced risk of thrombocytopenia (P=0.00 Baseline, nadir and day-4 platelet counts, presence of thrombocytopenia on admission, sepsis, coagulopathy and a higher mean PRISM score on univariate analysis were significantly associated with mortality

  17. The Use of Modafinil in the Intensive Care Unit.

    Science.gov (United States)

    Gajewski, Michal; Weinhouse, Gerald

    2016-02-01

    As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution's Thoracic Surgery Intensive Care Unit. Our 3 patients were chosen as a result of their fatigue, EDS, and/or depression, which prolonged their ICU stay and precluded them from participating in physical therapy, an integral component of the rehabilitative process. The patients were given 200 mg of modafinil each morning to increase patient wakefulness, encourage their participation, and enable a more restful sleep during the night. Although the drug was undoubtedly not the sole reason why our patients became more active, the temporal relationship between starting the drug and our patients' clinical improvement makes it likely that it contributed. Based on our observations with these patients, the known effects of modafinil, its safety profile, and the published experiences of others, we believe that modafinil has potential benefits when utilized in some critically ill patients and that the consequences of delayed patient recovery and a prolonged ICU stay may outweigh the risks of potential modafinil side effects.

  18. The Use of Modafinil in the Intensive Care Unit.

    Science.gov (United States)

    Gajewski, Michal; Weinhouse, Gerald

    2016-02-01

    As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution's Thoracic Surgery Intensive Care Unit. Our 3 patients were chosen as a result of their fatigue, EDS, and/or depression, which prolonged their ICU stay and precluded them from participating in physical therapy, an integral component of the rehabilitative process. The patients were given 200 mg of modafinil each morning to increase patient wakefulness, encourage their participation, and enable a more restful sleep during the night. Although the drug was undoubtedly not the sole reason why our patients became more active, the temporal relationship between starting the drug and our patients' clinical improvement makes it likely that it contributed. Based on our observations with these patients, the known effects of modafinil, its safety profile, and the published experiences of others, we believe that modafinil has potential benefits when utilized in some critically ill patients and that the consequences of delayed patient recovery and a prolonged ICU stay may outweigh the risks of potential modafinil side effects. PMID:25716122

  19. 76 FR 13209 - United States and State of Texas v. United Regional Health Care System; Proposed Final Judgment...

    Science.gov (United States)

    2011-03-10

    ... an intensive care unit, OB suite, and cardiology department. Today, Kell West has 41 beds. As alleged... beds and additional services, such as additional intensive care capabilities, cardiology services,...

  20. Intermittent Demand Forecasting in a Tertiary Pediatric Intensive Care Unit.

    Science.gov (United States)

    Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions. PMID:27562485

  1. Intermittent Demand Forecasting in a Tertiary Pediatric Intensive Care Unit.

    Science.gov (United States)

    Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions.

  2. Nurses Empathy and Family Needs in the Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Sima Moghaddasian

    2013-08-01

    Full Text Available Introduction: The patients’ families in intensive care units (ICUs experience excessive stress which may disrupt their performance in daily life. Empathy is basic to the nursing role and has been found to be associated with improved patient outcomes and greater satisfaction with care in patient and his/her family. However, few studies have investigated the nursing empathy with ICU patients. This study aimed to assess nursing empathy and its relationship with the needs, from the perspective of families of patients in ICU.Methods: In this cross-sectional study, 418 subjects were selected among families of patients admitted to ICUs in Tabriz, Iran, by convenience sampling, from May to August 2012. Data were collected through Barrett-Lennard Relationship inventory (BLRI empathy scale and Critical Care Family Needs Intervention (CCFNI inventories and were analyzed using descriptive and inferential statistical tests. Results: Findings showed that most of the nurses had high level of empathy to the patients (38.8%. There was also statistically significant relationship between nurses’ empathy and needs of patients’ families (p < 0.001. Conclusion: In this study we found that by increasing the nurse’s empathy skills, we would be able to improve providing family needs. Through empathic communication, nurses can encourage family members to participate in planning for the care of their patients. However, further studies are necessary to confirm the results.

  3. Acceptable long-term outcome in elderly intensive care unit patients

    DEFF Research Database (Denmark)

    Schrøder, Morten; Poulsen, Jesper Brøndum; Perner, Anders

    2011-01-01

    The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care.......The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care....

  4. [Information system at Department of Cardiac Surgery Intensive Care Unit].

    Science.gov (United States)

    Dokozić, Josipa

    2014-03-01

    This paper analyzes the aspects of using computer technology in nursing practice. Transfer and managing of data, information and knowledge in nursing is enabled by using modern technology and suitable applications. Cardio applications at the Intensive Care Unit of Department of Cardiac Surgery in Osijek enables nurses/technicians to gain insight into patient personal data, medical history, microbiological findings, interventions that have been made as well as those scheduled in the field of health care, all this by using a few simple connections. Nurses/technicians are those who enter patient data into his/her Electronic Health Record. There are multiple contributions of cardiac system. In comparison with previous paper-based managing of nursing documentation, this program has considerably facilitated and improved nursing practice.

  5. Acinetobacter baumannii Infection in the Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    AMK AL Jarousha

    2008-09-01

    Full Text Available Background: To perform a prospective case control study of blood stream infection to determine the infection rate of Acine­tobac­ter baumannii and the risk factors associated with mortality."nMethods:   From February 2004 to January 2005, 579 consecutive episodes of blood stream infection were obtained at two neo­na­tal intensive care units Al Nasser and Al Shifa hospitals in Gaza City. Forty (6.9% isolates of A. baumannii were ob­tained from the neonates under 28 d. Most of the isolates (92% were from hospitalized patients in the intensive care units."nResults: Community acquired infection was 8%.  Sixty three percent of the patients were males. The isolates of A. bauman­nii were resistant to commonly used antibiotics while being sensitive to meropenem (92.5%, imipenem (90%, chloram­pheni­col (80%, ciprofloxacin (75%, gentamicin (57.5%, ceftriaxone (50%, amikacin (37.5%, cefuroxime and ce­fo­taxime (35%. Over all crude mortality rate was 20% with much higher crude mortality among patients with noso­co­mial infec­tion.  Based on logistic regression, the following factors were statistically significant: weight < 1500g, age < 7 d, mean of hospitalization equal 20 days, antibiotic use, and mechanical ventilation, when compared to the control group (P< 0.05."nConclusion:  Infection rate of nosocomial blood stream infection was considerable and alarming in neonatal intensive care unit infants and associated with a significant excess length of NICU stay and a significant economic burden.  

  6. The influence of care interventions on the continuity of sleep of intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Fernanda Luiza Hamze

    2015-10-01

    Full Text Available Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit.Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software.Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8% caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients.Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.

  7. Frailty and Organization of Health and Social Care.

    Science.gov (United States)

    Clegg, Andrew; Young, John

    2015-01-01

    In this chapter, we consider how health and social care can best be organized for older people with frailty. We will consider the merits of routine frailty identification, including risk stratification methods, to inform the provision of evidence-based treatment and holistic, goal-oriented care. We will also consider how best to place older people with frailty at the heart of health and social care systems so that the complex challenges associated with this vulnerable group are addressed. PMID:26301988

  8. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, M; Perner, A; Wetterslev, J;

    2015-01-01

    frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP. CONCLUSIONS: In this international survey, most participating ICUs reported using SUP, primarily proton......BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection...

  9. Non-invasive respiratory monitoring in paediatric intensive care unit.

    Directory of Open Access Journals (Sweden)

    Nadkarni U

    2000-04-01

    Full Text Available Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU, as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2 and transcutaneous PCO2 (PtcCO2 using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Considering the financial and maintenance constraints pulse oximetry with end tidal CO2 monitoring can be considered as most feasible.

  10. Overview of Accountable Care Organizations for Oncology Specialists

    OpenAIRE

    Mehta, Anish J.; Macklis, Roger M.

    2013-01-01

    The authors review the economic factors leading to the growth of accountable care organizations and describe how oncology specialists may participate in the model to ensure success for physicians and patients.

  11. 76 FR 35017 - United States et al. v. United Regional Health Care System; Public Comments and Response on...

    Science.gov (United States)

    2011-06-15

    ... effectively prevented insurers from contracting with United Regional's competitors (``exclusionary contracts... entry of its competitors, likely leading to higher health-care costs and higher health insurance... competitors. The Complaint sought to enjoin United Regional from entering exclusionary contracts with...

  12. Target value design: applications to newborn intensive care units.

    Science.gov (United States)

    Rybkowski, Zofia K; Shepley, Mardelle McCuskey; Ballard, H Glenn

    2012-01-01

    There is a need for greater understanding of the health impact of various design elements in neonatal intensive care units (NICUs) as well as cost-benefit information to make informed decisions about the long-term value of design decisions. This is particularly evident when design teams are considering the transition from open-bay NICUs to single-family-room (SFR) units. This paper introduces the guiding principles behind target value design (TVD)-a price-led design methodology that is gaining acceptance in healthcare facility design within the Lean construction methodology. The paper also discusses the role that set-based design plays in TVD and its application to NICUs.

  13. Target value design: applications to newborn intensive care units.

    Science.gov (United States)

    Rybkowski, Zofia K; Shepley, Mardelle McCuskey; Ballard, H Glenn

    2012-01-01

    There is a need for greater understanding of the health impact of various design elements in neonatal intensive care units (NICUs) as well as cost-benefit information to make informed decisions about the long-term value of design decisions. This is particularly evident when design teams are considering the transition from open-bay NICUs to single-family-room (SFR) units. This paper introduces the guiding principles behind target value design (TVD)-a price-led design methodology that is gaining acceptance in healthcare facility design within the Lean construction methodology. The paper also discusses the role that set-based design plays in TVD and its application to NICUs. PMID:23224803

  14. Health Literacy and Communication Quality in Health Care Organizations

    OpenAIRE

    Wynia, Matthew K; Osborn, Chandra Y.

    2010-01-01

    The relationship between limited health literacy and poor health may be due to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. O...

  15. Arterial pulmonary hypertension in noncardiac intensive care unit

    Directory of Open Access Journals (Sweden)

    Mykola V Tsapenko

    2008-10-01

    Full Text Available Mykola V Tsapenko1,5, Arseniy V Tsapenko2, Thomas BO Comfere3,5, Girish K Mour1,5, Sunil V Mankad4, Ognjen Gajic1,51Division of Pulmonary and Critical Care Medicine; 3Division of Critical Care Medicine; 4Division of Cardiovascular Diseases, Mayo Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C, Mayo Clinic, Rochester, MN, USA; 2Division of Pulmonary and Critical Care Medicine, Brown University, Miriam Hospital, Providence, RI, USAAbstract: Pulmonary artery pressure elevation complicates the course of many complex disorders treated in a noncardiac intensive care unit. Acute pulmonary hypertension, however, remains underdiagnosed and its treatment frequently begins only after serious complications have developed. Significant pathophysiologic differences between acute and chronic pulmonary hypertension make current classification and treatment recommendations for chronic pulmonary hypertension barely applicable to acute pulmonary hypertension. In order to clarify the terminology of acute pulmonary hypertension and distinguish it from chronic pulmonary hypertension, we provide a classification of acute pulmonary hypertension according to underlying pathophysiologic mechanisms, clinical features, natural history, and response to treatment. Based on available data, therapy of acute arterial pulmonary hypertension should generally be aimed at acutely relieving right ventricular (RV pressure overload and preventing RV dysfunction. Cases of severe acute pulmonary hypertension complicated by RV failure and systemic arterial hypotension are real clinical challenges requiring tight hemodynamic monitoring and aggressive treatment including combinations of pulmonary vasodilators, inotropic agents and systemic arterial vasoconstrictors. The choice of vasopressor and inotropes in patients with acute pulmonary hypertension should take into consideration their effects on vascular resistance and cardiac output when used alone or in

  16. [Operational Management of Multidisciplinary Organ-Based Tumor Units in Our Cancer Center].

    Science.gov (United States)

    Kato, Hiroaki; Tsujie, Masanori; Ichimura, Noriko; Yukawa, Masao; Inoue, Masatoshi

    2016-05-01

    Owing to the advances in diagnosis and treatment, it is imperative to develop a multidisciplinary approach for the management of cancer patients. In our cancer center, multidisciplinary organ-based tumor units have been organized for team medical care. These units consist of cancer specialists from multiple departments including medical oncology, surgery, radiology, histopathology, and nursing. Members of each unit regularly conduct meetings to discuss diagnostic and therapeutic aspects, as well as to report the progress of cancer patients. Co-operation with the counseling and support center, utilization of the computerized medical record system, and using brochures for advertisement, all play important roles in adequate management of multidisciplinary organ-based tumor units. PMID:27210090

  17. Quality of life and persisting symptoms in intensive care unit survivors: implications for care after discharge

    Directory of Open Access Journals (Sweden)

    Dorsett Joanna

    2009-08-01

    Full Text Available Abstract Background We assessed the quality of life of ICU survivors using SF-36 at 4 months after ICU discharge and investigated any correlation of PCS and MCS with age, illness severity and hospital or ICU length of stay. We examined the relationship between these variables, persisting physical and psychological symptoms and the perceived benefit of individual patients of follow-up. Findings For one year, adult patients admitted for multiple organ or advanced respiratory support for greater than 48 hours to a 16-bedded teaching hospital general intensive care unit were identified. Those surviving to discharge were sent a questionnaire at 4 months following ICU discharge assessing quality of life and persisting symptoms. Demographic, length of stay and illness severity data were recorded. Higher or lower scores were divided at the median value. A two-tailed Students t-test assuming equal variances was used for normally-distributed data and Mann-Whitney tests for non-parametric data. 87 of 175 questionnaires were returned (50%, but only 65 had sufficient data giving a final response rate of 37%. Elderly patients had increased MCS as compared with younger patients. The PCS was inversely related to hospital LOS. There was a significant correlation between the presence of psychological and physical symptoms and desire for follow-up. Conclusion Younger age and prolonged hospital stay are associated with lower mental or physical quality of life and may be targets for rehabilitation. Patients with persisting symptoms at 4 months view follow-up as beneficial and a simple screening questionnaire may identify those likely to attend outpatient services.

  18. Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.

    Science.gov (United States)

    Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S

    2012-01-01

    Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure.

  19. Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.

    Science.gov (United States)

    Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S

    2012-01-01

    Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure. PMID:22095668

  20. Cluster of Candida parapsilosis primary bloodstream infection in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Silva Carmem Lúcia P. da

    2001-01-01

    Full Text Available Candida parapsilosis is an increasingly important bloodstream pathogen in neonatal intensive care units (NICU. We investigated a cluster of bloodstream infections in a NICU to determine whether nosocomial transmission occurred. During a 3-day period, 3 premature infants hospitalized in the same unit presented with sepsis caused by C. parapsilosis. Electrophoretic karyotype of the organisms was performed by using pulsed field gel electrophoresis in a countour-clamped homogeneous electric field system. The isolate from 1 newborn could not be typed, and the isolates from the remaining 2 infants had identical patterns. All 3 cases are described. We conclude that nosocomial transmission of C. parapsilosis occurred and that neonates under intensive care may represent a risk group for this pathogen.

  1. Implementation of sepsis algorithm by nurses in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Paula Pedroso Peninck

    2012-04-01

    Full Text Available Sepsis is defined as a clinical syndrome consisting of a systemic inflammatory response associated to an infection, which may determine malfunction or failure of multiple organs. This research aims to verify the application of implementation of sepsis algorithm by nurses in the Intensive Care Unit and create an operational nursing assistance guide. This is an exploratory, descriptive study with quantitative approach. A data collection instrument based on relevant literature was elaborated, assessed, corrected and validated. The sample consisted of 20 intensive care unit nurses. We obtained satisfactory evaluations on nurses’ performance, but some issues did not reach 50% accuracy. We emphasize the importance of greater numbers of nurses getting acquainted and correctly applying the sepsis algorithm. Based on the above, an operational septic patient nursing assistance guide was created, based on the difficulties that arose vis-à-vis the variables applied in research and relevant literature.

  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. [Nursing care systematization at the intensive care unit (ICU) based on Wanda Horta's theory].

    Science.gov (United States)

    Amante, Lúcia Nazareth; Rossetto, Annelise Paula; Schneider, Dulcinéia Ghizoni

    2009-03-01

    The purpose of this study was to implement the Nursing Care Systematization--Sistematização da Assistência de Enfermagem (SAE)--with Wanda Aguiar Horta's Theory of Basic Human Necessities and the North American Nursing Diagnosis Association's (NANDA) Nursing Diagnosis as its references. The starting point was the evaluation of the knowledge of the nursing team about the SAE, including their participation in this process. This is a qualitative study, performed in the Intensive Care Unit in a hospital in the city of Brusque, Santa Catarina, from October, 2006 to March, 2007. It was observed that the nursing professionals know little about SAE, but they are greatly interested in learning and developing it in their daily practice. In conclusion, it was possible to execute the healthcare systematization in an easy way, with the use of simple brochures that provided all the necessary information for the qualified development of nursing care.

  4. [Treatment in the Intensive Care Unit: continue or withdraw?].

    Science.gov (United States)

    Savelkoul, Claudia; de Graeff, Nienke; Kompanje, Erwin J O; Tjan, Dave H T

    2016-01-01

    End-of-life decision-making in the Intensive Care Unit is a common and complex process. The step-by-step process of decision-making leading to withdrawal of life-sustaining treatment is illustrated in this paper by a clinical case. A variety of factors influences the decision to adjust the initial curative treatment policy towards withdrawal of life-sustaining therapy and the pursuit of comfort care. For a smooth decision-making process, it is necessary to make a prognosis and obtain consensus amongst the healthcare team. Withdrawal of life-sustaining treatment is ultimately a medical decision and a consensual decision should be reached by all medical staff and nurses, and preferably also by the patient and family. Timely involvement of a legal representative of the patient is essential for an uncomplicated decision-making process. Advance care planning and advance directives provide opportunities for patients to express their preferences beforehand. It is important to realise that end-of-life decisions are significantly influenced by personal and cultural values. PMID:27050494

  5. Let Them In: Family Presence during Intensive Care Unit Procedures.

    Science.gov (United States)

    Beesley, Sarah J; Hopkins, Ramona O; Francis, Leslie; Chapman, Diane; Johnson, Joclynn; Johnson, Nathanael; Brown, Samuel M

    2016-07-01

    Families have for decades advocated for full access to intensive care units (ICUs) and meaningful partnership with clinicians, resulting in gradual improvements in family access and collaboration with ICU clinicians. Despite such advances, family members in adult ICUs are still commonly asked to leave the patient's room during invasive bedside procedures, regardless of whether the patient would prefer family to be present. Physicians may be resistant to having family members at the bedside due to concerns about trainee education, medicolegal implications, possible effects on the technical quality of procedures due to distractions, and procedural sterility. Limited evidence from parallel settings does not support these concerns. Family presence during ICU procedures, when the patient and family member both desire it, fulfills the mandates of patient-centered care. We anticipate that such inclusion will increase family engagement, improve patient and family satisfaction, and may, on the basis of studies of open visitation, pediatric ICU experience, and family presence during cardiopulmonary resuscitation, decrease psychological distress in patients and family members. We believe these goals can be achieved without compromising the quality of patient care, increasing provider burden significantly, or increasing risks of litigation. In this article, we weigh current evidence, consider historical objections to family presence at ICU procedures, and report our clinical experience with the practice. An outline for implementing family procedural presence in the ICU is also presented. PMID:27104301

  6. Central nervous system infections in the intensive care unit

    Directory of Open Access Journals (Sweden)

    B. Vengamma

    2014-04-01

    Full Text Available Neurological infections constitute an uncommon, but important aetiological cause requiring admission to an intensive care unit (ICU. In addition, health-care associated neurological infections may develop in critically ill patients admitted to an ICU for other indications. Central nervous system infections can develop as complications in ICU patients including post-operative neurosurgical patients. While bacterial infections are the most common cause, mycobacterial and fungal infections are also frequently encountered. Delay in institution of specific treatment is considered to be the single most important poor prognostic factor. Empirical antibiotic therapy must be initiated while awaiting specific culture and sensitivity results. Choice of empirical antimicrobial therapy should take into consideration the most likely pathogens involved, locally prevalent drug-resistance patterns, underlying predisposing, co-morbid conditions, and other factors, such as age, immune status. Further, the antibiotic should adequately penetrate the blood-brain and blood- cerebrospinal fluid barriers. The presence of a focal collection of pus warrants immediate surgical drainage. Following strict aseptic precautions during surgery, hand-hygiene and care of catheters, devices constitute important preventive measures. A high index of clinical suspicion and aggressive efforts at identification of aetiological cause and early institution of specific treatment in patients with neurological infections can be life saving.

  7. The importance of parents in the neonatal intensive care units

    Directory of Open Access Journals (Sweden)

    Hercília Guimarães

    2015-10-01

    Full Text Available The premature birth and the hospitalization in a neonatal intensive care unit (NICU are potential risk factors for the development and behavior of the newborn, as has been shown in recent studies. Premature birth of an infant is a distressing event for the family. Several feelings are experienced by parents during hospitalization of their baby in the NICU. Feelings of guilt, rejection, stress and anxiety are common. Also the attachment processes have the potential to be disrupted or delayed as a result of the initial separation of the premature newborn and the mother after the admission to the NICU. Added to these difficulties, there is the distortion of infant’s “ideal image”, created by the family, in contrast with the real image of the preterm. This relationship-based family-centered approach, the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP, promotes the idea that infants and their families are collaborators in developing an individualized program to maximize physical, mental, and emotional growth and health and to improve long-term outcomes for the high risk newborns. The presence of parents in NICUs and their involvement caring their babies, in a family centered care philosophy, is vital to improve the outcome of their infants and the relationships within each family. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA

  8. Israeli breast care nurses as a learning organization

    Directory of Open Access Journals (Sweden)

    Ilana Kadmon

    2015-01-01

    Full Text Available This article will look at the theory of a Learning Organization as described by Senge and the Israeli Breast Care Nurses as an example. A description of the theory of a Learning Organization, the role of the Breast Care Nurses in Israel and the relation between the two will be described. Since 1996, the role of the Breast Care Nurse was founded in Israel. At that time, the role with its importance was very hard to be recognized by the health care team and other professionals of the multidisciplinary team for breast cancer patients. Since the role was initiated, it had been developing all over Israel through the support given by the Israel Cancer Association. As a learning organization, the Breast Care Nurses have a few goals: To learn to give patients the most updated and relevant information; to be a part and be seen as equal as the other members of the multidisciplinary team for breast cancer patients; to have knowledge which empowers them as a working group; to enable to teach students, mainly nursing students, in basic and further education and to help continually teach a new generation of nurses. This learning organization involves some formal and informal education. Although oncology nurses do much of the ideas we have described, we suggest using a strict model to help in implementing a Learning Organization. Future research can examine the outcomes of a Learning Organization on oncology nursing.

  9. Chromatin Domains: The Unit of Chromosome Organization.

    Science.gov (United States)

    Dixon, Jesse R; Gorkin, David U; Ren, Bing

    2016-06-01

    How eukaryotic chromosomes fold inside the nucleus is an age-old question that remains unanswered today. Early biochemical and microscopic studies revealed the existence of chromatin domains and loops as a pervasive feature of interphase chromosomes, but the biological implications of such organizational features were obscure. Genome-wide analysis of pair-wise chromatin interactions using chromatin conformation capture (3C)-based techniques has shed new light on the organization of chromosomes in interphase nuclei. Particularly, the finding of cell-type invariant, evolutionarily conserved topologically associating domains (TADs) in a broad spectrum of cell types has provided a new molecular framework for the study of animal development and human diseases. Here, we review recent progress in characterization of such chromatin domains and delineation of mechanisms of their formation in animal cells. PMID:27259200

  10. [Resistance of hospital flora to imipenem. Experience in two intensive care units].

    Science.gov (United States)

    Hamon-Poupinel, V; Le Coutour, X; Vergnaud, M; Malbruny, B

    1991-10-19

    Imipenem is a beta-lactam antibiotic active against most Gram-negative bacilli. Between July 1, 1987 and September 30, 1989 (9 semesters), the activity of imipenem against 6 micro-organisms was tested in two intensive care units attached to the university hospital of Caen (Normandy). During the same period, the consumption of imipenem was evaluated from the number of vials drawn by each of these two units from the central pharmacy. Imipenem was found to be 100 percent effective against 5 of the 6 micro-organisms tested, but transient falls in sensitivity and an increase in imipenem consumption were observed when Pseudomonas aeruginosa was the pathogen. The most probable cause of these transient decreases of imipenem activity against Ps. aeruginosa was the existence of a resistant strain which showed a protein abnormality in its outer membrane by temporary selection pressure.

  11. Predicting SOA from organic nitrates in the southeastern United States

    Science.gov (United States)

    Organic nitrates have been identified as an important component of ambient aerosol in the Southeast United States. In this work, we use the Community Multiscale Air Quality (CMAQ) model to explore the relationship between gas-phase production of organic nitrates and their subsequ...

  12. Optimal physicians schedule in an Intensive Care Unit

    Science.gov (United States)

    Hidri, L.; Labidi, M.

    2016-05-01

    In this paper, we consider a case study for the problem of physicians scheduling in an Intensive Care Unit (ICU). The objective is to minimize the total overtime under complex constraints. The considered ICU is composed of three buildings and the physicians are divided accordingly into six teams. The workload is assigned to each team under a set of constraints. The studied problem is composed of two simultaneous phases: composing teams and assigning the workload to each one of them. This constitutes an additional major hardness compared to the two phase's process: composing teams and after that assigning the workload. The physicians schedule in this ICU is used to be done manually each month. In this work, the studied physician scheduling problem is formulated as an integer linear program and solved optimally using state of the art software. The preliminary experimental results show that 50% of the overtime can be saved.

  13. End-of-life decisions in the intensive care unit

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene

    2012-01-01

    Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...... regarding considerations of: o What should induce withholding or withdrawing therapy. o The multidisciplinary collaboration regarding end-of-life decisions. o Interventions that may improve collaboration and decision-making. • Examine and evaluate different methods to improve interdisciplinary collaboration...... and decision-making. Hypotheses • Nurses, intensivists, and primary physicians have different experiences of interdisciplinary collaboration regarding end-of-life decision-making in the ICU. • Specific interventions targeting end-of-life decision-making in the ICU, such as interdisciplinary audits...

  14. Chest roentgenology in the intensive care unit: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Maffessanti, M. [Istituto di Radiologia, Universita di Trieste, Ospedale di Cattinara, I-34 100 Trieste (Italy); Berlot, G. [Istituto di Anestesia e Rianimazione, Universita di Trieste, Ospedale di Cattinara, I-34 100 Trieste (Italy); Bortolotto, P. [Servizio di Radiologia, Ospedale Maggiore, I-34 100 Trieste (Italy)

    1998-02-01

    Chest roentgenology in the intensive care unit is a real challenge for the general radiologist. Beyond the basic disease, the critically ill is at risk for developing specific cardiopulmonary disorders, all presenting as chest opacities, their diagnosis often being impossible if based only on the radiological aspect. To make things harder, their appearance can vary with the subject`s position and the mechanical ventilation. Patients require a continuous monitoring of the vital functions and their mechanical and pharmacological support, for which they are connected to different instruments. The radiologist should know the normal position of these devices, and promptly recognize when they are misplaced or when complications from their insertion occurred. Our aim is to suggest for each of the above-mentioned conditions a guideline of interpretation based not only on the radiological aspect and distribution of the lesions, but also on the physiopathological and clinical grounds. (orig.) With 13 figs., 58 refs.

  15. Difficult airway management from Emergency Department till Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Debasis Pradhan

    2015-01-01

    Full Text Available We report a case of "can ventilate but can′t intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don′t struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.

  16. Peripartum Cardiomyopathy in Intensive Care Unit: An Update

    Science.gov (United States)

    Dinic, Vesna; Markovic, Danica; Savic, Nenad; Kutlesic, Marija; Jankovic, Radmilo J.

    2015-01-01

    Peripartum cardiomyopathy (PPCM) is a systolic heart failure that occurs during the last month of pregnancy or within 5 months after delivery. It is an uncommon disease of unknown etiopathogenesis and has a very high rate of maternal mortality. Because of similarity between symptoms of PPCM and physiological discomforts during pregnancy, the early diagnosis of PPCM presents a major challenge. Since hemodynamic changes during PPCM can vitally jeopardize the mother and the fetus, patients with severe forms of PPCM require a multidisciplinary approach in intensive care units. This review summarizes the current state of knowledge about the diagnosis, monitoring, and the treatment of PPCM. Having reviewed the recent researches, it gives insight into the new treatment strategies of this rare disease. PMID:26636086

  17. Acute renal failure in the intensive care unit.

    Science.gov (United States)

    Weisbord, Steven D; Palevsky, Paul M

    2006-06-01

    Acute renal failure (ARF) is a common complication in critically ill patients, with ARF requiring renal replacement therapy (RRT) developing in approximately 5 to 10% of intensive care unit (ICU) patients. Epidemiological studies have demonstrated that ARF is an independent risk factor for mortality. Interventions to prevent the development of ARF are currently limited to a small number of settings, primarily radiocontrast nephropathy and rhabdomyolysis. There are no effective pharmacological agents for the treatment of established ARF. Renal replacement therapy remains the primary treatment for patients with severe ARF; however, the data guiding selection of modality of RRT and the optimal timing of initiation and dose of therapy are inconclusive. This review focuses on the epidemiology and diagnostic approach to ARF in the ICU and summarizes our current understanding of therapeutic approaches including RRT.

  18. Supporting Neonatal Intensive Care Unit Parents Through Social Media.

    Science.gov (United States)

    Dzubaty, Dolores R

    2016-01-01

    Parents of infants in the neonatal intensive care unit may often find themselves seeking healthcare information from online and social media sources. Social media applications are available to healthcare consumers and their families, as well as healthcare providers, in a variety of formats. Information that parents gather on their own, and information that is explained by providers, is then used when parents make healthcare decisions regarding their infants. Parents also seek support from peers and family while making healthcare decisions. The combination of knowledge obtained and social support given may empower the parent to feel more confident in their decision making. Healthcare professionals can guide parents to credible resources. The exchange of information between providers and parents can occur using a variety of communication methods. Misperceptions can be corrected, support given, open sharing of information occurs, and parent empowerment may result. PMID:27465452

  19. MRSA infection in the neonatal intensive care unit.

    Science.gov (United States)

    Giuffrè, Mario; Bonura, Celestino; Cipolla, Domenico; Mammina, Caterina

    2013-05-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is well known as one of the most frequent etiological agents of healthcare-associated infections. The epidemiology of MRSA is evolving with emergence of community-associated MRSA, the clonal spread of some successful clones, their spillover into healthcare settings and acquisition of antibacterial drug resistances. Neonatal intensive care unit (NICU) patients are at an especially high risk of acquiring colonization and infection by MRSA. Epidemiology of MRSA in NICU can be very complex because outbreaks can overlap endemic circulation and make it difficult to trace transmission routes. Moreover, increasing prevalence of community-associated MRSA can jeopardize epidemiological investigation, screening and effectiveness of control policies. Surveillance, prevention and control strategies and clinical management have been widely studied and are still the subject of scientific debate. More data are needed to determine the most cost-effective approach to MRSA control in NICU in light of the local epidemiology.

  20. Modes of death in neonatal intensive care units.

    LENUS (Irish Health Repository)

    Finan, E

    2006-04-01

    With the ever-increasing availability of aggressive medical treatment and technical support, neonatologists are offered an increasing ability to prolong life. While "end-of-life" decisions within NICUs have been studied internationally, there is limited data available for Ireland. Through the auspices of the Irish Faculty of Paediatrics 2002 Neonatal Mortality Ouestionnaire, decisions made around the time of death in Irish Neonatal Intensive Care Units were examined. The overall response rate to the questionnaire was 96% (n=25). One hundred and eighty seven deaths were reported for 2002. Information pertaining to the mode of death was available in 53% of cases. Seventy seven percent of those paediatricians who answered this question, reported either withdrawing or withholding treatment in babies thought to have a hopeless outcome, with the greatest proportion of these deaths occurring in premature infants (n=30) and babies with congenital defects (n=40).

  1. Heart rate dynamics preceding hemorrhage in the intensive care unit.

    Science.gov (United States)

    Moss, Travis J; Clark, Matthew T; Lake, Douglas E; Moorman, J Randall; Calland, J Forrest

    2015-01-01

    Occult hemorrhage in surgical/trauma intensive care unit (STICU) patients is common and may lead to circulatory collapse. Continuous electrocardiography (ECG) monitoring may allow for early identification and treatment, and could improve outcomes. We studied 4,259 consecutive admissions to the STICU at the University of Virginia Health System. We collected ECG waveform data captured by bedside monitors and calculated linear and non-linear measures of the RR interbeat intervals. We tested the hypothesis that a transfusion requirement of 3 or more PRBC transfusions in a 24 hour period is preceded by dynamical changes in these heart rate measures and performed logistic regression modeling. We identified 308 hemorrhage events. A multivariate model including heart rate, standard deviation of the RR intervals, detrended fluctuation analysis, and local dynamics density had a C-statistic of 0.62. Earlier detection of hemorrhage might improve outcomes by allowing earlier resuscitation in STICU patients. PMID:26342251

  2. Pilot Study of Behavioral Treatment in Dementia Care Units.(practice Concepts)(author Abstract)

    Science.gov (United States)

    Lichtenberg, Peter A.; Kemp-Havican, Julie; MacNeill, Susan E.; Johnson, Amanda Schafer

    2005-01-01

    Purpose: This article reports on the development and use of behavioral treatment as a well-being intervention for individuals with dementia residing at special care units in a nursing home. Design and Methods: The project took place upon the construction and opening of two new homelike units for dementia care in a rural community-care center.…

  3. Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

    Science.gov (United States)

    Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

    2010-01-01

    Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

  4. Ethics of drug research in the pediatric intensive care unit.

    Science.gov (United States)

    Kleiber, Niina; Tromp, Krista; Mooij, Miriam G; van de Vathorst, Suzanne; Tibboel, Dick; de Wildt, Saskia N

    2015-02-01

    Critical illness and treatment modalities change pharmacokinetics and pharmacodynamics of medications used in critically ill children, in addition to age-related changes in drug disposition and effect. Hence, to ensure effective and safe drug therapy, research in this population is urgently needed. However, conducting research in the vulnerable population of the pediatric intensive care unit (PICU) presents with ethical challenges. This article addresses the main ethical issues specific to drug research in these critically ill children and proposes several solutions. The extraordinary environment of the PICU raises specific challenges to the design and conduct of research. The need for proxy consent of parents (or legal guardians) and the stress-inducing physical environment may threaten informed consent. The informed consent process is challenging because emergency research reduces or even eliminates the time to seek consent. Moreover, parental anxiety may impede adequate understanding and generate misconceptions. Alternative forms of consent have been developed taking into account the unpredictable reality of the acute critical care environment. As with any research in children, the burden and risk should be minimized. Recent developments in sample collection and analysis as well as pharmacokinetic analysis should be considered in the design of studies. Despite the difficulties inherent to drug research in critically ill children, methods are available to conduct ethically sound research resulting in relevant and generalizable data. This should motivate the PICU community to commit to drug research to ultimately provide the right drug at the right dose for every individual child.

  5. Bedside Diagnosis in the Intensive Care Unit. Is Looking Overlooked?

    Science.gov (United States)

    Metkus, Thomas S; Kim, Bo Soo

    2015-10-01

    Bedside diagnosis, including but not limited to the physical examination, can be lifesaving in the setting of critical illness and is a core competency in both medical school and at the postgraduate level. Data as to the clinical usefulness of bedside diagnosis in the modern intensive care unit (ICU) is sparse, however, and there are no clinical guidelines addressing performance, interpretation, and usefulness of the bedside assessment in critically ill patients. Bedside assessment and physical examination are used in a heterogeneous manner across institutions and even across ICUs within the same institution, which has implications for medical education, patient care, and the overuse/misuse of diagnostic testing. In this commentary, we review the existing data addressing bedside diagnosis in the ICU, describe various models of bedside assessment use in the ICU based on our clinical practice and on the limited evidence base, share our practical "checklist-based" approach to bedside assessment in the critically ill patient, and advocate for more formal study of physical examination and bedside assessment in the ICU to enhance clinical practice. PMID:26389653

  6. Quality improvement in radiography in a neonatal intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Loovere, L.; Boyle, E.M. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada); Blatz, S. [Dept. of Pediactrics, McMaster Children' s Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Bowslaugh, M.; Kereliuk, M. [Dept. of Radiology, Diagnostic Imaging, Hamilton Health Sciences, Hamilton, Ontario (Canada); Paes, B. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada)], E-mail: paes@mcmaster.ca

    2008-10-15

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  7. Quality improvement in radiography in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  8. Conflict across organizational boundaries: managed care organizations versus health care providers.

    Science.gov (United States)

    Callister, R R; Wall, J A

    2001-08-01

    This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions.

  9. Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Mohammad Feroz Azfar

    2013-01-01

    Full Text Available Background: Eye care is an essential component in the management of critically ill patients. Standardized eye care can prevent corneal complications in ventilated patients. Objective: This study was designed to compare old and new practices of corneal care for reduction in corneal complications in ventilated patients. Methods: This study was done in three phases each of six month duration. Phase 1 was the ongoing practice of eye care in the unit. Before the start of phase 2, a new protocol was made for eye care. Corneal complications were observed in terms of haziness, dryness, and ulceration. All nursing staffs were educated and made compliant with the new protocol. In phase 2, a follow-up audit was done to check the effectiveness and compliance to protocol. In phase 3, a follow-up audit was started 3 months after phase 2. Results: In phase 1, total ventilated patients were 40 with 240 ventilator days. The corneal dryness rate was 40 per 1000 ventilator days while the haziness and ulceration rate was 16 per 1000 ventilator days each. In the second phase 2, total ventilated patients were 53 making 561 ventilator days. The rate of corneal haziness and dryness was 3.52 and 1.78 per 1000 ventilator days, respectively, with no case of corneal ulceration. In phase 3, the number of ventilated patients was 91 with 1114 ventilator days. The corneal dryness rate was 2.69 while the haziness and ulceration rate was 1.79 each. Conclusion: Protocolized eye care can reduce the risk of corneal complications in ventilated patients.

  10. Expanded Organic Building Units for the Construction of Highly Porous Metal-Organic Frameworks

    NARCIS (Netherlands)

    G.Q. Kong; Z.D. Han; Y. He; S. Qu; W. Zhou; T. Yildirim; R. Krishna; C. Zou; B. Chen; C.D. Wu

    2013-01-01

    wo new organic building units that contain dicarboxylate sites for their self-assembly with paddlewheel [Cu2(CO2)4] units have been successfully developed to construct two isoreticular porous metal-organic frameworks (MOFs), ZJU-35 and ZJU-36, which have the same tbo topologies (Reticular Chemistry

  11. Implementing nutrition diagnosis at a multisite health care organization.

    Science.gov (United States)

    Van Heukelom, Holly; Fraser, Valli; Koh, Jiak-Chin; McQueen, Kay; Vogt, Kara; Johnson, Frances

    2011-01-01

    The American Dietetic Association Nutrition Care Process (NCP) is designed to improve patient care and interdisciplinary communication through the consistent use of standardized nutrition language. Supported by Dietitians of Canada, the NCP has been gaining prominence across Canada. In spring 2009, registered dietitians at Providence Health Care, an academic, multisite health care organization in Vancouver, British Columbia, began using the NCP with a focus on nutrition diagnosis. The success of nutrition diagnosis at Providence Health Care has depended on support from the Clinical Nutrition Department leadership, commitment from the NCP champions, regularly scheduled lunch-and-learn sessions, revised nutrition assessment forms with a section for nutrition diagnosis statements, and the Pocket Guide for International Dietetics & Nutrition Terminology (IDNT) Reference Manual. Audit results from June through August 2010 showed a 92% nutrition diagnosis completion rate for acute-care and long-term care sites within Providence Health Care. Ongoing audits will be used to evaluate the accuracy and quality of nutrition diagnosis statements. This evaluation will allow Providence Health Care dietitians to move forward with nutrition intervention.

  12. Accountable Care Organizations in the Era of Healthcare Reform

    OpenAIRE

    2010-01-01

    Under the Patient Protection and Affordable Care Act (PPACA) of 2010, Medicare providers, including physician groups and hospitals, will soon have the option to form accountable care organizations (ACOs) to improve quality and efficiency. ACO participants may share financial gains generated from improved clinical and economic performance, provided that quality goals and patient safeguards are met. Through future regulations, the Centers for Medicare & Medicaid Services (CMS) must implement th...

  13. Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Sachin Logani

    2011-01-01

    Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

  14. Bloodstream Infections in a Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mehmet Sah Ižpek

    2014-12-01

    Full Text Available Aim: To determine the pattern of bloodstream infections (BSIs and antimicrobial susceptibility of pathogens in a neonatal intensive care unit (NICU.Material and Method: Positive hemoculture of neonates diagnosed with nosocomial sepsis from March 2011 to March 2014 in the NICU of Diyarbakir Maternity and Children%u2019s Hospital, in the southeastern region of Anatolia, Turkey, were retrospectively reviewed. Results: A total of 148 pathogens were isolated in 142 neonates. The most common microorganisms isolated were Klebsiella pneumoniae (40.5% and Acinetobacter baumannii (29.7% which was a result of a hospital outbreak. Multi-drug resistant (MDR strains accounted for 20.0% of K. pneumoniae isolates and 93.2% of A. baumannii isolates. The sepsis-attributable mortality rate was higher in cases infected with MDR strains than in cases infected without MDR strains or Candida spp (24% vs. 9.7%, p=0.032. Discussion: In our unit, BSIs were more often caused by Gram negative bacteria. BSIs caused by MDR strains were associated with a higher rate of sepsis-attributable mortality.

  15. Patient perception of pain care in hospitals in the United States

    Directory of Open Access Journals (Sweden)

    Anita Gupta

    2009-11-01

    Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

  16. Primary care and ophthalmology in the United Kingdom

    OpenAIRE

    Riad, S F; Dart, J K G; Cooling, R J

    2003-01-01

    The National Health Service is now primary care led. There are different definitions for primary care and in this review they are analysed and related to ophthalmology to produce a working definition for ophthalmic primary care, summarised as the provision of first contact care for all ophthalmic conditions and follow up, preventive, and rehabilitative care of selected ophthalmic conditions, in a variety of settings, by a diverse workforce. The attributes of primary care are first contact, ac...

  17. Design of an Innovative Information System for the Intensive Care Unit in a Public Hospital.

    Science.gov (United States)

    Tsoromokos, Dimitrios; Tsaloukidis, Nikolaos; Dermatis, Zacharias; Gozadinos, Filippos; Lazakidou, Athina

    2016-01-01

    The health sector is increasingly focused on the use of Communication Technology (ICT) Information and Communication. New technologies which introduced in health, should lead to lower cost of procedures, saving employees' working time and immediate and secure data storages for easy future search or meta-analysis. The DPP4ICU application which presented in this document, allows at the Intensive Care Unit's nurses (ICU) to enter directly the handwritten accountability, in the Organization Information System. Through this application is accelerated the proper completion of a document and is improved data quality. The application provides the ability to authorized users to exchange information with an automated manner.

  18. Design of an Innovative Information System for the Intensive Care Unit in a Public Hospital.

    Science.gov (United States)

    Tsoromokos, Dimitrios; Tsaloukidis, Nikolaos; Dermatis, Zacharias; Gozadinos, Filippos; Lazakidou, Athina

    2016-01-01

    The health sector is increasingly focused on the use of Communication Technology (ICT) Information and Communication. New technologies which introduced in health, should lead to lower cost of procedures, saving employees' working time and immediate and secure data storages for easy future search or meta-analysis. The DPP4ICU application which presented in this document, allows at the Intensive Care Unit's nurses (ICU) to enter directly the handwritten accountability, in the Organization Information System. Through this application is accelerated the proper completion of a document and is improved data quality. The application provides the ability to authorized users to exchange information with an automated manner. PMID:27350492

  19. Pediatric medication errors in the postanesthesia care unit: analysis of MEDMARX data.

    Science.gov (United States)

    Payne, Christopher H; Smith, Christopher R; Newkirk, Laura E; Hicks, Rodney W

    2007-04-01

    Medication errors involving pediatric patients in the postanesthesia care unit may occur as frequently as one in every 20 medication orders and are more likely to cause harm when compared to medication errors in the overall population. Researchers examined six years of records from the MEDMARX database and used consecutive nonprobability sampling and descriptive statistics to compare medication errors in the pediatric data set to those occurring in the total population data set. Nineteen different causes of error involving 28 different products were identified. The results of the study indicate that an organization can focus on causes of errors and products involved in errors to mitigate future error occurrence.

  20. Full-cost determination of different levels of care in the intensive care unit. An activity-based costing approach.

    Science.gov (United States)

    Doyle, J J; Casciano, J P; Arikian, S R; Mauskopf, J; Paul, J E

    1996-10-01

    We applied an activity-based costing methodology to determine the full cost of intensive care service at a community hospital, a university hospital and a health maintenance organisation (HMO)-affiliated hospital. A total of 5 patient care units were analysed: the intensive care unit (ICU) and surgical ICU (SICU) at the university setting, the ICU at the community setting, and the SICU and cardiac care unit at the HMO setting. The selection of the different ICU types was based on the types of critical care units that were found in each setting (e.g. the HMO did not have an ICU). Institution-specific cost data and clinical management parameters were collected through surveys and site visits from the 3 respective organisation types. The analysis revealed a marked increase in patient-minute cost associated with mechanical ventilation. Higher costs associated with prolonged neuromuscular blockade have important economic implications with respect to selection of an appropriate neuromuscular blocking agent.

  1. Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany.

    Science.gov (United States)

    Holm-Pedersen, Poul; Vigild, Merete; Nitschke, Ina; Berkey, Douglas B

    2005-09-01

    This article reviews access to and financing of dental care for aging populations in selected nations in Europe. Old age per se does not seem to be a major factor in determining the use of dental services. Dentition status, on the other hand, is a major determinant of dental attendance. In addition to perceived need, a variety of social and behavioral factors as well as general health factors have been identified as determinants of dental service use. Frail and functionally dependent elderly have special difficulties in accessing dental care; private dental practitioners are hesitant to provide dental care to these patients. One reason may be that the fee for treating these patients is too low, considering high dental office expenses. Another reason may be problems related to management of medically compromised patients. This raises an important question: does inadequate training in geriatric dentistry discourage dentists from seeking opportunities to treat geriatric patients? Overall, the availability of dental services, the organization of the dental health care delivery system, and price subsidy for dental treatment are important factors influencing access to dental care among older people in Europe as well as in the United States. PMID:16141084

  2. Oral care practices for patients in Intensive Care Units: A pilot survey

    Directory of Open Access Journals (Sweden)

    Alexandre Franco Miranda

    2016-01-01

    Full Text Available Objective: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs. Study Population and Methods: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages. A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. Results: Most participants were nursing professionals (80.3% working 12-h shifts in the ICU (70.4%; about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05. Most reported using spatulas, gauze, and toothbrushes (49.3% or only toothbrushes (28.2% with 0.12% chlorhexidine (49.3% to sanitize the oral cavity of ICU patients (P < 0.01. Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05. However, most professionals (56.4% reported feeling that the oral cavity was difficult to clean (P < 0.05. Conclusion: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.

  3. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    OpenAIRE

    Leppert, Wojciech; Majkowicz, Mikolaj; Forycka, Maria; Mess, Eleonora; Zdun-Ryzewska, Agata

    2014-01-01

    Aim of the study To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care center (DCC). Patients and methods QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL), the Edmonton Symptom Assessment System (ESAS), and the Karnofsky Perfor...

  4. Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

    Science.gov (United States)

    Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

    2015-01-01

    Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers.

  5. Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

    Science.gov (United States)

    Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

    2015-01-01

    Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. PMID:25862425

  6. 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

  7. Protocol on the constipation in an oncology palliative care unit

    Directory of Open Access Journals (Sweden)

    Montserrat Cordero Ponce

    2008-07-01

    Full Text Available Constipation is a problem relatively common even in healthy people, mainly in the western world, influenced mainly by the nutritional diets and the diminution of the physical activity. It is a symptom of difficult valuation by its subjective nature and the difficulty to establish a normality pattern.The incidence is high. It is observed in a 70 - 80% of the patients in terminal situation, the 40 - 50% of the patients with disease outpost and in 90% of the patients dealing with opiate.As nurses in of a palliative care unit we detected the high number of patients which they present/display the symptom and the time that takes in its diagnose and treatment, increasing the incidence-appearance of fecal impactación and intestinal obstruction. It is one of the symptoms that worry to our patients more.We take too frequently the “rectal measures,” being more painful and a little shameful for these patients, instead of using preventive measures, precocious oral treatment and continuous evaluation of the symptom. The knowledge that these patients have of the constipation is in many deficient cases. In order to be able to educate and to take care of to the oncology terminal patient in terminal state with constipation it is essential that we know its physiopathology, causes and complications. Also we will deepen in the most suitable treatment according to the consistency, the effort that the patient must make when defecating and the symptoms that presents/displays, trying that the treatment is customized and individual, although starting off of a previous protocol of performance decided by the health professionals who are going to treat the patient.

  8. Hemodynamic monitoring in the intensive care unit: a Brazilian perspective

    Science.gov (United States)

    Dias, Fernando Suparregui; Rezende, Ederlon Alves de Carvalho; Mendes, Ciro Leite; Silva Jr., João Manoel; Sanches, Joel Lyra

    2014-01-01

    Objective In Brazil, there are no data on the preferences of intensivists regarding hemodynamic monitoring methods. The present study aimed to identify the methods used by national intensivists, the hemodynamic variables they consider important, the regional differences, the reasons for choosing a particular method, and the use of protocols and continued training. Methods National intensivists were invited to answer an electronic questionnaire during three intensive care events and later, through the Associação de Medicina Intensiva Brasileira portal, between March and October 2009. Demographic data and aspects related to the respondent preferences regarding hemodynamic monitoring were researched. Results In total, 211 professionals answered the questionnaire. Private hospitals showed higher availability of resources for hemodynamic monitoring than did public institutions. The pulmonary artery catheter was considered the most trusted by 56.9% of the respondents, followed by echocardiograms, at 22.3%. Cardiac output was considered the most important variable. Other variables also considered relevant were mixed/central venous oxygen saturation, pulmonary artery occlusion pressure, and right ventricular end-diastolic volume. Echocardiography was the most used method (64.5%), followed by pulmonary artery catheter (49.3%). Only half of respondents used treatment protocols, and 25% worked in continuing education programs in hemodynamic monitoring. Conclusion Hemodynamic monitoring has a greater availability in intensive care units of private institutions in Brazil. Echocardiography was the most used monitoring method, but the pulmonary artery catheter remains the most reliable. The implementation of treatment protocols and continuing education programs in hemodynamic monitoring in Brazil is still insufficient. PMID:25607264

  9. Attitude of resident doctors towards intensive care units' alarm settings.

    Science.gov (United States)

    Garg, Rakesh; Bhalotra, Anju R; Goel, Nitesh; Pruthi, Amit; Bhadoria, Poonam; Anand, Raktima

    2010-11-01

    Intensive care unit (ICU) monitors have alarm options to intimate the staff of critical incidents but these alarms needs to be adjusted in every patient. With this objective in mind, this study was done among resident doctors, with the aim of assessing the existing attitude among resident doctors towards ICU alarm settings. This study was conducted among residents working at ICU of a multispeciality centre, with the help of a printed questionnaire. The study involved 80 residents. All residents were in full agreement on routine use of ECG, pulse oximeter, capnograph and NIBP monitoring. 86% residents realised the necessity of monitoring oxygen concentration, apnoea monitoring and expired minute ventilation monitoring. 87% PGs and 70% SRs routinely checked alarm limits for various parameters. 50% PGs and 46.6% SRs set these alarm limits. The initial response to an alarm among all the residents was to disable the alarm temporarily and try to look for a cause. 92% of PGs and 98% of SRs were aware of alarms priority and colour coding. 55% residents believed that the alarm occurred due to patient disturbance, 15% believed that alarm was due to technical problem with monitor/sensor and 30% thought it was truly related to patient's clinical status. 82% residents set the alarms by themselves, 10% believed that alarms should be adjusted by nurse, 4% believed the technical staff should take responsibility of setting alarm limits and 4% believed that alarm levels should be pre-adjusted by the manufacturer. We conclude that although alarms are an important, indispensable, and lifesaving feature, they can be a nuisance and can compromise quality and safety of care by frequent false positive alarms. We should be familiar of the alarm modes, check and reset the alarm settings at regular interval or after a change in clinical status of the patient. PMID:21224968

  10. Acinetobacter infections as an emerging threat in intensive care units

    International Nuclear Information System (INIS)

    Nosocomial infections caused by Acinetobacter species (Spp.) is an emerging threat in health care setups especially intensive care units (ICU). The objective of this observational study was to determine the pattern of Acinetobacter infections and its association with length of stay in patients admitted to our medical ICU from January to August 2011. Methods: All patients above 16 years of age with stay of more than 48 hours were checked for any development of new infections not present or incubating at the time of admission. Nosocomial infections were documented in the light of clinical findings and lab results. Data was analysed using statistical software SPSS 15.0. Results: A total of 146 patients had a stay of at least 48 hours; frequency of nosocomial infection was 30.8% out of which 57.8% were Acinetobacter infections. Respiratory system was most commonly involved. Acinetobacter Spp showed high resistance (96.2%) to penicillins, cephalosporins and even extended spectrum antibiotics including carbepenems, quinolones and piperacillin plus tazobactam. Extended drug resistance was seen in 92.3% isolates; while we found high susceptibility to tigecycline (88.5%) and polymyxins (100%). Acinetobacter Spp. infected patients had mean length of stay (LOS) of 12.92 days when compared to patients with other nosocomial infections and no infection with mean LOS of 7.05 days (p=0.05) and 4.86 days (p=0.00) respectively. Conclusions: Acinetobacter Spp infections increase with longer duration of stay in ICU. Emergence of multi-drug and extended-drug resistant Acinetobacter Spp is alarming and overwhelming at this rate for already stretched out health system with its economic and health implications. (author)

  11. Impact of clinical pharmacist in an Indian Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mohamed Hisham

    2016-01-01

    Full Text Available Background and Objectives: A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This study was conducted to assess the impact and effectiveness of having a clinical pharmacist in an Indian Intensive Care Unit (ICU. It also evaluates the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety. Materials and Methods: The prospective, observational study was carried out in medical and surgical/trauma ICU over a period of 1 year. All detected drug-related problems and interventions were categorized based on the Pharmaceutical Care Network Europe system. Results: During the study period, average monthly census of 1032 patients got treated in the ICUs. A total of 986 pharmaceutical interventions due to drug-related problems were documented, whereof medication errors accounted for 42.6% (n = 420, drug of choice problem 15.4% (n = 152, drug-drug interactions were 15.1% (n = 149, Y-site drug incompatibility was 13.7% (n = 135, drug dosing problems were 4.8% (n = 47, drug duplications reported were 4.6% (n = 45, and adverse drug reactions documented were 3.8% (n = 38. Drug dosing adjustment done by the clinical pharmacist included 140 (11.9% renal dose, 62 (5.2% hepatic dose, 17 (1.4% pediatric dose, and 104 (8.8% insulin dosing modifications. A total of 577 drug and poison information queries were answered by the clinical pharmacist. Conclusion: Clinical pharmacist as a part of multidisciplinary team in our study was associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.

  12. Intraocular infections in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Sisk RA

    2012-05-01

    Full Text Available Hassan A Aziz1, Audina M Berrocal1,2, Robert A Sisk1, Kristin Hartley1, Magaly Diaz-Barbosa2, Rose A Johnson2, Ditte Hess1, Sander R Dubovy1, Timothy G Murray1, Harry W Flynn Jr11Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Jackson Memorial Hospital, Miami, FL, USABackground: The purpose of this study was to report on the incidence and treatment outcomes of endogenous endophthalmitis among newborns in the neonatal intensive care unit (NICU of a single medical center.Methods: This was a noncomparative, retrospective case series of endogenous endophthalmitis among infants at the Jackson Memorial Hospital NICU treated between March 1, 2002 and March 1, 2007.Results: Of 4323 infants admitted to the NICU, seven eyes of six (0.139% infants (two males, four females were diagnosed with endophthalmitis during the study period. Four patients were born prematurely with a mean gestational age of 27.5 weeks and a mean birth weight of 1153 g. Retinopathy of prematurity was reported in two of the six patients. Mean follow-up was 3.5 years. The diagnosis was confirmed by positive cultures or polymerase chain reaction testing at a median age of 34 postnatal days. Positive cultures included Candida albicans (n = 4, Pseudomonas aeruginosa (n = 1, and Herpes simplex type 2 (n = 1. All patients received systemic treatment and five received adjunctive ophthalmic interventions, including intravitreal antibiotics in five eyes of four patients and vitrectomy with pars plana lensectomy in three eyes. One patient underwent primary enucleation and another had delayed evisceration. In the remaining five eyes, there was a normal appearing posterior segment and normal intraocular pressures at last follow-up.Conclusion: Endogenous endophthalmitis is a rare complication in infants in the NICU, but may occur in patients with candidemia, bacteremia, retinopathy of prematurity, and low birth weight. Despite early and

  13. Framing the issue of ageing and health care spending in Canada, the United Kingdom and the United States.

    Science.gov (United States)

    Gusmano, Michael K; Allin, Sara

    2014-07-01

    Political debates about the affordability of health care programmes in high-income countries often point to population ageing as a threat to sustainability. Debates in the United States, in particular, highlight concerns about intergenerational equity, whereby spending on older people is perceived as a threat to spending on the young. This paper compares how the problem of health spending is defined in Canada, the United Kingdom and the United States by presenting the results of a content analysis of print media during the period 2005-2010. We found that population ageing was cited as an important source of health care cost increases in all three countries but was cited less frequently in Canadian newspapers than in the UK or US papers. Direct claims about intergenerational equity are infrequent among the articles we coded, but newspaper articles in the United States were more likely than those in Canada and the United Kingdom to claim that of high health care spending on older people takes resources away from younger people. In Canada a much larger percentage of articles in our sample either claimed that high health care spending is crowding out other types of government expenditure. Finally, we found that almost no articles in the United States challenged the view that population ageing causes health care spending, whereas in both Canada and the United Kingdom a small, but steady stream of articles challenged the idea that population ageing is to blame for health care spending increases. PMID:24759155

  14. Accountable care organization formation is associated with integrated systems but not high medical spending.

    Science.gov (United States)

    Auerbach, David I; Liu, Hangsheng; Hussey, Peter S; Lau, Christopher; Mehrotra, Ateev

    2013-10-01

    Medicare's approximately 250 accountable care organizations (ACOs) care for a growing portion of all fee-for-service beneficiaries across the United States. We examined where ACOs have formed and what regional factors are predictive of ACO formation. Understanding these factors could help policy makers foster growth in areas with limited ACO development. We found wide variation in ACO formation, with large areas, such as the Northwest, essentially empty of ACOs, and others, such as the Northeast and Midwest, dense with the organizations. Key regional factors associated with ACO formation include a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups. Area income, Medicare per capita spending, Medicare Advantage enrollment rates, and physician density were not associated with ACO formation. Together, these results imply that underlying provider integration in a region may help drive the formation of ACOs.

  15. [Management and organization of ambulatory medical care in a district].

    Science.gov (United States)

    Schneider, K; Keune, H G; Miethe, D; Ringel, M; Szkibik, B

    1990-01-01

    An analysis is given of the management and organization of out-patient medical care in 15 districts and of the District Physician's responsibilities as well as the profile of a District Health Department. Compared to the situation of a decade ago, substantial changes in the territorial health organization have occurred (decentralization, formation of care areas, affiliation of small health facilities to bigger ones). The District Physician's scope of responsibility is increasingly determined by activities within the framework of the District Council, the proportion of organizational work has increased. In order to be able to fulfill his tasks the District Physician needs the support of a special Health Department. Skeleton regulations for out-patient medical care are necessary.

  16. Accountable care organizations: principles and implications for hospital administrators.

    Science.gov (United States)

    Bennett, Andrew Russell

    2012-01-01

    With the passage of the Affordable Care Act (ACA) in 2010, broad agreement has been reached on the need for fundamental reform of healthcare delivery and payment systems. Accountable care organizations (ACOs) have become one of the most discussed provisions of the ACA, and Medicare's Shared Savings Program (SSP), the incentive program tied to ACOs, has the potential to change the delivery of healthcare. The SSP will attempt to improve the quality of care while reducing the growth in expenditures by encouraging the formation of ACOs. The SSP is voluntary, and organizations that wish to participate will encounter advantages and disadvantages in its adoption. This article provides hospital administrators with basic information about the ACO requirements set forth by the Centers for Medicare & Medicaid Services and helps frame decision making about hospital participation in ACOs. PMID:22905603

  17. 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

  18. The World Health Organization Global Health Emergency Workforce: What Role Will the United States Play?

    Science.gov (United States)

    Burkle, Frederick M

    2016-08-01

    During the May 2016 World Health Assembly of 194 member states, the World Health Organization (WHO) announced the process of developing and launching emergency medical teams as a critical component of the global health workforce concept. Over 64 countries have either launched or are in the development stages of vetting accredited teams, both international and national, to provide surge support to national health systems through WHO Regional Organizations and the delivery of emergency clinical care to sudden-onset disasters and outbreak-affected populations. To date, the United States has not yet committed to adopting the emergency medical team concept in funding and registering an international field hospital level team. This article discusses future options available for health-related nongovernmental organizations and the required educational and training requirements for health care provider accreditation. (Disaster Med Public Health Preparedness. 2016;10:531-535). PMID:27364937

  19. Nursing strategies for coping with the care of a potential organ donor

    Directory of Open Access Journals (Sweden)

    Silvia Silva Souza

    2013-05-01

    Full Text Available This work aimed to understand strategies that the nursing staff from an Intensive Care Unit applies to situations involving the care of a person with brain death as a potential donor. The study was conducted through qualitative, descriptive and exploratory research, carried out by 14 members of the nursing staff who work with the potential organ donor. Data were collected through semi-structured interviews, and a thematic context analysis was applied. The strategies of coping focused on emotion were: escape from reality, and reframe the event. And the strategies focused on the problem were: provide competent care, and search for other support. It is concluded that caring for a person with brain death is constituted as a very stressful event to the nursing professionals. These professionals need institutional support to better cope with these situations, because depending on how they manage their task, it may directly influence the assistance provided to patients.

  20. An Analysis of Organ Donation Policy in the United States.

    Science.gov (United States)

    Ahmad, Ghazi; Iftikhar, Sadia

    2016-01-01

    There is currently an organ shortage crisis in the United States. This paper analyzes the magnitude of the problem, the organ procurement programs in other developed countries as compared to the US, and discusses the changes that can be made to address this problem. With the opt-in or explicit-consent method currently practiced in the US, less that one third of the population consents to organ donation. In order to narrow the gap between the demand and supply of organs, steps need to be taken to improve the organ procurement infrastructure. The public needs to be educated about the dire need, the benefits and risks in organ donation, and living vs. deceased donation. [Full article available at http://rimed.org/rimedicaljournal-2016-05.asp, free with no login]. PMID:27128513

  1. Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: A pilot study.

    Science.gov (United States)

    Delgado, Tim; Wolfe, Brianne; Davis, Gary; Ansari, Safdar

    2016-08-01

    Integral to the management of the neurocritically injured patient are the prevention and treatment of hypotension, maintenance of cerebral perfusion pressure, and occasionally blood pressure augmentation. When adequate volume resuscitation fails to meet perfusion needs, vasopressors are often used to restore end-organ perfusion. This has historically necessitated central venous access given well-documented incidence of extravasation injuries associated with peripheral administration of vasopressors. In this pilot study, we report our 6-month experience with peripheral administration of low-concentration phenylephrine (40 μg/mL) in our neurocritical care unit. We were able to administer peripheral phenylephrine, up to a dose of 2 μg/(kg min), for an average of 14.29hours (1-54.3) in 20 patients with only 1 possible minor complication and no major complications. This was achieved by adding additional safety measures in our computerized physician order entry system and additional nurse-driven safety protocols. Thus, with careful monitoring and safety precautions, peripheral administration of phenylephrine at an optimized concentration appears to have an acceptable safety profile for use in the neurocritical care unit up to a mean infusion time of 14hours. PMID:27288620

  2. Origins of authority: the organization of medical care in Sweden.

    Science.gov (United States)

    Gustafsson, R A

    1989-01-01

    Earlier research by Gardell and Gustafsson indicates a general discrepancy between perceived needs and organizational structure in Swedish somatic hospitals; the work organization directs the work process as if cure and medical treatment were the only appropriate goals in almost all kinds of health care settings. The standard organizational model for general hospitals, here named "the acute care model"--which is a merger of medical and administrative hierarchies--forces great segments of the staff into a work content that is neither appropriate for patients' needs nor satisfying for the personnel. The present study is a historical-sociological discourse in which the structural antecedents of the acute care model are traced. It gives an exposé of the main stages in the formation of the Swedish health care system from the middle ages to the present. In 1864 a regulation of the hospital boards was issued. This meant the definite consolidation of the acute care model and was in line with earlier developments, which were characterized by an incremental interorganizational activity demarcation that divided the core of institutional care into three branches: somatic hospitals, mental hospitals, and homes for the elderly. The driving forces in the formation of the total health care system are shown to be closely related to premedical and extramedical factors, such as military needs, mercantilism, and the emergence of the middle class.

  3. Karakteristik Dengue Berat yang Dirawat di Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Dzulfikar D. Lukmanul Hakim

    2012-09-01

    Full Text Available Dengue viral infections affect all age groups and produce a spectrum of clinical illness that ranges from asymptomatic to severe and occasionally fatal disease. Severe dengue characterized by plasma leakage, hemoconcentration, and hemostatic disorder. The aim of this study was to know the characteristic of severe dengue patients admitted to Pediatric Intensive Care Unit (PICU Dr. Hasan Sadikin Hospital Bandung during January 2009 to December 2010. This was a retrospective descriptive study based on the data collected from the medical records. Twenty-one severe dengue cases in two years were admitted 15/21 girls and 6/21 boys, and 5/21 of them died during hospitalization because of dengue shock syndrome (DSS and disseminated intravascular coagulation (DIC. Most of them were 1−5 years old with good nutritional status. Hepatomegaly was found in all cases with mean hematocrit was 38%. In this research, the most manifestation of severe dengue were DSS (15/21, DIC (11/21, encephalopathy (6/21, pleural effusion (5/21, myocarditis (3/21, and acute respiratory distress syndrome (3/21. In conclusions, severe dengue are more common in girls, 1–5 years old, and well-nourished children. The most common clinical manifestation of severe dengue are shock, disseminated intravascular coagulation, and encephalopathy.

  4. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-03-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  5. Candida colonization in intensive care unit patients' urine

    Directory of Open Access Journals (Sweden)

    Xisto Sena Passos

    2005-12-01

    Full Text Available The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10³ yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100% and indwelling urinary catheter (92.6%. The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.

  6. Antimicrobial usage in an intensive care unit: a prospective analysis.

    LENUS (Irish Health Repository)

    Conrick-Martin, I

    2012-01-31

    Antimicrobial therapies in the Intensive Care Unit (ICU) need to be appropriate in both their antimicrobial cover and duration. We performed a prospective observational study of admissions to our semi-closed ICU over a three-month period and recorded the indications for antimicrobial therapy, agents used, duration of use, changes in therapy and reasons for changes in therapy. A change in therapy was defined as the initiation or discontinuation of an antimicrobial agent. There were 51 patients admitted during the three-month study period and all received antimicrobial therapy. There were 135 changes in antimicrobial therapy. 89 (66%) were made by the ICU team and 32 (24%) were made by the primary team. Changes were made due to a deterioration or lack of clinical response in 41 (30%) cases, due to the completion of prescribed course in 36 (27%) cases, and in response to a sensitivity result in 25 (19%) cases. Prophylactic antibiotic courses (n=24) were of a duration greater than 24 hours in 15 (63%) instances. In conclusion, the majority of changes in antimicrobial therapy were not culture-based and the duration of surgical prophylaxis was in excess of current recommended guidelines.

  7. Elective open bedside tracheostomy in the neurosurgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Niran Maharjan

    2015-09-01

    Full Text Available JCMSBackground and Objectives: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. The present study was designed to determine the safety of open bedside tracheostomy (OBT as a routine intensive care units (ICU procedure without any selection criteria, considering its peri and postoperative complications.Materials & Methods: Retrospective medical chart review of all patients that underwent elective tracheostomy between June 2014 and January 2015.Results: The study group comprised 52 patients with a mean age of 40.4±15.1 years. The incidence of intra-procedure complications was 5.7% and post-procedure complications was 3.8%.Conclusions: Open bedside tracheostomy seems to be a safe and simple procedure, even when performed by a trained resident under controlled circumstances, and should be considered as an option for ICU patients.JCMS Nepal. 2015;11(1: 9-11

  8. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-01-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  9. Challenges of Rural Cancer Care in the United States.

    Science.gov (United States)

    Charlton, Mary; Schlichting, Jennifer; Chioreso, Catherine; Ward, Marcia; Vikas, Praveen

    2015-09-01

    Rural cancer patients face many challenges in receiving care, including limited availability of cancer treatments and cancer support providers (oncologists, social workers, mental healthcare providers, palliative care specialists, etc), transportation barriers, financial issues, and limited access to clinical trials. Oncologists and other cancer care providers experience parallel challenges in delivering care to their rural cancer patients. Although no one approach fully addresses the many challenges of rural cancer care, a number of promising strategies and interventions have been developed that transcend the issues associated with long travel distances. These include outreach clinics, virtual tumor boards, teleoncology and other telemedicine applications, workforce recruitment and retention initiatives, and provider and patient education programs. Given the projected increase in demand for cancer care due to the aging population and increasing number of Americans with health insurance through the Affordable Care Act, expansion of these efforts and development of new approaches are critical to ensure access to high-quality care. PMID:26384798

  10. Changes in Patients’ Experiences in Medicare Accountable Care Organizations

    Science.gov (United States)

    McWilliams, J. Michael; Landon, Bruce E.; Chernew, Michael E.; Zaslavsky, Alan M.

    2014-01-01

    BACKGROUND Incentives for accountable care organizations (ACOs) to limit health care use and improve quality may enhance or hurt patients’ experiences with care. METHODS Using Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data covering 3 years before and 1 year after the start of Medicare ACO contracts in 2012 as well as linked Medicare claims, we compared patients’ experiences in a group of 32,334 fee-for-service beneficiaries attributed to ACOs (ACO group) with those in a group of 251,593 beneficiaries attributed to other providers (control group), before and after the start of ACO contracts. We used linear regression and a difference-in-differences analysis to estimate changes in patients’ experiences in the ACO group that differed from concurrent changes in the control group, with adjustment for the sociodemographic and clinical characteristics of the patients. RESULTS After ACO contracts began, patients’ reports of timely access to care and their primary physicians’ being informed about specialty care differentially improved in the ACO group, as compared with the control group (P = 0.01 and P = 0.006, respectively), whereas patients’ ratings of physicians, interactions with physicians, and overall care did not differentially change. Among patients with multiple chronic conditions and high predicted Medicare spending, overall ratings of care differentially improved in the ACO group as compared with the control group (P = 0.02). Differential improvements in timely access to care and overall ratings were equivalent to moving from average performance among ACOs to the 86th to 98th percentile (timely access to care) and to the 82nd to 96th percentile (overall ratings) and were robust to adjustment for group differences in trends during the preintervention period. CONCLUSIONS In the first year, ACO contracts were associated with meaningful improvements in some measures of patients’ experience and with unchanged performance in

  11. Terminalidade e cuidados paliativos na unidade de terapia intensiva End of life and palliative care in intensive care unit

    Directory of Open Access Journals (Sweden)

    Rachel Duarte Moritz

    2008-12-01

    pacientes são submetidos a grande estresse e tensão sendo desejável que lhes sejam disponíveis programas de educação continuados sobre cuidados paliativos.The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on

  12. Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units.

    Science.gov (United States)

    Grover, Theresa R; Pallotto, Eugenia K; Brozanski, Beverly; Piazza, Anthony J; Chuo, John; Moran, Susan; McClead, Richard; Mingrone, Teresa; Morelli, Lorna; Smith, Joan R

    2015-01-01

    Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases. PMID:25919608

  13. Basic principles of information technology organization in health care institutions.

    Science.gov (United States)

    Mitchell, J A

    1997-01-01

    This paper focuses on the basic principles of information technology (IT) organization within health sciences centers. The paper considers the placement of the leader of the IT effort within the health sciences administrative structure and the organization of the IT unit. A case study of the University of Missouri-Columbia Health Sciences Center demonstrates how a role-based organizational model for IT support can be effective for determining the boundary between centralized and decentralized organizations. The conclusions are that the IT leader needs to be positioned with other institutional leaders who are making strategic decisions, and that the internal IT structure needs to be a role-based hybrid of centralized and decentralized units. The IT leader needs to understand the mission of the organization and actively use change-management techniques.

  14. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way

    OpenAIRE

    Sarit Sharma; Shruti Sharma; Deepinder Chhina; Chhina, R. S.

    2015-01-01

    Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulm...

  15. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    OpenAIRE

    Jitender Sodhi; Sidhartha Satpathy; D K Sharma; Rakesh Lodha; Arti Kapil; Nitya Wadhwa; Shakti Kumar Gupta

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India.Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertia...

  16. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    OpenAIRE

    Sodhi, Jitender; Satpathy, Sidhartha; D K Sharma; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty terti...

  17. Professionalism: good for patients and health care organizations.

    Science.gov (United States)

    Brennan, Michael D; Monson, Verna

    2014-05-01

    Professionalism is an indispensable element in the compact between the medical profession and society that is based on trust and putting the needs of patients above all other considerations. The resurgence of interest in professionalism dates back to the 1980s when health maintenance organizations were formed and proprietary influences in health care increased. Since then, a rich and comprehensive literature has emerged in defining professionalism, including desirable individual attributes and behaviors and how they may be taught, promoted, and assessed. More recently, scholarship has shifted from individual to organizational professionalism. This literature addresses the role that health care organizations can play to establish environments that are conducive to the consistent expression of professionalism by individuals and health care teams. We reviewed interdisciplinary empirical studies from health care effectiveness and outcomes, organizational sciences, positive psychology, and social psychology, finding evidence that organizational and individual professionalism is associated with a wide range of benefits to patients and the organization. We identify actionable organizational strategies and approaches that, if adopted, can foster and promote combined organizational and individual professionalism. In doing so, trust in the medical profession and its institutions can be enhanced, which in turn will reconfirm a commitment to the social compact. PMID:24797645

  18. The Hospital Medicine Reengineering Network (HOMERuN): a learning organization focused on improving hospital care.

    Science.gov (United States)

    Auerbach, Andrew D; Patel, Mitesh S; Metlay, Joshua P; Schnipper, Jeffrey L; Williams, Mark V; Robinson, Edmondo J; Kripalani, Sunil; Lindenauer, Peter K

    2014-03-01

    Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general medicine and none in adult medicine that have leveraged the role of hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN's collaborative model, which focuses on a community-based participatory approach modified to include hospital-based staff as well as the larger community. HOMERuN's initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders. PMID:24448050

  19. Volume of activity and occupancy rate in intensive care units. Association with mortality

    NARCIS (Netherlands)

    Iapichino, G; Gattinoni, L; Radrizzani, D; Simini, B; Bertolini, G; Ferla, L; Mistraletti, G; Porta, F; Miranda, DR

    2004-01-01

    Objective. Mortality after many procedures is lower in centers where more procedures are done. It is controversial whether this is true for intensive care units, too. We examined the relationship between the volume of activity of intensive care units (ICUs) and mortality by a measure of risk-adjuste

  20. Intensive care unit-acquired weakness: early diagnosis, symptomatology and prognosis

    NARCIS (Netherlands)

    L. Wieske

    2014-01-01

    During admission to an intensive care unit (ICU), many critically ill patients develop generalized muscle weakness, a condition called intensive care unit-acquired weakness (ICU-AW). ICU-AW can be caused by muscle problems, peripheral nerve problems or a combination of both. As the name of the condi

  1. Hypophosphatemia on the intensive care unit: individualized phosphate replacement based on serum levels and distribution volume.

    NARCIS (Netherlands)

    Bech, A.; Blans, M.; Raaijmakers, M.; Mulkens, C.; Telting, D.; Boer, H. de

    2013-01-01

    BACKGROUND: Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available. OBJECTIVE: To evaluate an individualized phosphate replacement regimen. DESIGN: Fifty consecutive intensive care unit patie

  2. [Organization of health services and tuberculosis care management].

    Science.gov (United States)

    Barrêto, Anne Jaquelyne Roque; de Sá, Lenilde Duarte; Nogueira, Jordana de Almeida; Palha, Pedro Fredemir; Pinheiro, Patrícia Geórgia de Oliveira Diniz; de Farias, Nilma Maria Porto; Rodrigues, Débora Cezar de Souza; Villa, Tereza Cristina Scatena

    2012-07-01

    The scope of this study was to analyze the discourse of managers regarding the relationship between the organization of the health services and tuberculosis care management in a city in the metropolitan region of João Pessoa, State of Pernambuco. Using qualitative research in the analytical field of the French line of Discourse Analysis, 16 health workers who worked as members of the management teams took part in the study. The transcribed testimonials were organized using Atlas.ti version 6.0 software. After detailed reading of the empirical material, an attempt was made to identify the paraphrasic, polyssemic and metaphoric processes in the discourses, which enabled identification of the following discourse formation: Organization of the health services and the relation with TB care management: theory and practice. In the discourse of the managers the fragmentation of the actions of control of tuberculosis, the lack of articulation between the services and sectors, the compliance of the specific activities for TB, as well as the lack of strategic planning for management of care of the disease are clearly revealed. In this respect, for the organization of the health services to be effective, it is necessary that tuberculosis be considered a priority and acknowledged as a social problem in the management agenda.

  3. [Choice of Expiration for Cancer Patients under Home Medical Care - Palliative Care Unit or Home].

    Science.gov (United States)

    Okino, Takashi; Okagaki, Tetsuya; Nakamura, Hiromi; Okino, Akie

    2015-12-01

    Kohka Public Hospital(KPH)was rebuilt at a new place in April 2013. The Palliative Care Unit(PCU)was newly constructed during renovation. We examined the will and outcome of cancer patients, especially on expiration. A 123 patients died in 2014: 27 died at the PCU, and the remaining 7 at home. Of 27 patients, 20 were willing to die at the PCU, and one patient visited the hospital after judgment by the Visiting Nurse Center. Other 6 patients were admitted finally after their families experienced fatigue. Six of seven patients who died at home, showed a strong will to stay at home. We think that patients' will drives the clinical course, especially in their end-stage. In this context, the majority of the patients decided their terminal place based on their will. On the contrary, there were several cases whose requests were not fulfilled. To overcome the problem, we should discuss cancer patients' will to make a choice regarding death at the end-stage of their lives and the place of expiration in advance. We including the staff of social care and regional medical resources, should co-operate and share information on these patients to solve the problems. PMID:26809413

  4. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series

    Directory of Open Access Journals (Sweden)

    Rehan Ali

    2013-01-01

    Full Text Available Objective: Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies.Methods: A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit.Results: Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%, hyaline membrane disease (20%, meconium aspiration syndrome (20% and congenital diaphragmatic hernia (10%. Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions.Conclusion: The study showed a higher number of mortality cases (60%. Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces.

  5. 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

  6. Physiotherapy practices in Intensive Care Units across Maharashtra

    Directory of Open Access Journals (Sweden)

    Ujwal Lakshman Yeole

    2015-01-01

    Full Text Available Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of the respondents were bachelors qualified, 15% were masters in physiotherapy with only 4% specialized in cardio-respiratory physiotherapy; 82% had <5 years experience in ICU. Almost 19% had not at all attended any seminars/workshops related to ICU management while 61% attended up to three within last 2 years. The availability of a physiotherapist during the night was affirmed by 63%, 58% responded initiation of physiotherapy to be "always physician referred" and 39% mentioned "physiotherapist initiated." Almost 80% performed chest wall techniques, 86% positioning, 27% postural drainage, 5% manual hyperinflation, 12% application of nebulizer, and 56% bedsores management. Only 5% reported involvement in ventilator setting, 11% had their opinion sought before weaning from ventilator, 29% practiced noninvasive ventilation, 11% were involved in decision-making for extubation and 44% reported involvement in patient family education. Conclusion: The study showed that physiotherapists among the responding ICUs surveyed lack in experience and updated knowledge. Physician reference is necessary to initiate physiotherapy and there exists no established criteria for physiotherapy treatment in ICU. All physiotherapists were routinely involved in chest physiotherapy, mobilization, and positioning.

  7. Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

    Directory of Open Access Journals (Sweden)

    Anasua Deb

    2016-05-01

    Full Text Available Background: Strict asepsis is necessary in operating theatres (OT and intensive care units (ICU as the patients undergo invasive procedures. The filters of contaminated air conditioning (AC units provide a niche for proliferation of fungi and production of fungal spores. Methods: The routine procedure for maintenance of sterile atmosphere in our hospital, i.e. fumigation and mopping walls with disinfectants often fail to address these fungal spores of the AC filters. We therefore carried out a surveillance of the ACs in ICUs and OTs to find the level of contamination with fungal spores and also to improvise on intervention strategies to tackle the problem. Over 3 months period, 34 ACs from 7 OTs and 2 ICUs were screened by taking 2 swabs from each AC which were then tested for the presence of fungal spores as per standard methods. Results: The contamination rate was 88.2% before fumigation and 76.9% after fumigation. The fungal spore contamination rate was reduced to 20% (1 out of 5 ACs after servicing of the ACs was done. Aspergillus spp. was the most common fungal isolate. Conclusion: Based on the observations, we recommend regular servicing of the ACs as well as wet mopping of the ducts with sporicidal solution at regular intervals. [Int J Res Med Sci 2016; 4(5.000: 1583-1589

  8. Microbial contamination of manually reprocessed, ready to use ECG lead wire in intensive care units

    Directory of Open Access Journals (Sweden)

    Lestari, Trisasi

    2013-04-01

    Full Text Available [english] Background: A number of studies have shown that non-critical medical devices can be contaminated with pathogens, including those resistant to antibiotics and thus become a potential vector for transmission. Electrocardiography (ECG lead wire are non-critical medical device which are always attached on patient skin during their stay in intensive care unit (ICU. In view of the patient’s critical conditions and exposure to invasive procedures, identification and prevention of possible risks are important to prevent infection in ICUs. Objective: The objective of this study was to determine the presence of bacterial and fungal contamination on cleaned and disinfected reusable ECG lead wires in intensive care units in a hospital.Methods: A total of 408 cleaned ECG lead wires from 93 bed-side ECG devices and 43 ECG lead wires from 5 portable ECG devices from 4 intensive care units (ICUs and 1 post-anaesthesia care unit (PACU were sampled. ECG lead wires were stirred in 0.89% NaCl with added neutralizer for 30 seconds. Samples of the solutions were cultured directly on blood agar. The remaining solution was cultured on blood agar after sterile filtration. The number of colony forming units (CFUs was counted and the microorganisms were identified.Results: More than half of examined ECG lead wires (n=232; 51.4% were contaminated with >30 CFUs/mL sample of bacteria or with risk pathogens. Gram-positive bacteria were the most frequently isolated organisms; particularly, (96% and aerobic spore forming bacteria (71.2%. Compared to ICUs, PACU had significantly lower proportion of contaminated ECG lead wires (p<0.05. The proportion of contaminated ECG lead wires, as well as mean number of cfus per ECG lead wire, was also significantly lower among multi-wire ECG leads compared to single-wire ECG leads. Conclusions: Manually cleaned ECG lead wires may serve as a vector for transmission of nosocomial pathogens. The current reprocessing technique for

  9. Hospital organization based on intensity of care: potential errors to avoid

    Directory of Open Access Journals (Sweden)

    Roberto NardI

    2012-01-01

    Full Text Available IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High dependency units”, “sub-intensive care areas” – “high care units” are particularly suitable for patients who have a lower risk compared to patients treated in intensive care, but liable to develop complications and needing a close monitoring much more than the “standard”, “routine” care. The implementation of the a new organizational model must be careful and consider the possible enlargement errors that can be made. The analysis of the context is necessary for assess prerequisites, excluding the elements opposed to the success of the proposed model (i.e.: wards congestion and overcrowding, with a consequential with increased risk of adverse events. Before implementing and admitting patients in new “models”, we have to define the epidemiological population characteristics, their level of complexity/criticality/instability and the current assessment tools.ConclusionsAny new proposal of hospital management change has, as first obligation, to explicit the basic visions and primary goals for “the added value” resulting to the patient and the whole organization, with the evidence of an “health technology assessment” approach, for the professional hospital overall governance. But without the presumption, or worse, the apodictic assertion, to proclaim the implementation of structures with “differentiated intensity of hospital care” organizations that are not.

  10. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

    DEFF Research Database (Denmark)

    Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef;

    2012-01-01

    for intensive care unit admission. INTERVENTIONS:: Admission or rejection to intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Demographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were......RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions...... on mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    closeness. CONCLUSION: Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation......OBJECTIVE: The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING: The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where...... intubated patients included unpredictability, ambiguous needs and complex actions, while the rewarding aspects included personal interaction. Three sub-themes were identified: (i) caring for and with the patient, (ii) negotiating relational and instrumental care and (iii) managing physical and emotional...

  12. Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units

    OpenAIRE

    Tucker, Anita L; Nembhard, Ingrid M.; Amy C. Edmondson

    2007-01-01

    This paper contributes to research on organizational learning by investigating specific learning activities undertaken by improvement project teams in hospital intensive care units and proposing an integrative model to explain implementation success. Organizational learning is important in this context because medical knowledge changes constantly and hospital care units must learn new practices if they are to provide high-quality care. To develop a model of factors affecting improvement proje...

  13. Filipino Child Health in the United States: Do Health and Health Care Disparities Exist?

    OpenAIRE

    Javier, Joyce R.; Huffman, Lynne C; Mendoza, Fernando S

    2007-01-01

    Introduction Filipinos are the second largest Asian subgroup in the United States, but few studies have examined health and health care disparities in Filipino children. The objectives of this review are 1) to appraise current knowledge of Filipino children's health and health care and 2) to present the implications of these findings for research, clinical care, and policy. Methods We identified articles for review primarily via a Medline search emphasizing the terms Filipino and United State...

  14. Psychosocial factors and prevalence of burnout syndrome among nursing workers in intensive care units

    OpenAIRE

    da Silva, Jorge Luiz Lima; Soares, Rafael da Silva; Costa, Felipe dos Santos; Ramos, Danusa de Souza; Lima, Fabiano Bittencourt; Teixeira, Liliane Reis

    2015-01-01

    Objective To evaluate the prevalence of burnout syndrome among nursing workers in intensive care units and establish associations with psychosocial factors. Methods This descriptive study evaluated 130 professionals, including nurses, nursing technicians, and nursing assistants, who performed their activities in intensive care and coronary care units in 2 large hospitals in the city of Rio de Janeiro, Brazil. Data were collected in 2011 using a self-reported questionnaire. The Maslach Burnout...

  15. Improved nurse-parent communication in neonatal intensive care unit

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

    2014-01-01

    and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. RESULTS: Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context...... family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication. DESIGN: Qualitative and quantitative...... data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care. METHODS: Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation...

  16. Report a Complaint (about a Health Care Organization)

    Science.gov (United States)

    ... Accreditation Accreditation Ambulatory Health Care Behavioral Health Care Critical Access Hospitals Home Care (+ Pharmacy) Hospital Laboratory Nursing Care Center International Accreditation Accreditation Top Spots What ...

  17. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  18. Musculoskeletal problems in intensive care unit patients post discharge

    OpenAIRE

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

    2016-01-01

    Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Int...

  19. Managing the transition to integrated health care organizations.

    Science.gov (United States)

    Griffith, J R

    1996-01-01

    Today's successful community hospitals should and will evolve into integrated health care organizations (IHCOs) that will share several common characteristics. IHCOs will have a community--not a membership--orientation, and this will be a distinguishing characteristic and a source of market appeal. The transition to IHCO will be a slow one, and to prosper, the IHCO will have to accommodate both price-oriented markets and traditional ones. Successful IHCOs will expand technical skills and capabilities to control costs and quality. New strategic competencies will have to be developed, and to do this, emerging IHCOs will improve the ability of managers to support decisions and sell them both to the buyers and the public at large. Excellent patient care will rest upon better trained, advised, and informed management teams. Making the change to an IHCO will take time and money, but organizations that make steady progress are likely to succeed. PMID:10156172

  20. Arterial pulmonary hypertension in noncardiac intensive care unit

    OpenAIRE

    Tsapenko, Mykola

    2008-01-01

    Mykola V Tsapenko1,5, Arseniy V Tsapenko2, Thomas BO Comfere3,5, Girish K Mour1,5, Sunil V Mankad4, Ognjen Gajic1,51Division of Pulmonary and Critical Care Medicine; 3Division of Critical Care Medicine; 4Division of Cardiovascular Diseases, Mayo Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C), Mayo Clinic, Rochester, MN, USA; 2Division of Pulmonary and Critical Care Medicine, Brown University, Miriam Hospital, Providence, RI, USAAbstract: Pulmonary artery pressure elev...

  1. PATIENT DATA MANAGEMENT SYSTEM IN INTENSIVE CARE UNIT (ICU) USING LABVIEW

    OpenAIRE

    Amritjot Kaur*, Shimi S. L

    2016-01-01

    This paper proposes a new system that takes the benefits of data flow technology. Its objective is to collect the data from monitoring system in the intensive care unit (ICU) and store that data for further analysis. Then it will be available for medical personnel to analyze data and take the suitable medication for patients. In fact, the monitoring system in intensive care unit provides a large amount of data quickly and continuously. Most units operate with a very limited storage capacity w...

  2. Evaluation of functional independence after discharge from the intensive care unit

    OpenAIRE

    Curzel, Juliane; Forgiarini Junior, Luiz Alberto; Rieder, Marcelo de Mello

    2013-01-01

    Objective 1) To evaluate the functional independence measures immediately after discharge from an intensive care unit and to compare these values with the FIMs 30 days after that period. 2) To evaluate the possible associated risk factors. Methods The present investigation was a prospective cohort study that included individuals who were discharged from the intensive care unit and underwent physiotherapy in the unit. Functional independence was evaluated using the functional independence meas...

  3. [For a coordination of the supportive care for people affected by severe illnesses: proposition of organization in the public and private health care centres].

    Science.gov (United States)

    Krakowski, Ivan; Boureau, François; Bugat, Roland; Chassignol, Laurent; Colombat, Philippe; Copel, Laure; d'Hérouville, Daniel; Filbet, Marylène; Laurent, Bernard; Memran, Nadine; Meynadier, Jacques; Parmentier, Gérard; Poulain, Philippe; Saltel, Pierre; Serin, Daniel; Wagner, Jean-Philippe

    2004-05-01

    The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses

  4. [For a coordination of the supportive care for people affected by severe illnesses: proposition of organization in the public and private health care centres].

    Science.gov (United States)

    Krakowski, Ivan; Boureau, François; Bugat, Roland; Chassignol, Laurent; Colombat, Philippe; Copel, Laure; d'Hérouville, Daniel; Filbet, Marylène; Laurent, Bernard; Memran, Nadine; Meynadier, Jacques; Parmentier, Gérard; Poulain, Philippe; Saltel, Pierre; Serin, Daniel; Wagner, Jean-Philippe

    2004-05-01

    The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses

  5. Organization of prehospital medical care for patients with cerebral stroke

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

    Full Text Available The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

  6. Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units!

    Directory of Open Access Journals (Sweden)

    Ashu Sara Mathai

    2016-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is the most common nosocomial infection acquired by patients in the Intensive Care Unit (ICU. However, there are scarce clinical data, particularly from Indian ICUs on the occurrence of this infection. Aims: To collect data on the incidence, microbiological profile, and outcomes of patients with VAP. Settings and Design: Tertiary level, medical-surgical ICU; prospective, observational study. Subjects and Methods: All patients who were mechanically ventilated for >48 h in the ICU during the study were enrolled. VAP was diagnosed according to the Centre for Disease Control (CDC criteria. Results: A total of 95 (38% patients developed VAP infections, an incidence of 40.1 VAP infections/1000 mechanical ventilation days. These were predominantly caused by Gram-negative organisms, especially the Acinetobacter species (58 isolates, 53.2%. Many of the VAP-causing isolates (27.3% demonstrated multidrug resistance. Patients with VAP infections experienced a significantly longer ICU stay (13 days [Interquartile Range (IQ range = 10-21] vs. 6 days [IQ = 4-8], P 60 years and those with higher Acute Physiology and Chronic Health Evaluation II scores at admission had significantly greater mortality rates if they acquired a VAP infection (P = 0.010. Conclusions: VAP continues to be a major threat to patients who are admitted for mechanical ventilation into the critical care unit, emphasizing the urgent need for infection control measures.

  7. Post-traumatic pulmonary embolism in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Mabrouk Bahloul

    2011-01-01

    Full Text Available Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE admitted in the intensive care unit (ICU. Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients admitted to our ICU were classified into two groups. The first group included all patients with confirmed PE; the second group included patients without clinical manifestations of PE. The diagnosis of PE was confirmed either by a high-probability ventilation/perfusion (V/Q scan or by a spiral computed tomography (CT scan showing one or more filling defects in the pulmonary artery or its branches. Results: During the study period, 1067 trauma patients were admitted in our ICU. The diagnosis of PE was confirmed in 34 patients (3.2%. The mean delay of development of PE was 11.3 ± 9.3 days. Eight patients (24% developed this complication within five days of ICU admission. On the day of PE diagnosis, the clinical examination showed that 13 patients (38.2% were hypotensive, 23 (67.7% had systemic inflammatory response syndrome (SIRS, three (8.8% had clinical manifestations of deep venous thrombosis (DVT, and 32 (94% had respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 32 cases (94% and low molecular weight heparin was used in two cases (4%. The mean ICU stay was 31.6 ± 35.7 days and the mean hospital stay was 32.7 ± 35.3 days. The mortality rate in the ICU was 38.2% and the in-hospital mortality rate was 41%. The multivariate analysis showed that factors associated with poor prognosis in the ICU were the presence of circulatory failure (Shock (Odds ratio (OR = 9.96 and thrombocytopenia (OR = 32

  8. What Does Change with Nutrition Team in Intensive Care Unit?

    Directory of Open Access Journals (Sweden)

    Ahmet Fatih Yılmaz

    2016-08-01

    Full Text Available Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU, the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Health Evaluation (APACHE II scores, rate of usege of parenteral and enteral products, and the change in expenses per patient within the first year of activity of the nutrition team in comparison to the previous year was presented. Material and Method: In this study a 6-bed GICU was used. The patients who was admitted through retrospective file scanning between 1 January 2012 and 31 December 2012 and between 1 January 2013 and 31 December 2013 were compared. Results: The number of the patients admitted to the GICU was 341 in 2012 and 369 in 2013. The number of the patients who died in 2012 was 86 (25.2%, while it was 106 in 2013 (28.7%. In 2012, 122 patients (35.7% had decubitus ulcers, while this number was 92 (24.7% in 2013. Human albumin usage was reduced by 23% for the 100 mL (225 in 2012, 175 in 2013 and by 33% for the 50 mL doses (122 in 2012, 82 in 2013. Duration of stay in the hospital was 6.3±0.9 vs. 5.8±0.9 (days (p=0.06. The mean APACHE II scores were observed to be 24.7±6.9 vs. 30.5±11.4 (p=0.03. When the distribution of product types were analyzed, it was observed that the ratio of parenteral products: enteral products was 2:1 in 2012, however the ratio of enteral products to parenteral products was 2:1 in 2013. The daily expense of a patient decreased from 100 TL to 55 TL. Conclusion: The nutrition team directly influences the clinical process outcomes of patients under treatment in the ICU. It was thought that using appropriate nutritional

  9. Quality of life after stay in surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Castro Maria A

    2007-07-01

    Full Text Available Abstract Background In addition to mortality, Health Related Quality of Life (HRQOL has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL six months after discharge from an Intensive Care Unit (ICU, and to study its determinants. Methods All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS, type and magnitude of surgical procedure, ICU and hospital length of stay (LOS, mortality and Simplified Acute Physiology Score II (SAPS II. Six months after discharge, a Short Form-36 questionnaire (SF-36 and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. Results Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV, had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01 – 1.11, p = 0,016. Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI and personal ADL (ADLP. ASA-PS (OR 3.00, 95%CI 1.31 – 6.87, p = 0.009 and age (OR 2.36, 95%CI, 1.04 – 5.34, p = 0.04 were associated with dependency in

  10. 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

  11. Microbiological pattern of arterial catheters in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Patel Bharat

    2010-10-01

    Full Text Available Abstract Background Intravascular catheter related infection (CRI is one of the most serious nosocomial infections. Diagnostic criteria include a positive culture from the catheter tip along with blood, yet in many patients with signs of infection, current culture techniques fail to identify pathogens on catheter segments. We hypothesised that a molecular examination of the bacterial community on short term arterial catheters (ACs would improve our understanding of the variety of organisms that are present in this niche environment and would help develop new methods for the diagnosis of CRI. Results The whole bacterial community presenting on all ACs was evaluated by molecular methods, i.e., a strategy of whole community DNA extraction, PCR amplification followed by cloning and 16S rDNA sequence analysis. Ten ACs were removed from patients suspected of CRI and 430 clones from 5 "colonised" and 5 "uncolonised" (semi-quantitative method AC libraries were selected for sequencing and subsequent analysis. A total of 79 operational taxonomic units (OTUs were identified at the level of 97% similarity belonging to six bacterial divisions. An average of 20 OTUs were present in each AC, irrespective of colonisation status. Conventional culture failed to reveal the majority of these bacteria. Conclusions There was no significant difference in the bacterial diversity between the 'uncolonised' and 'colonised' ACs. This suggests that vascular devices cultured conventionally and reported as non infective may at times potentially be a significant source of sepsis in critically ill patients. Alternative methods may be required for the accurate diagnosis of CRI in critically ill patients.

  12. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered. PMID:26694313

  13. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered.

  14. United States and Canadian approaches to justice in health care: a comparative analysis of health care systems and values.

    Science.gov (United States)

    Jecker, N S; Meslin, E M

    1994-06-01

    The purpose of this study is to compare and contrast the basic ethical values underpinning national health care policies in the United States and Canada. We use the framework of ethical theory to name and elaborate ethical values and to facilitate moral reflection about health care reform. Section one describes historical and contemporary social contract theories and clarifies the ethical values associated with them. Sections two and three show that health care debates and health care systems in both countries reflect the values of this tradition; however, each nation interprets the tradition differently. In the U.S., standards of justice for health care are conceived as a voluntary agreement reached by self-interested parties. Canadians, by contrast, interpret the same justice tradition as placing greater emphasis on concern for others and for the community. The final section draws out the implications of these differences for future U.S. and Canadian health care reforms.

  15. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    Science.gov (United States)

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care.

  16. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    Science.gov (United States)

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care. PMID:25852202

  17. Quality of care for hypertension in the United States

    Directory of Open Access Journals (Sweden)

    LaPuerta Pablo

    2005-01-01

    Full Text Available Abstract Background Despite heavy recent emphasis on blood pressure (BP control, many patients fail to meet widely accepted goals. While access and adherence to therapy certainly play a role, another potential explanation is poor quality of essential care processes (QC. Yet little is known about the relationship between QC and BP control. Methods We assessed QC in 12 U.S. communities by reviewing the medical records of a randomly selected group of patients for the two years preceding our study. We included patients with either a diagnosis of hypertension or two visits with BPs of ≥140/90 in their medical records. We used 28 process indicators based on explicit evidence to assess QC. The indicators covered a broad spectrum of care and were developed through a modified Delphi method. We considered patients who received all indicated care to have optimal QC. We defined control of hypertension as BP Results Of 1,953 hypertensive patients, only 57% received optimal care and 42% had controlled hypertension. Patients who had received optimal care were more likely to have their BP under control at the end of the study (45% vs. 35%, p = .0006. Patients were more likely to receive optimal care if they were over age 50 (76% vs. 63%, p Conclusions Higher QC for hypertensive patients is associated with better BP control. Younger patients without cardiac risk factors are at greatest risk for poor care. Quality measurement systems like the one presented in this study can guide future quality improvement efforts.

  18. Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

    2016-01-01

    There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork. PMID:27455363

  19. Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

    2016-01-01

    There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

  20. The Molecular Adsorbent Recirculating System (MARS®) in the intensive care unit: a rescue therapy for patients with hepatic failure

    OpenAIRE

    Saliba, Faouzi

    2006-01-01

    Treatment in the intensive care unit of patients with end-stage liver disease has been limited. Liver transplantation has been a major improvement in this and has become standard in the management of these patients. However, many patients die awaiting liver transplantation, mainly due to the scarcity of organ donors. Conventional hemodialysis techniques have little or no effect on liver detoxification and do not improve the prognosis of these patients. In patients with acute hepatic failure, ...

  1. [Health care access and receptivity to users in a unit in Porto Alegre, Rio Grande do Sul, Brazil].

    Science.gov (United States)

    Ramos, Donatela Dourado; Lima, Maria Alice Dias da Silva

    2003-01-01

    This study focuses on users' views of factors influencing quality of care at a health care unit in the city of Porto Alegre, relating to access and receptivity. The data were collected using a semi-structured interview and participatory observation and treated using thematic analysis. The results compare ease and difficulties in geographic, economic, and functional access. Organization of services and professional competency were determinant factors in ease of reception, leading to user satisfaction. Poor reception and unsatisfactory professional performance were identified as difficulties. The study concluded that there is a need to increase the professional staff, train them in receiving users, implement a complementary modality for dental care, open the facility earlier for scheduling appointments, and prioritize care for residents of the catchment area. PMID:12700781

  2. Climate and cultural aspects in intensive care units

    OpenAIRE

    Guidet, Bertrand; González-Romá, Vicente

    2011-01-01

    Research carried out in the field of work and organisational psychology shows that work unit climate and culture are important determinants of work unit performance. We briefly summarise what we have learnt about the climate-performance relationship in work units distinct from ICUs. Then, we show how the ICU culture can be measured, and summarise research on the culture-performance relationship in ICUs.

  3. Managing corporate governance risks in a nonprofit health care organization.

    Science.gov (United States)

    Troyer, Glenn T; Brashear, Andrea D; Green, Kelly J

    2005-01-01

    Triggered by corporate scandals, there is increased oversight by governmental bodies and in part by the Sarbanes-Oxley Act of 2002. Corporations are developing corporate governance compliance initiatives to respond to the scrutiny of regulators, legislators, the general public and constituency groups such as investors. Due to state attorney general initiatives, new legislation and heightened oversight from the Internal Revenue Service, nonprofit entities are starting to share the media spotlight with their for-profit counterparts. These developments are changing nonprofit health care organizations as well as the traditional role of the risk manager. No longer is the risk manager focused solely on patients' welfare and safe passage through a complex delivery system. The risk manager must be aware of corporate practices within the organization that could allow the personal objectives of a few individuals to override the greater good of the community in which the nonprofit organization serves.

  4. Managing corporate governance risks in a nonprofit health care organization.

    Science.gov (United States)

    Troyer, Glenn T; Brashear, Andrea D; Green, Kelly J

    2005-01-01

    Triggered by corporate scandals, there is increased oversight by governmental bodies and in part by the Sarbanes-Oxley Act of 2002. Corporations are developing corporate governance compliance initiatives to respond to the scrutiny of regulators, legislators, the general public and constituency groups such as investors. Due to state attorney general initiatives, new legislation and heightened oversight from the Internal Revenue Service, nonprofit entities are starting to share the media spotlight with their for-profit counterparts. These developments are changing nonprofit health care organizations as well as the traditional role of the risk manager. No longer is the risk manager focused solely on patients' welfare and safe passage through a complex delivery system. The risk manager must be aware of corporate practices within the organization that could allow the personal objectives of a few individuals to override the greater good of the community in which the nonprofit organization serves. PMID:20200865

  5. Residents Living in Residential Care Facilities: United States, 2010

    Science.gov (United States)

    ... population with a high burden of functional and cognitive impairment. Residential care is an important component of ... RCF and the month and year of the interview. Medicaid beneficiary : A resident who, during the 30 ...

  6. Competition and primary care in the United States: separating fact from fancy.

    Science.gov (United States)

    Siminoff, L

    1986-01-01

    Competitive strategies have been advocated as the solution for the economic ills of the U.S. economy. During the 1980s many economists and health care practitioners are arguing that a competitive strategy will bring down health care costs; these plans emphasize the existence of perverse incentives which reward cost reducing behavior with less revenue. Competitive strategies assume the existence of a "health care marketplace." Historically, the United States health care sector has not conformed to the ideal of the competitive market because of the special characteristics involved in the production and consumption of health care. Consumers have the least power in the health care sector and yet most competitive proposals are explicitly directed at changing consumer behavior, especially in the area of primary care. Much evidence indicates that competitive plans inhibit consumers from using primary care services, increase long-term health care costs, and ultimately require more government regulatory action.

  7. Accountable Care Organizations and Clinical Commissioning Groups face an uncertain challenge for improving public health

    Directory of Open Access Journals (Sweden)

    Douglas J. Noble

    2012-04-01

    Full Text Available Accountable Care Organizations (ACO in the United States of America (USA and Clinical Commissioning Groups (CCG in the United Kingdom (UK are new proposed organizations in health services both tasked with a role which includes improving public health.  Although there are very significant differences between the UK and USA health systems there appears to be a similar confusion as to how ACO and CCG will regard and address public or population health.  The role of ACO in improving population health and evaluating the health needs of their registered and insured patients remains ill-defined and poorly explored.  Likewise, in the current UK National Health Service (NHS reorganisation, control and commissioning of appropriate local health services are passing from Primary Care Trusts (PCT to new cross-organizational structures (CCG.  CCG groups aim to be, like ACO, physician led.  They will also assume a role for public or population health, but this role, like that of the newly-forming ACO, is currently unclear.  Lessons learned from the USA and UK experience of new organizations tasked with a role in improving public health may inform mechanisms for physician led organizations in the UK and the USA to assess health needs, monitor population health information and improve population health outcomes.

  8. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  9. Caring for our youngest: public attitudes in the United States.

    Science.gov (United States)

    Sylvester, K

    2001-01-01

    Families make choices about employment and care for their children in a context that is shaped by public policies and colored by public opinion. Debates over whether the government should increase funding for child care or do more to help parents stay home with their children reflect tensions among strongly held ideas about family life, work, and the role of government. This article summarizes the results of public opinion polls that probe attitudes about parent and government roles and responsibilities with respect to children's care. The polling findings yield three main lessons: The American public believes that parents should be the primary influence in their children's lives and that it is best if mothers can be home to care for the very young. The public also values family self-sufficiency and understands that low-income families may need child care assistance to balance child rearing and employment responsibilities. However, skepticism about the appropriateness of government involvement in family life limits public support for proposals that the government act directly to provide or improve child care. From these lessons, the author draws several conclusions for policymakers: Policies focused on caregiving should respect the rights of parents to raise their children by ensuring that an array of options is available. Public programs should help families who are struggling economically to balance their obligations to work and family. Rather than directly providing child care services, government should fund community-based child care programs, and provide flexible assistance to help families secure the services they need and want. PMID:11712455

  10. Frequency of admission in Intensive Care Unit due to road accident

    OpenAIRE

    Vasilios Tziallas; Dimitrios Karagiorgis; Stergios Voutos; Othon Vlachopoulos; Dimitrios Tziallas; Mariana Ntokou

    2011-01-01

    During recent years, it has been noticed a remarkable increase in admission of the young in Intensive Care Unit due to road accident. The aim of the present study was to explore the injuries, the special conditions of admission of young 18-40 years old that were admitted to Intensive Care Unit due to road accident. Method and material: The sample studied consisted of young individuals 18-40 years old that were admitted in the Intensive Care Unit (ICU) of public hospitals in the area of Attica...

  11. Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement

    OpenAIRE

    Tai, Shu-Yu; Lee, Chung-Yin; Wu, Chien-Yi; Hsieh, Hui-ya; Huang, Joh-Jong; Huang, Chia-Tsuan; Chien, Chen-Yu

    2016-01-01

    Background This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement. Methods This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the “Symptom Reporting Form”, and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1st, 3rd, 5th, and 7th Day in the palliative care unit...

  12. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States

    Directory of Open Access Journals (Sweden)

    Donald Murphy R

    2011-07-01

    Full Text Available Abstract It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs. Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.

  13. Advances in migraine management: implications for managed care organizations.

    Science.gov (United States)

    Dodick, David W; Lipsy, Robert J

    2004-05-01

    Migraine headache is a disabling disease that poses a significant societal burden. Stratified care and early intervention are current strategies for migraine management. It has been shown that early treatment with triptans in select patients can improve treatment outcomes. Triptans are selective 5-HT receptor agonists that are specific and effective treatments in the management of migraine, and they meet the acute treatment goal of rapid relief with minimal side effects. Triptans are associated with improved quality of life. Factors such as speed of onset, need for a second triptan dose, and patient satisfaction should be considered in the selection of a specific triptan treatment. Appropriate treatment can decrease costs. The patient's migraine history and response to prior therapy should be considered when selecting acute treatment. Cost-effectiveness models can be used to understand the effect of treatment choices on health care budgets. The direct cost per migraine episode, driven primarily by the need for rescue medications, is important to include in economic models. All aspects of effectiveness (efficacy, tolerability, and cost) should be considered to reduce overall managed care expenditures for migraine treatment. The improved clinical profiles of the triptans provide substantial value to managed care organizations.

  14. Managing facility risk: external threats and health care organizations.

    Science.gov (United States)

    Reid, Daniel J; Reid, William H

    2014-01-01

    Clinicians and clinical administrators should have a basic understanding of physical and financial risk to mental health facilities related to external physical threat, including actions usually viewed as "terrorism" and much more common sources of violence. This article refers to threats from mentally ill persons and those acting out of bizarre or misguided "revenge," extortionists and other outright criminals, and perpetrators usually identified as domestic or international terrorists. The principles apply both to relatively small and contained acts (such as a patient or ex-patient attacking a staff member) and to much larger events (such as bombings and armed attack), and are relevant to facilities both within and outside the U.S. Patient care and accessibility to mental health services rest not only on clinical skills, but also on a place to practice them and an organized system supported by staff, physical facilities, and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or to serve at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state and national standards for hospital safety, or insurance providers' individual facility requirements. PMID:24733720

  15. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain.

    Science.gov (United States)

    Giovanella, Lígia; Stegmüller, Klaus

    2014-11-01

    The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms' impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems. PMID:25493982

  16. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain

    Directory of Open Access Journals (Sweden)

    Lígia Giovanella

    2014-11-01

    Full Text Available The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date, and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.

  17. Improving Surgical Care in Low- and Middle-Income Countries: A Pivotal Role for the World Health Organization

    OpenAIRE

    Bickler, Stephen W.; Spiegel, David

    2010-01-01

    In response to increasing evidence that surgical conditions are an important global public health problem, and data suggesting that essential surgical services can be delivered in a cost-effective manner in low- and middle-income countries, the World Health Organization (WHO) has expanded its interest in surgical care. In 2004, WHO established a Clinical Procedures Unit within the Department of Essential Health Technologies. This unit has developed the Emergency and Essential Surgical Project...

  18. Evaluation of radiation dose to neonates in a special care baby unit

    Science.gov (United States)

    Alzimami, K.; Sulieman, A.; Yousif, A.; Babikir, E.; Salih, I.

    2014-11-01

    The purpose of this study was to evaluate the patient entrance surface dose (ESD), organ dose and effective dose for neonates in the special care baby unit (SCBU) up to 28 days after birth. A total of 135 patients were examined during 4 months. ESDs were calculated from patient exposure parameters using DosCal software. Effective doses were calculated using software from the National Radiological Protection Board (NRPB). The mean patient ESD per procedure was 80±0.02 μGy. The mean and range of the effective dose per procedure were 0.02 (0.01-0.3) mSv. The radiation dose in this study was higher compared to previous studies. A dedicated X-ray machine with additional filtration is recommended for patient dose reductions.

  19. [Management of quality in an Intensive Care Unit: implementation of ISO 9001:2008 international standard].

    Science.gov (United States)

    Lorenzo Torrent, R; Sánchez Palacios, M; Santana Cabrera, L; Cobian Martinez, J L; García del Rosario, C

    2010-10-01

    The Quality Management Systems make it possible to prioritize actions to maintain the safety and efficacy of health technologies. The Intensive Care Unit of our hospital has implemented a quality management plan, which has obtained accreditation as "Service Certificate that manages its activities according to UNE-EN ISO 9001:2008" standard. With the application of quality management system, it has been possible to detect the needs that the Service can cover in order to obtain the satisfaction of the patient, relative or health personnel of the other services of the hospital, to improve communications inside and outside of service, to secure greater understanding of the processes of the organization and control of risk, to delimit responsibilities clearly to all the personnel, to make better use of the time and resources and, finally, to improve the motivation of the personnel.

  20. The Parents' Perception of Nursing Support in their Neonatal Intensive Care Unit (NICU Experience

    Directory of Open Access Journals (Sweden)

    Amani F. Magliyah

    2015-02-01

    Full Text Available NICU is an environment that has many challenges in information receiving and understanding. The infants that are cared for might have serious and complex medical problems. For Parents the NICU experience is filled with stress, fear, sadness, guilt and shock of having a sick baby in NICU. The aim of this research was to explore and describe parents' experience when their infant is admitted to the NICU. And assess their perception of nursing support of information provision and according to their emotional feelings. This study was undertaken at Neonatal Intensive Care Unit in King Abdulaziz Medical City (KAMC, Jeddah, Saudi Arabia which is part of National Guard Health Affairs (NGHA organization in the kingdom. The study utilized a self-report questionnaire with likert scale measurement and telephone interview with closed questions. One hundred and four parents agree to be the part of study and provided their consent to include their children in the study. The majority of respondents were mothers (76%, the remaining (24% from the total sample were Fathers. All their infants have been admitted to the NICU at 2014. Many parents did not able to receive enough information easily from the unit; most of them found the information by nurses was difficult to understand. The majority of parent's perceived high stress and anxiety level according to this information. Also, Most Parents was not agreed about the nurses' support towards their emotional feeling and care. Additional finding indicate that a decrease in support level being associated with an increase in stress and anxiety level. In order to provide a high level of support and decrease the level of stress, there is a need for developing support strategies. One strategy is through a technology to develop an automatic daily summary for parent.

  1. Demographic profile and utilization statistics of a Canadian inpatient palliative care unit within a tertiary care setting

    OpenAIRE

    Napolskikh, J.; Selby, D.; Bennett, M.; Chow, E.; Harris, K; Sinclair, E.; Myers, J.

    2009-01-01

    Background Canadian data describing inpatient palliative care unit (pcu) utilization are scarce. In the present study, we performed a quality assessment of a 24-bed short-term pcu with a 3-months-or-less life expectancy policy in a tertiary care setting. Methods Using a retrospective chart review, we explored wait time (wt) for admission (May 2005 to April 2006), length of stay [los (February 2005 to January 2006)], and patient demographics. Results The wt data showed 508 referrals, with 242 ...

  2. The Eldicus prospective, observational study of triage decision making in European intensive care units: Part I-European Intensive Care Admission Triage Scores (EICATS)

    DEFF Research Database (Denmark)

    Sprung, Charles L; Baras, Mario; Iapichino, Gaetano;

    2012-01-01

    OBJECTIVE:: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage...... decision rule based on 28-day mortality rates of admitted and refused patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with a request for intensive...... care unit admission. INTERVENTIONS:: Admission or rejection to an intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Clinical, laboratory, and physiological variables and data from severity scores were collected. Separate scores for accepted and rejected patients with 28-day mortality end point were...

  3. Costs of quality management systems in long-term care organizations: an exploration.

    NARCIS (Netherlands)

    Wagner, C.; Merode, G.G. van; Oort, M. van

    2003-01-01

    The article describes a method for measuring and reporting the costs of quality management in 11 long-term care organizations (nursing homes, home health care organizations, and homes for the elderly) and a national survey in 489 organizations providing long-term care. Site visits and a questionnair

  4. Nosocomial infections in a neonatal intensive care unit during 16 years: 1997-2012

    Directory of Open Access Journals (Sweden)

    Jane Eire Urzedo

    2014-06-01

    Full Text Available Introduction Surveillance of nosocomial infections (NIs is an essential part of quality patient care; however, there are few reports of National Healthcare Safety Network (NHSN surveillance in neonatal intensive care units (NICUs and none in developing countries. The purpose of this study was to report the incidence of NIs, causative organisms, and antimicrobial susceptibility patterns in a large cohort of neonates admitted to the NICU during a 16-year period. Methods The patients were followed 5 times per week from birth to discharge or death, and epidemiological surveillance was conducted according to the NHSN. Results From January 1997 to December 2012, 4,615 neonates, representing 62,412 patient-days, were admitted to the NICU. The device-associated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonia infections per 1,000 ventilator-days. A total of 1,182 microorganisms were isolated from sterile body site cultures in 902 neonates. Coagulase-negative staphylococci (CoNS (34.3% and Staphylococcus aureus (15.6% were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and Staphylococcus aureus were 86.4% and 28.3%, respectively. Conclusions The most important NI remains bloodstream infection with staphylococci as the predominant pathogens, observed at much higher rates than those reported in the literature. Multiresistant microorganisms, especially oxacillin-resistant staphylococci and gram-negative bacilli resistant to cephalosporin were frequently found. Furthermore, by promoting strict hygiene measures and meticulous care of the infected infants, the process itself of evaluating the causative organisms was valuable.

  5. Applying the new concept of maternal near-miss in an intensive care unit

    Directory of Open Access Journals (Sweden)

    Fátima Aparecida Lotufo

    2012-01-01

    Full Text Available OBJECTIVES: The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria. METHODS: In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate's correction or Fisher's exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95% confidence intervals. RESULTS: Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially lifethreatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission (67.7% of the cases, 107/158; however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths. CONCLUSIONS: Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care.

  6. Use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units.

    Science.gov (United States)

    Bauchner, H; May, A; Coates, E

    1992-10-01

    The purpose of this study was to assess the use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units. The directors of 38 pediatric units and 31 neonatal units reported that analgesics were infrequently used for intravenous cannulation (10%), suprapubic bladder aspiration (8%), urethral catheterization (2%), or venipuncture (2%). Analgesics were used significantly more regularly in pediatric than in neonatal intensive care units for arterial line placement, bone marrow aspiration, central line placement, chest tube insertion, paracentesis, and lumbar puncture. PMID:1403404

  7. Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)

    2013-01-01

    textabstractBackground: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy usi

  8. Auditing the standard of anaesthesia care in obstetric units.

    Science.gov (United States)

    Mörch-Siddall, J; Corbitt, N; Bryson, M R

    2001-04-01

    We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area. PMID:15321622

  9. Vulnerabilities of children admitted to a pediatric inpatient care unit

    OpenAIRE

    Larissa Natacha de Oliveira; Márcia Koja Breigeiron; Sofia Hallmann; Maria Carolina Witkowski

    2014-01-01

    OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital.METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and fro...

  10. Communicating Chaplains' Care: Narrative Documentation in a Neuroscience-Spine Intensive Care Unit.

    Science.gov (United States)

    Johnson, Rebecca; Wirpsa, M Jeanne; Boyken, Lara; Sakumoto, Matthew; Handzo, George; Kho, Abel; Emanuel, Linda

    2016-01-01

    Chaplaincy care is different for every patient; a growing challenge is to ensure that electronic health records function to support personalized care. While ICU health care teams have advanced clinical practice guidelines to identify and integrate relevant aspects of the patient's story into whole person care, recommendations for documentation are rare. This qualitative study of over 400 free-text EHR notes offers unique insight into current use of free-text documentation in ICU by six chaplains integrated into the healthcare team. Our research provides insight into the phenomena chaplains record in the electronic record. Content analysis shows recurrent report of patient and family practices, beliefs, coping mechanisms, concerns, emotional resources and needs, family and faith support, medical decision making and medical communications. These findings are important for health care team discussions of factors deemed essential to whole person care in ICUs, and, by extension have the potential to support the development of EHR designs that aim to advance personalized care.

  11. Psychosocial factors and mental work load: a reality perceived by nurses in intensive care units1

    OpenAIRE

    Paula Ceballos-Vásquez; Gladys Rolo-González; Estefanía Hérnandez-Fernaud; Dolores Díaz-Cabrera; Tatiana Paravic-Klijn; Mónica Burgos-Moreno

    2015-01-01

    OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care un...

  12. Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit

    OpenAIRE

    Jaquilene Barreto da Costa; Sonia Silva Marcon; Claudia Rejane Lima de Macedo; Amaury Cesar Jorge; Péricles Almeida Delfino Duarte

    2014-01-01

    Objective To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the partici...

  13. Practice patterns of physiotherapists in neonatal intensive care units: A national survey

    OpenAIRE

    Chokshi, Tejas; Alaparthi, Gopala Krishna; Krishnan, Shyam; Vaishali, K; Zulfeequer, C.P.

    2013-01-01

    Objective: To determine practice pattern of physiotherapists in the neonatal intensive care units (ICUs) in India with regards to cardiopulmonary and neuromuscular physiotherapy. Materials and Methods: A cross-sectional survey was conducted across India, in which 285 questionnaires were sent via e-mail to physiotherapists working in neonatal intensive care units. Results: A total of 139 completed questionnaires were returned with a response rate of 48.7%, with a majority of responses from Kar...

  14. Enteral nutrition practices in the intensive care unit: Understanding of nursing practices and perspectives

    OpenAIRE

    Babita Gupta; Pramendra Agrawal; Soni, Kapil D; Vikas Yadav; Roshni Dhakal; Shally Khurana; M C Misra

    2012-01-01

    Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs). Aim: The study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses′ perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit. Materials...

  15. Monitoring of health care personnel employee and occupational health immunization program practices in the United States.

    Science.gov (United States)

    Carrico, Ruth M; Sorrells, Nikka; Westhusing, Kelly; Wiemken, Timothy

    2014-01-01

    Recent studies have identified concerns with various elements of health care personnel immunization programs, including the handling and management of the vaccine. The purpose of this study was to assess monitoring processes that support evaluation of the care of vaccines in health care settings. An 11-question survey instrument was developed for use in scripted telephone surveys. State health departments in all 50 states in the United States and the District of Columbia were the target audience for the surveys. Data from a total of 47 states were obtained and analyzed. No states reported an existing monitoring process for evaluation of health care personnel immunization programs in their states. Our assessment indicates that vaccine evaluation processes for health care facilities are rare to nonexistent in the United States. Identifying existing practice gaps and resultant opportunities for improvements may be an important safety initiative that protects patients and health care personnel.

  16. Nursing students’ experiences of professional patient care encounters in a hospital unit

    DEFF Research Database (Denmark)

    Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth

    2015-01-01

    experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing......REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to identify, appraise and synthesize the best available evidence on nursing students’ experiences of professional patient care encounters in a hospital unit. More specifically the research questions are: How do nursing students...... describe their experiences of professional patient care in a hospital unit? What kinds of experiences do nursing students have in professional patient care encounters? INCLUSION CRITERIA Types of participants This review will consider studies that include undergraduate and postgraduate nursing students...

  17. Predictors of postoperative pulmonary complications after liver resection: Results from a tertiary care intensive care unit

    Directory of Open Access Journals (Sweden)

    Anirban Hom Choudhuri

    2014-01-01

    Full Text Available Background: Postoperative pulmonary complication (PPC is a serious complication after liver surgery and is a major cause of mortality and morbidity in the intensive care unit (ICU. Therefore, the early identification of risk factors of PPCs may help to reduce the adverse outcomes. Objective: The aim of this retrospective study was to determine the predictors of PPCs in patients undergoing hepatic resection. Design: Retrospective, observational. Methods: The patients admitted after hepatic resection in the gastrosurgical ICU of our institute between October 2009 and June 2013 was identified. The ICU charts were retrieved from the database to identify patients who developed PPCs. A comparison of risk factors was made between the patients who developed PPC (PPC group against the patients who did not (no-PPC group. Results: Of 117 patients with hepatic resection, 28 patients developed PPCs. Among these, pneumonia accounted for 12 (42.8% followed by atelectasis in 8 (28.5% and pleural effusion in 3 (10.7%. Among the patients developing PPCs, 16 patients were over a 70-year-old (57.1%, 21 patients were smokers (75% and 8 patients (28.5% had chronic obstructive pulmonary disease (COPD. The requirement for blood transfusion and duration of mechanical ventilation were greater in the patients developing PPC (2000 ± 340 vs. 1000 ± 210 ml; 10 ± 4.5 vs. 3 ± 1.3 days. Conclusion: Old age, chronic smoking, COPD, increased blood product transfusion, increased duration of mechanical ventilation and increased length of ICU stay increased the relative risk of PPC, presence of diabetes and occurrence of surgical complications (leak, dehiscence, etc. were independent predictive variables for the development of PPC.

  18. The Creation of a Biocontainment Unit at a Tertiary Care Hospital. The Johns Hopkins Medicine Experience.

    Science.gov (United States)

    Garibaldi, Brian T; Kelen, Gabor D; Brower, Roy G; Bova, Gregory; Ernst, Neysa; Reimers, Mallory; Langlotz, Ronald; Gimburg, Anatoly; Iati, Michael; Smith, Christopher; MacConnell, Sally; James, Hailey; Lewin, John J; Trexler, Polly; Black, Meredith A; Lynch, Chelsea; Clarke, William; Marzinke, Mark A; Sokoll, Lori J; Carroll, Karen C; Parish, Nicole M; Dionne, Kim; Biddison, Elizabeth L D; Gwon, Howard S; Sauer, Lauren; Hill, Peter; Newton, Scott M; Garrett, Margaret R; Miller, Redonda G; Perl, Trish M; Maragakis, Lisa L

    2016-05-01

    In response to the 2014-2015 Ebola virus disease outbreak in West Africa, Johns Hopkins Medicine created a biocontainment unit to care for patients infected with Ebola virus and other high-consequence pathogens. The unit team examined published literature and guidelines, visited two existing U.S. biocontainment units, and contacted national and international experts to inform the design of the physical structure and patient care activities of the unit. The resulting four-bed unit allows for unidirectional flow of providers and materials and has ample space for donning and doffing personal protective equipment. The air-handling system allows treatment of diseases spread by contact, droplet, or airborne routes of transmission. An onsite laboratory and an autoclave waste management system minimize the transport of infectious materials out of the unit. The unit is staffed by self-selected nurses, providers, and support staff with pediatric and adult capabilities. A telecommunications system allows other providers and family members to interact with patients and staff remotely. A full-time nurse educator is responsible for staff training, including quarterly exercises and competency assessment in the donning and doffing of personal protective equipment. The creation of the Johns Hopkins Biocontainment Unit required the highest level of multidisciplinary collaboration. When not used for clinical care and training, the unit will be a site for research and innovation in highly infectious diseases. The lessons learned from the design process can inform a new research agenda focused on the care of patients in a biocontainment environment. PMID:27057583

  19. Evaluation of the european heart failure self-care behaviour scale in a united kingdom population

    NARCIS (Netherlands)

    Shuldham, Caroline; Theaker, Chris; Jaarsma, Tiny; Cowie, Martin R.

    2007-01-01

    Title. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population Aim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in

  20. Physical Therapy Observation and Assessment in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Campbell, Suzann K.

    2013-01-01

    This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert…

  1. Health Risk Behaviors in Family Caregivers During Patients’ Stay in Intensive Care Units: A Pilot Analysis

    Science.gov (United States)

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

    2014-01-01

    Background Studies of family caregivers of the critically ill have mainly focused on the psychological impact of the patients’ stay in the intensive care unit and related stress. Despite known associations between stress and physical health, limited attention has been paid to the need to promote and maintain physical health in these caregivers. Objective To explore how family caregivers’ health risk behaviors are associated with patients’ preexisting care needs and the caregivers’ depressive symptoms and burden. Methods During the intensive-care-unit stay of critically ill patients (who required mechanical ventilation for ≥4 days), 50 family caregivers were surveyed to determine the caregivers’ depressive symptoms, burden, and health risk behaviors. Data were also collected on patients’ care needs before admission to the intensive care unit. Results One or more health risk behaviors were reported by 94% of family caregivers. More than 90% of caregivers reported depressive symptoms above the score indicating risk for clinical depression. A high level of burden was reported by 36% of caregivers. More health risk behaviors were associated with higher scores of depressive symptoms and burden (P<.001 for both). Caregivers’ responses did not differ according to patients’ preexisting care needs. Conclusion Health risk behaviors of family caregivers are associated with greater perceptions of burden and/or depressive symptoms but not with patients’ care needs before admission to the intensive care unit. PMID:23283087

  2. Recovery at the post anaesthetic care unit after breast cancer surgery

    DEFF Research Database (Denmark)

    Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl;

    2010-01-01

    Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine, the...

  3. An Ecological Understanding of Kinship Foster Care in the United States

    Science.gov (United States)

    Hong, Jun Sung; Algood, Carl L.; Chiu, Yu-Ling; Lee, Stephanie Ai-Ping

    2011-01-01

    We review empirical studies on kinship foster care in the United States. We conceptualize kinship foster care within the context of Urie Bronfenbrenner's (1994) most recent ecological systems theory. Because there are multiple levels of influences on the developmental outcomes of children placed in kinship foster home, understanding the…

  4. Scoring system for the selection of high-risk patients in the intensive care unit

    NARCIS (Netherlands)

    Iapichino, G; Mistraletti, G; Corbella, D; Bassi, G; Borotto, E; Miranda, DR; Morabito, A

    2006-01-01

    Objective. Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment. Design: A posteriori analysi

  5. Patients with diabetes in the intensive care unit; not served by treatment, yet protected?

    NARCIS (Netherlands)

    S.E. Siegelaar; J.H. Devries; J.B. Hoekstra

    2010-01-01

    Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ( ICU), de

  6. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2002-08-01

    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  7. Bench-to-bedside review: Dealing with increased intensive care unit staff turnover: a leadership challenge

    OpenAIRE

    Laporta, Denny P; Burns, Judy; Doig, Chip J

    2005-01-01

    Critical care leaders frequently must face challenging situations requiring specific leadership and management skills for which they are, not uncommonly, poorly prepared. Such a fictitious scenario was discussed at a Canadian interdisciplinary critical care leadership meeting, whereby increasing intensive care unit (ICU) staff turnover had led to problems with staff recruitment. Participants discussed and proposed solutions to the scenario in a structured format. The results of the discussion...

  8. Expanded organic building units for the construction of highly porous metal-organic frameworks.

    Science.gov (United States)

    Kong, Guo-Qiang; Han, Zhi-Da; He, Yabing; Ou, Sha; Zhou, Wei; Yildirim, Taner; Krishna, Rajamani; Zou, Chao; Chen, Banglin; Wu, Chuan-De

    2013-10-25

    Two new organic building units that contain dicarboxylate sites for their self-assembly with paddlewheel [Cu2(CO2)4] units have been successfully developed to construct two isoreticular porous metal-organic frameworks (MOFs), ZJU-35 and ZJU-36, which have the same tbo topologies (Reticular Chemistry Structure Resource (RCSR) symbol) as HKUST-1. Because the organic linkers in ZJU-35 and ZJU-36 are systematically enlarged, the pores in these two new porous MOFs vary from 10.8 Å in HKUST-1 to 14.4 Å in ZJU-35 and 16.5 Å in ZJU-36, thus leading to their higher porosities with Brunauer-Emmett-Teller (BET) surface areas of 2899 and 4014 m(2) g(-1) for ZJU-35 and ZJU-36, respectively. High-pressure gas-sorption isotherms indicate that both ZJU-35 and ZJU-36 can take up large amounts of CH4 and CO2, and are among the few porous MOFs with the highest volumetric storage of CH4 under 60 bar and CO2 under 30 bar at room temperature. Their potential for high-pressure swing adsorption (PSA) hydrogen purification was also preliminarily examined and compared with several reported MOFs, thus indicating the potential of ZJU-35 and ZJU-36 for this important application. Studies show that most of the highly porous MOFs that can volumetrically take up the greatest amount of CH4 under 60 bar and CO2 under 30 bar at room temperature are those self-assembled from organic tetra- and hexacarboxylates that contain m-benzenedicarboxylate units with the [Cu2(CO2)4] units, because this series of MOFs can have balanced porosities, suitable pores, and framework densities to optimize their volumetric gas storage. The realization of the two new organic building units for their construction of highly porous MOFs through their self-assembly with [Cu2(CO2)4] units has provided great promise for the exploration of a large number of new tetra- and hexacarboxylate organic linkers based on these new organic building units in which different aromatic backbones can be readily incorporated

  9. An audit of intensive care unit admission in a pediatric cardio-thoracic population in Enugu, Nigeria

    Directory of Open Access Journals (Sweden)

    Azike Jerome

    2010-08-01

    Full Text Available BACKGROUND: The study aimed to perform an audit of intensive care unit admissions in the paediatric cardio-thoracic population in Enugu, Nigeria and examine the challenges and outcome in this high risk group. Ways of improvement based on this study are suggested. METHODS: The hospital records of consecutive postoperative pediatric cardiothoracic admissions to the multidisciplinary and cardiothoracic intensive care units of the University of Nigeria Teaching Hospital (UNTH Enugu, Nigeria to determine their Intensive Care Unit management and outcome over a 2 year span - June 2002 to June 2004 were retrospectively reviewed. Data collected included patient demographics, diagnosis, duration of stay in the intensive care unit, therapeutic interventions and outcome. RESULTS: There were a total of thirty consecutive postoperative paediatric admissions to the intensive care unit over the 2 year study period. The average age of the patients was 5.1 years with a range of 2 weeks to 13 years. Twelve patients had cardiac surgery with cardiopulmonary bypass (CPB, three patients had colon transplant, four patients had pericardiotomy/pericardicectomy, and five patients had diagnostic/therapeutic bronchoscopy. The remaining patients had the following surgeries, thoracotomy for repair of diaphragmatic hernia/decortications, delayed primary repair of esophageal atresia and gastrostomy. Two patients had excision of a cervical teratoma and cystic hygroma. The average duration of stay in the intensive care unit was 6.2 days. Ten patients (33% received pressor agents for organ support. Five patients (17% had mechanical ventilation, while twenty-five patients (83% received oxygen therapy via intranasal cannula or endotracheal tube. Seven patients (23% received blood transfusion in the ICU. There was a 66% survival rate with ten deaths. CONCLUSION: Paediatric cardio-thoracic services in Nigeria suffer from the problems of inadequate funding and manpower flight to better

  10. PROFILE OF ASPHYXIATED BABIES AT NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL IN NORTH EASTERN INDIA

    Directory of Open Access Journals (Sweden)

    Ananta Kumar

    2016-05-01

    Full Text Available BACKGROUND Birth asphyxia is one of the major causes of neonatal mortality as well as morbidity in India, but it studied that the causes which lead to asphyxia are usually preventable. Many metabolic as well as other sequential changes occurs in the body as a result of birth asphyxia which further lead to major long-term sequelae like cerebral palsy, mental retardation and seizure disorder. AIM To identify antepartum, intrapartum and postnatal risk factors for neonatal mortality due to birth asphyxia and to assess the clinico-biochemical status and outcome in the early neonatal period of babies who were asphyxiated at birth. DESIGN Cohort study. SETTING Neonatal Intensive Care Unit, Gauhati Medical College and Hospital. METHODS After clearance from the Hospital Ethical Committee, all severely asphyxiated babies at birth, admitted to neonatal unit from August 2009 to July 2010 were included in the study. A specially designed questionnaire was used to assess the role of maternal factors and neonatal presentation of birth asphyxia. Antenatal and intrapartum factors like maternal anaemia, Pregnancy Induced Hypertension (PIH, eclampsia, antenatal visits, Meconium Stained Amniotic Fluid (MSAF were recorded. Asphyxiated babies were observed for stages of Hypoxic Ischaemic Encephalopathy (HIE, reflexes and any end organ involvement. Investigations were done for blood counts, electrolytes, USG, etc. RESULTS Among 150 babies, we found significant association between birth asphyxia and factors like poor antenatal check-up (48%, MSAF (38.7%, maternal anaemia (78%, PIH (20.7%, eclampsia (15.3%, prolonged labour (28%, ante partum foetal distress (14.7%; 24% cases were in HIE stage I, 32% in stage II and 44% in stage III. Multiorgan involvement seen with renal (9.3%, haematological (3.3% abnormalities. During management 54.6% needed inotropes (54.6% for circulatory support, 60% cases needed anticonvulsant and mortality rate was (48%. CONCLUSION There were lots

  11. Parkinson’s disease permanent care unit: managing the chronic-palliative interface

    Directory of Open Access Journals (Sweden)

    Lökk J

    2011-04-01

    Full Text Available Johan LökkDepartment of Neurobiology, Caring Sciences, and Society, Karolinska Institutet; Geriatric Department, Karolinska University Hospital Huddinge, Stockholm, SwedenBackground: Parkinson’s disease (PD eventually leads to severe functional decline and dependence. Specialized care units for PD patients in need of permanent care are lacking.Methods: Patients with severe PD are referred to the PD permanent care unit harboring 30 patients with specialized medical and health care provided by trained staff. Patients need to have intensive medical and care needs, and be no longer able to stay at home or at an ordinary institution. A written and continuously reviewed care plan is made for each patient at admission, with the overriding aim to preserve quality of life and optimize functionality.Results: After five years, the PD permanent care unit has cared for 70 patients (36 men and 34 women with a mean age of 76.6 years and a mean duration of Parkinsonism of 11.8 years. Hoehn and Yahr severity of disease was 3.7, cognition was 25.3 (Mini-Mental State Examination, and the mean daily levodopa dose was 739 mg. The yearly fatality rate was seven, and the mean duration of stay was 26.9 months. Only five patients moved out from the unit.Conclusion: A specially designed and staffed care unit for Parkinsonism patients seems to fill a need for patients and caregivers, as well as for social and health care authorities. This model is sensitive to the changing needs and capacities of patients, ensuring that appropriate services are available in a timely manner. There was a rather short duration of patient stay and remaining life span after admission to the unit. Despite the chronic/palliative state of patients at the PD permanent care unit, there are many therapeutic options, with the overriding objective being to allow the patients to end their days in a professional and comfortable environment.Keywords: Parkinsonism, palliative care, end-stage disease

  12. Assessment of Environmental Sustainability in Health Care Organizations

    Directory of Open Access Journals (Sweden)

    María Carmen Carnero

    2015-06-01

    Full Text Available Healthcare organizations should set a standard in corporate social responsibility and encourage environmental sustainability, since protection of the environment implies the development of preventive measures in healthcare. Environmental concern has traditionally focused on manufacturing plants. However, a Health Care Organization (HCO is the only type of company which generates all existing classes of waste, and 20% is dangerous, being infectious, toxic or radioactive in nature. Despite the extensive literature analysing environmental matters, there is no objective model for assessing the environmental sustainability of HCOs in such a way that the results may be compared over time for an organization, and between different organizations, to give a comparison or benchmarking tool for HCOs. This paper presents a Multi-Criteria Decision Analysis model integrating a Fuzzy Analytic Hierarchy Process and utility theory, to evaluate environmental sustainability in HCOs. The model uses criteria assessed as a function of the number of annual treatments undertaken. The model has been tested in two HCOs of very different sizes.

  13. The Social Organization of Care Work in India: Challenges and alternative strategies

    OpenAIRE

    Neetha N

    2010-01-01

    Care work is organized differently in varied economies, though the broader contours may suggest some degree of uniformity. Understanding the social organization of care work and, the processes involved are important in evolving alternative strategies that are otherwise guided by the existing normative assumptions of care. Neetha Pillai addresses care work in social and labour policies, drawing attention to the possibilities of alternative care strategies, beyond the market, in the context of ...

  14. Family members' lived experience in the intensive care unit: a phemenological study.

    LENUS (Irish Health Repository)

    McKiernan, Margaret

    2012-01-31

    AIM: To describe the lived experience of family members of patients in the intensive care unit. BACKGROUND: Admission of a critically ill relative to an intensive care unit causes anxiety and stress to family members. Nursing care is initially focused on maintaining the physiological stability of the patient and less on the needs and concerns of family members. Understanding how families make sense of this experience may help nurses focus on the delivery of family centred care. METHODOLOGY: A phenomenological method was used to describe the lived experiences of family members of patients in an intensive care unit. In-depth interviews were conducted with six family members and analysed using qualitative thematic analysis. RESULTS: Four main themes emerged from the data: the need to know, making sense of it all, being there with them and caring and support. Family members needed honest information about the patient\\'s progress and outcome to make the situation more bearable for them. Making sense of the situation was a continuous process which involved tracking and evaluating care given. Being with their relative sustained their family bond and was a way to demonstrate love and support. Caring reassurance provided by the nurses enabled a sense of security. Support was needed by family members to assist them in coping. CONCLUSION: The research provided an insight into how family members viewed the impact of the admission and how they subsequently found ways of dealing with the situation. RELEVANCE TO CLINICAL PRACTICE: Using a holistic approach to nursing assessment and care delivery in intensive care necessitates that nurses interact with and care for family members of patients. Development of a philosophy of family centred care is necessary, with formal assessment of families to take place soon after admission and an appropriate plan of care drawn up at this time.

  15. Examining Health Care Costs: Opportunities to Provide Value in the Intensive Care Unit.

    Science.gov (United States)

    Chang, Beverly; Lorenzo, Javier; Macario, Alex

    2015-12-01

    As health care costs threaten the economic stability of American society, increasing pressures to focus on value-based health care have led to the development of protocols for fast-track cardiac surgery and for delirium management. Critical care services can be led by anesthesiologists with the goal of improving ICU outcomes and at the same time decreasing the rising cost of ICU medicine.

  16. Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit

    Science.gov (United States)

    El-Nawawy, Ahmed Ahmed; Al-Halawany, Amina Sedky; Antonios, Manal Abdelmalik; Newegy, Reem Gamal

    2016-01-01

    Objective: Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention. Aims: The objective of the study was to evaluate cases developing pneumothorax following admission to a Pediatric Intensive Care Unit (PICU) over a 5-year period. Settings and Design: Case notes of all PICU patients (n = 1298) were reviewed, revealing that 135 cases (10.4%) developed pneumothorax, and these were compared with those patients who did not. The most common tool for diagnosis used was chest X-ray followed by a clinical examination. Subjects and Methods: Case notes of 1298 patients admitted in PICU over 1-year study. Results: Patients with pneumothorax had higher mortality rate (P pediatric index of mortality 2 score on admission (P pediatric logistic organ dysfunction score (P patients without pneumothorax, ventilated patients who developed pneumothorax had a longer duration of MV care (P patients, especially in those on MV and emphasized the importance of the strict application of protective lung strategies among ventilated patients to minimize the risk of pneumothorax.

  17. The organizational context of ethical dilemmas: a role-playing simulation for the intensive care unit.

    Science.gov (United States)

    Strosberg, M A

    2001-01-01

    The allocation of health care resources often requires decision makers to balance conflicting ethical principles. The resource-constrained intensive care unit (ICU) provides an ideal setting to study how decision makers go about their balancing act in a complex and dynamic environment. The author presents a role-playing simulation exercise which models ICU admission and discharge decision making. Designed for the class-room, the simulation engages a variety of ethical, managerial, and public policy issues including end-of-life decision making, triage, and rationing. The simulation is based on a sequence of scenarios or "decision rounds" delineating conditions in the ICU in terms of disposition of ICU patients, number of available ICU beds, prognoses of candidates for admission, and other physiological and organizational information. Students, playing the roles of attending physician, hospital administrator, nurse manager, triage officer, and ethics committee member, are challenged to reach consensus in the context of multiple power centers and conflicting goals. An organization theory perspective, incorporated into the simulation, provides insight on how decisions are actually made and stimulates discussion on how decision making might be improved.

  18. The Impact of Multiple Master Patient Index Records on the Business Performance of Health Care Organizations: A Qualitative Grounded Theory Study

    Science.gov (United States)

    Banton, Cynthia L.

    2014-01-01

    The purpose of this qualitative grounded theory study was to explore and examine the factors that led to the creation of multiple record entries, and present a theory on the impact the problem has on the business performance of health care organizations. A sample of 59 health care professionals across the United States participated in an online…

  19. Understanding health-care access and utilization disparities among Latino children in the United States.

    OpenAIRE

    Langellier, BA; Chen, J; Vargas-Bustamante, A; Inkelas, M; Ortega, AN

    2016-01-01

    It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., i...

  20. SUM (Service Unit Management): An Organizational Approach To Improved Patient Care.

    Science.gov (United States)

    Jelinek, Richard C.; And Others

    To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…

  1. 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.

  2. Allocation of patients with liver cirrhosis and organ failure to intensive care

    DEFF Research Database (Denmark)

    Prier Lindvig, Katrine; Søgaard Teisner, Ane; Kjeldsen, Jens;

    2015-01-01

    AIM: To propose an allocation system of patients with liver cirrhosis to intensive care unit (ICU), and developed a decision tool for clinical practice. METHODS: A systematic review of the literature was performed in PubMed, MEDLINE and EMBASE databases. The search includes studies on hospitalized...... patients with cirrhosis and organ failure, or acute on chronic liver failure and/or intensive care therapy. RESULTS: The initial search identified 660 potentially relevant articles. Ultimately, five articles were selected; two cohort studies and three reviews were found eligible. The literature...... on this topic is scarce and no studies specifically address allocation of patients with liver cirrhosis to ICU. Throughout the literature, there is consensus that selection criteria for ICU admission should be developed and validated for this group of patients and multidisciplinary approach is mandatory. Based...

  3. The Crisis in Emergency and Trauma Care in California and the United States

    Directory of Open Access Journals (Sweden)

    Mansuri, Oveys

    2006-12-01

    Full Text Available A crisis affecting every geographic region and every socioeconomic segment of the United States is threatening the future viability of emergency and trauma care in America. As the financial and social burden of providing trauma care has fallen on individual states, hospitals and physicians, record numbers of emergency departments and trauma centers have been forced to close. The ultimate cost of these closures falls upon patients who will receive inadequate emergency and trauma care. In the fall of 2004 King Drew Medical Center Trauma Services, the second largest trauma center in Los Angeles County closed. Continuing on this path may threaten the emergency and trauma care in the United States, touted as one of the finest in the world. This article provides a general overview of the trauma center crisis in California and reviews the history of the problem and its future implications in California as well as the United States.

  4. Perceptions on psychiatric nursing care at a general hospital inpatient unit

    Directory of Open Access Journals (Sweden)

    Renata Marques de Oliveira

    2016-06-01

    Full Text Available The objective was to investigate the perception of nurses, nursing assistants and patients about nursing care at a general hospital psychiatric unit. Exploratory study with 16/20 nursing professionals and 27/84 patients from the psychiatric inpatient unit of a general hospital. Interviews were based on guiding questions about the nursing care in said unit. Thematic content analysis was adopted. The subjects acknowledge that nursing promotes the recovery of patients, that it is essential during hospitalization, and defend that working in psychiatry requires a taste and profile for it. The patients value warmth, attention, serenity, good mood, patience, concern, presence, promptness, respect and responsibility. The professionals value affection, dedication, effort, patience, security and serenity. Professionals and patients wonder if changes in nursing care during hospitalization stimulate independence/autonomy for discharge or reflect carelessness. In conclusion, nursing care is essential during psychiatric hospitalization, but it requires that professionals like it and have the right profile.

  5. Radiation dose to premature infants in neonatal intensive care units in Kuwait

    International Nuclear Information System (INIS)

    Entrance surface dose (ESD) and effective dose (E) to premature infants were estimated at three neonatal intensive care units in Kuwait for three standard X-ray examinations - abdominal, chest and skull X rays using a simple water phantom. The ESD was found to vary between 58 and 102 μGy for abdominal X rays, between 51 and 102 μGy for chest X rays and between 58 and 145 μGy for skull examinations. These doses are comparable to the entrance skin doses published elsewhere. The E-values were estimated using normalised organ dose dataset from the National Radiological Protection Board. The E-values for abdominal, chest and skull examinations were in the ranges of 30-46, 20-36 and 8-18 μSv per examination, respectively. The risk of developing childhood cancers from each of the three examinations was estimated to be in the range (9-117) x 10-6 for infants undergoing 25 of these X-ray examinations during their stay in the NIC unit. (authors)

  6. X-ray diagnosis of pneumothorax in intensive care units

    International Nuclear Information System (INIS)

    Pneumothorax is the most severe manifestation of pulmonary barotrauma which occurs in mechanical ventilation. Diagnosis of pneumothorax in intensive care radiology is of particular difficulty. Chest radiographs in supine position show a variety of signs which may be helpful but are not conclusive. There are different techniques for verification of ventrally located pneumothorax. 450 tangential radiographs of the hemithorax in question are most conclusive for demonstration of extrapulmonary air located inside the pleural cavity. This 450 technique is easy to carry out without changing the patients position. (orig.)

  7. Intraocular infections in the neonatal intensive care unit

    OpenAIRE

    Sisk RA; Berrocal AM; Aziz HA; Flynn HW Jr; Murray TG; Dubovy SR; Hess D; Johnson RA; Hartley K; Diaz-Barbosa M

    2012-01-01

    Hassan A Aziz1, Audina M Berrocal1,2, Robert A Sisk1, Kristin Hartley1, Magaly Diaz-Barbosa2, Rose A Johnson2, Ditte Hess1, Sander R Dubovy1, Timothy G Murray1, Harry W Flynn Jr11Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Jackson Memorial Hospital, Miami, FL, USABackground: The purpose of this study was to report on the incidence and treatment outcomes of endogenous endophthalmitis among newborns in the neonatal intensive care uni...

  8. Radiation exposure of nurses in a coronary care unit

    International Nuclear Information System (INIS)

    In response to increasing awareness of radiation as a possible occupational hazard, nursing personnel staffing a hospital CCU were monitored over a 3-year period to determine occupational exposure. Portable x-ray machines, fluoroscopic units, and patients injected with radiopharmaceuticals were all potential radiation sources on such a unit. Whole-body TLD badges, exchanged monthly, indicated no cumulative exposures over 80 mR during the entire study period. The minimal exposures reported do not justify regular use of dosimeters. Adherence to standard protective measures precludes most exposure to machine-produced radiation. Close, prolonged contact with a patient after an RVG study that utilizes /sup 99m/Tc may account for some exposure. The data indicate that radiation is not a significant occupational hazard for CCU nurses at this hospital; similar minimal exposures would be expected of other nonoccupationally exposed nursing personnel in like environments

  9. Acute Surgical Unit: a new model of care.

    Science.gov (United States)

    Cox, Michael R; Cook, Lyn; Dobson, Jennifer; Lambrakis, Paul; Ganesh, Shanthan; Cregan, Patrick

    2010-06-01

    The traditional on-call system for the management of acute general surgical admissions is inefficient and outdated. A new model, Acute Surgical Unit (ASU), was developed at Nepean Hospital in 2006. The ASU is a consultant-driven, independent unit that manages all acute general surgical admissions. The team has the same make up 7 days a week and functions the same every day, including weekends and public holidays. The consultant does a 24-h period of on-call, from 7 pm to 7 pm. They are on remote call from 7 pm to 7 am and are in the hospital from 7 am to 7 pm with their sole responsibility being to the ASU. The ASU has a day team with two registrars, two residents and a nurse practitioner. All patients are admitted and stay in the ASU until discharge or transfer to other units. Handover of the patients at the end of each day is facilitated by a comprehensive ASU database. The implementation of the ASU at Nepean Hospital has improved the timing of assessment by the surgical unit. There has been significant improvement in the timing of operative management, with an increased number and proportion of cases being done during daylight hours, with an associated reduction in the proportion of cases performed afterhours. There is greater trainee supervision with regard to patient assessment, management and operative procedures. There has been an improvement in the consultants' work conditions. The ASU provides an excellent training opportunity for surgical trainees, residents and interns in the assessment and management of acute surgical conditions. PMID:20618194

  10. 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

  11. Health care policy reform: a microanalytic model for comparing hospitals in the United States and Germany.

    Science.gov (United States)

    Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B

    1999-01-01

    Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.

  12. Stressors in the relatives of patients admitted to an intensive care unit

    Science.gov (United States)

    Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner

    2016-01-01

    Objective To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Methods Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. Results The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Conclusion Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors.

  13. Evaluation of satisfaction with care in a midwifery unit and an obstetric unit: a randomized controlled trial of low-risk women

    OpenAIRE

    Bernitz, Stine; Øian, Pål; Sandvik, Leiv; Blix, Ellen

    2016-01-01

    Background Satisfaction with birth care is part of quality assessment of care. The aim of this study was to investigate possible differences in satisfaction with intrapartum care among low-risk women, randomized to a midwifery unit or to an obstetric unit within the same hospital. Methods Randomized controlled trial conducted at the Department of Obstetrics and Gynecology, Østfold Hospital Trust, Norway. A total of 485 women with no expressed preference for level of birth care, assessed to be...

  14. Latent risk factors in operating theatres and intensive care units

    NARCIS (Netherlands)

    Beuzekom, Martie van

    2012-01-01

    The safety of an organization can be improved by investigating and correcting the many processes that shape performance at the “sharp end”. Errors do not occur of themselves, but arise within the context of the work environment. Where the environment is one that makes errors by individuals more like

  15. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    OpenAIRE

    Armstrong, Susan J; Laetitia C. Rispel; Loveday Penn-Kekana

    2015-01-01

    Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospital...

  16. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    OpenAIRE

    Armstrong, Susan J; Laetitia C. Rispel; Penn-Kekana, Loveday

    2015-01-01

    Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals ...

  17. Mortality profile across our Intensive Care Units: A 5-year database report from a Singapore restructured hospital.

    Science.gov (United States)

    Siddiqui, Shahla

    2015-12-01

    Intensive care remains an area of high acuity and high mortality across the globe. With a rapidly aging population, the disease burden requiring intensive care is growing. The cost of critical care also is rising with new technology becoming available rapidly. We present the all-cause mortality results of 5 years database established in a restructured, large public hospital in Singapore, looking at all three types of Intensive Care Units present in our hospital. These include medical, surgical, and coronary care units.

  18. Nurse-led implementation of a ventilator-associated pneumonia care bundle in a children's critical care unit.

    Science.gov (United States)

    Hill, Charlotte

    2016-05-01

    Ventilator-associated pneumonia (VAP) is the leading cause of death with hospital-acquired infections, and preventing it is one of the Saving Lives initiatives ( Department of Health 2007 ). This article discusses the implementation of a purpose-designed VAP care bundle in a children's intensive care unit and examines the unique role of nurses in the management of the change process. A nurse-led VAP education, implementation and surveillance programme was set up. Nurse education was paramount, as nursing staff acceptance and involvement was a key feature. A multi-method training strategy was implemented, providing staff with multiple training opportunities and introducing VAP project education as a routine part of staff induction. Bundle compliance was monitored regularly and graphs of the results produced quarterly; feedback proved to be useful in keeping staff informed and engaged in VAP reduction. Comparison of VAP incidence before and after introduction of the care bundle showed a reduction after its implementation. With a co-ordinated, multidisciplinary approach, VAP care bundles can result in significant and sustained reductions in VAP rates in the paediatric intensive care unit. Effective co-ordination and leadership is crucial to successful implementation of the VAP bundle, and nurses are well placed to undertake this role. PMID:27156419

  19. Infection Prevention and Control for Ebola in Health Care Settings - West Africa and United States.

    Science.gov (United States)

    Hageman, Jeffrey C; Hazim, Carmen; Wilson, Katie; Malpiedi, Paul; Gupta, Neil; Bennett, Sarah; Kolwaite, Amy; Tumpey, Abbigail; Brinsley-Rainisch, Kristin; Christensen, Bryan; Gould, Carolyn; Fisher, Angela; Jhung, Michael; Hamilton, Douglas; Moran, Kerri; Delaney, Lisa; Dowell, Chad; Bell, Michael; Srinivasan, Arjun; Schaefer, Melissa; Fagan, Ryan; Adrien, Nedghie; Chea, Nora; Park, Benjamin J

    2016-01-01

    The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). PMID:27390018

  20. Serum procalcitonin level and SOFA score at discharge from the intensive care unit predict post-intensive care unit mortality: a prospective study.

    Directory of Open Access Journals (Sweden)

    Yosuke Matsumura

    Full Text Available PURPOSE: The final decision for discharge from the intensive care unit (ICU is uncertain because it is made according to various patient parameters; however, it should be made on an objective evaluation. Previous reports have been inconsistent and unreliable in predicting post-ICU mortality. To identify predictive factors associated with post-ICU mortality, we analyzed physiological and laboratory data at ICU discharge. METHODS: Patients admitted to our ICU between September 2012 and August 2013 and staying for critical care>2 days were included. Sequential Organ Failure Assessment (SOFA score; systemic inflammatory response syndrome score; white blood cell count; and serum C reactive protein, procalcitonin (PCT, interleukin-6 (IL-6, lactate, albumin, and hemoglobin levels were recorded. The primary end point was 90-day mortality after ICU discharge. Two hundred eighteen patients were enrolled (195 survivors, 23 non-survivors. RESULTS: Non-survivors presented a higher SOFA score and serum PCT, and IL-6 levels, as well as lower serum albumin and hemoglobin levels. Serum PCT, albumin, and SOFA score were associated with 90-day mortality in multiple logistic regression analysis. Hosmer-Lemeshow test showed chi-square value of 6.96, and P value of 0.54. The area under the curve (95% confidence interval was 0.830 (0.771-0.890 for PCT, 0.688 (0.566-0.810 for albumin, 0.861 (0.796-0.927 for SOFA score, and increased to 0.913 (0.858-0.969 when these were combined. Serum PCT level at 0.57 ng/mL, serum albumin at 2.5 g/dL and SOFA score at 5.5 predict 90-day mortality, and high PCT, low albumin and high SOFA groups had significantly higher mortality. Serum PCT and SOFA score were significantly associated with survival days after ICU discharge in Cox regression analysis. CONCLUSIONS: Serum PCT level and SOFA score at ICU discharge predict post-ICU mortality and survival days after ICU discharge. The combination of these two and albumin level might enable

  1. Knowledge and attitudes of health care professionals toward organ donation and transplantation

    Directory of Open Access Journals (Sweden)

    Osama Alsaied

    2012-01-01

    Full Text Available To identify and assess the level of knowledge and attitudes of health care professionals (HCP in Qatar toward organ donation and transplantation, this cross-sectional study was carried out from October 2007 to February 2008 in the Accident and Emergency Departments and Intensive Care Units of the hospitals of the Hamad Medical Corporation (HMC. A representative sample of 585 HCP working in the hospitals of the HMC was approached and 418 staff gave consent to participate in the study (71.5%. 36.8% were physicians, 48.6% nurses and 14.6% Emergency Medical Service (EMS technicians. Of the surveyed HCP, 40.7% were males and 59.3% were females. Majority of the staff were in the age group of 30-39 years (58.6%. More than half of the physicians (59.7% and technicians (57.4% assumed that organs can be bought and sold in the State of Qatar. Most of the physicians (76.6% and nurses (75.9% knew that brain-dead persons are eligible for organ donation, whereas only 57.4% of the EMS technicians thought so. Majority of the HCP supported organ donation; physicians (89.0%, nurses (82.3% and technicians (70.5%. The attitude of the physicians (24.0% and nurses (20.2% to donate a kidney to a family member was very poor compared with the attitude of the technicians (44.3%. Although the HCP support organ donation (83%, more than half of the physicians (51.3%, nurses (61.6% and technicians (54.1% wanted to be buried with all their organs intact. The findings, although they give cause for hope, suggest that there is much work yet to be done before organ donation and transplantation can become fully accepted by the medical community in Qatar.

  2. Renal replacement therapy in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Chacko Jose

    2008-01-01

    Full Text Available Acute renal failure is a frequent complication in critically ill patients that carries with it considerable morbidity and mortality. The management of renal failure in patients with multi-organ failure is different from that of renal failure that presents as a single organ failure. Intermittent haemodialysis, done in the conventional manner may not be tolerated by most critically ill patients. Continuous renal replacement therapy is physiologically superior; however, there is lack of strong evidence to prove a clinical benefit. Hybrid therapies that combine the benefits of intermittent haemodialysis and continuous therapies have emerged in the past few years. These are simpler to carry out, provide more flexibility and may be cost effective and need to be studied in a systematic manner.

  3. The organization of flash electroretinography unit in Veterinary Medicine

    International Nuclear Information System (INIS)

    Electroretinography is the technique that allows the evaluation of changes in electrical potential that occur when the eye is stimulated by light. Such changes reflect the response of several retinal cells including photoreceptors (cones and rods). Thus it evaluates the retinal functionality and can diagnose abnormalities in retinas seem to be normal by ophthalmoscopy. Due to the constant evolution in veterinary ophthalmology, new centers of retinal electrophysiology have been introduced around the world either for early diagnosis of retinopathies or for preoperative evaluation of animals with cataracts and glaucoma, as well as for continuing research. The Ophthalmology Unit of the “Governador Laudo Natel” Veterinary Teaching Hospital, in the Faculty of Agronomic and Veterinary Sciences (FCAV) – Sao Paulo State University (UNESP) – Jaboticabal Campus, Brazil, supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP (Sao Paulo State Foundation for Research), set up the Unit of Ocular Electrophysiology for animals in order to provide conditions for the diagnosis of retinopathies. As a pioneering venture in Brazil, the organization of the services faced many challenges till the moment it was set up: the organization and arrangement of appropriate rooms, independent electrical distribution for the installation of separate pieces of equipment, adaptation of containment tables, training and qualification of the staff, and the elaboration and standardization of anesthetic and stimulation protocols. The wealth of information generated by our experience gave us the inspiration to write this paper, which aims to contribute to the work of researchers and veterinary ophthalmologists in this new and opportune field of specialization

  4. Design of the environment of care for safety of patients and personnel: does form follow function or vice versa in the intensive care unit?

    Science.gov (United States)

    Bartley, Judene; Streifel, Andrew J

    2010-08-01

    We review the context of the environment of care in the intensive care unit setting in relation to patient safety and quality, specifically addressing healthcare-associated infection issues and solutions involving interdisciplinary teams. Issues addressed include current and future architectural design and layout trends, construction trends affecting intensive care units, and prevention of construction-associated healthcare-associated infections related to airborne and waterborne risks and design solutions. Specific elements include single-occupancy, acuity-scalable intensive care unit rooms; environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection (floor covering, countertops, furniture, and equipment) and cleaning, antimicrobial-treated or similar materials, ultraviolet germicidal irradiation, specialized rooms (airborne infection isolation and protective environments), and water system design and strategies for safe use of potable water and mitigation of water intrusion. Effective design and operational use of the intensive care unit environment of care must engage critical care personnel from initial planning and design through occupancy of the new/renovated intensive care unit as part of the infection control risk assessment team. The interdisciplinary infection control risk assessment team can address key environment of care design features to enhance the safety of intensive care unit patients, personnel, and visitors. This perspective will ensure the environment of care supports human factors and behavioral aspects of the interaction between the environment of care and its occupants. PMID:20647797

  5. Vulnerabilities of children admitted to a pediatric inpatient care unit

    Directory of Open Access Journals (Sweden)

    Larissa Natacha de Oliveira

    2014-12-01

    Full Text Available OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital.METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics.RESULTS: Of the total sample, 97.1% (n=132 of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4 of the children did not show any criteria to be classified in a category of vulnerability.CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family.

  6. Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians

    Science.gov (United States)

    Mohamed, Zubair Umer; Muhammed, Fazil; Singh, Charu; Sudhakar, Abish

    2016-01-01

    Background and Aims: The practice of intensive care includes withholding and withdrawal of care, when appropriate, and the goals of care change around this time to comfort and palliation. We decided to survey the attitudes, training, and skills of intensive care residents in relation to end-of-life (EoL) care. All residents at our institute who has worked for at least a month in an adult Intensive Care Unit were invited to participate. Materials and Methods: After Institutional Ethics Committee approval, a Likert-scale questionnaire, divided into five composite measures of EoL skills including training and attitude, was handed over to individual residents and completed data were anonymized. Frequency and descriptive analysis was performed for the demographic variables. Central tendency, variability, and reliability were examined for the five composite measures. Scale internal consistency was checked by Cronbach's coefficient alpha. Multivariate forward conditional regression analysis was conducted to examine the association of demographic data or EoL experience to composite measures. Results: Of the 170 eligible residents, we received 120 (70.5%) responses. Conclusions: Internal medicine residents have more experience in caring for dying patients and conducting EoL discussions. Even though majority of participants reported that they are comfortable with the concept of EoL care, this does not always reflect the actual practice in the hospital. There is a need for further training in skills around EoL care. As this is a self-assessment survey, the specific measures of attitudes and skills in EoL are poorly reflected, indicating a need for further research.

  7. [Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome].

    Science.gov (United States)

    Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

    2015-01-01

    Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers. PMID:26187519

  8. International care models for chronic kidney disease: methods and economics--United States.

    Science.gov (United States)

    Crooks, Peter

    2004-01-01

    In the United States, there is a major chronic kidney disease (CKD) problem with over 8 million adults having stage 3 or 4 CKD. There is good medical evidence that many of these patients can benefit from focused interventions. And while there are strong theoretical reasons to believe these interventions are cost-effective, there are little published data to back up this assertion. However, despite the lack of financial data proving cost-effectiveness and against the background of a disorganized health care system in the US, some models of CKD care are being employed. At the present time, the most comprehensive models of care in the US are emerging in vertically integrated health care programs. Other models of care are developing in the setting of managed care health plans that employ CKD disease management programs, either developed internally or in partnership with renal disease management companies.

  9. Urinary density measurement and analysis methods in neonatal unit care

    Directory of Open Access Journals (Sweden)

    Maria Vera Lúcia Moreira Leitão Cardoso

    2013-09-01

    Full Text Available The objective was to assess urine collection methods through cotton in contact with genitalia and urinary collector to measure urinary density in newborns. This is a quantitative intervention study carried out in a neonatal unit of Fortaleza-CE, Brazil, in 2010. The sample consisted of 61 newborns randomly chosen to compose the study group. Most neonates were full term (31/50.8% males (33/54%. Data on urinary density measurement through the methods of cotton and collector presented statistically significant differences (p<0.05. The analysis of interquartile ranges between subgroups resulted in statistical differences between urinary collector/reagent strip (1005 and cotton/reagent strip (1010, however there was no difference between urinary collector/ refractometer (1008 and cotton/ refractometer. Therefore, further research should be conducted with larger sampling using methods investigated in this study and whenever possible, comparing urine density values to laboratory tests.

  10. Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward.

    Science.gov (United States)

    Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A

    2011-06-01

    Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

  11. 76 FR 24816 - Government Employees Serving in Official Capacity in Nonprofit Organizations; Sector Unit...

    Science.gov (United States)

    2011-05-03

    ... in Nonprofit Organizations; Sector Unit Investment Trusts AGENCY: Office of Government Ethics (OGE... of nonprofit organizations in which they serve in an official capacity, notwithstanding the employees... financial interests of nonprofit organizations in which they participate, in their official...

  12. [Care provided by nursing students in a neonatal intensive care unit from the mother's point of view].

    Science.gov (United States)

    Pacheco, S T; do Valle, E R; Simões, S M

    2001-01-01

    The objective of the present study is to investigate the perspective of mothers regarding the care given by academics of nursing to their newborn in a neonatal intensive therapy unit. This is a qualitative research based on a phenomenological approach which has as its philosophical framework the thought of Martin Heidegger expressed in his book Being and Time. The data used in the investigation were interviews given by ten mothers who had their newborns in a neonatal intensive therapy unit of a university hospital in the city of Rio de Janeiro. The interpretation of the data collected revealed that mothers viewed the nursing academics as solicitous beings regarding the care given to their newborns. They also acknowledged that these students were engaged in the assistance given and concerned with what was being done and to whom it was being done. PMID:12098862

  13. Organ and tissue donation: an evaluation of health care professionals’ knowledge and training and implications for education

    OpenAIRE

    Collins, Timothy James

    2014-01-01

    The United Kingdom (UK) has one of the highest transplant waiting lists in Europe, with currently 7,000 people in the UK waiting for a transplant with many people dying before an organ becomes available (NHSBT 2013). An organ or tissue transplant has been proven to be an effective life enhancing treatment for end-stage organ or tissue failure (Collins 2005). The Department of Health (DH) in 2008 recommended that all health care professionals who had potential involvement in donor patients sho...

  14. Cost-benefit analysis: patient care at neurological intensive care unit.

    Science.gov (United States)

    Kopacević, Lenka; Strapac, Marija; Mihelcić, Vesna Bozan

    2013-09-01

    Modern quality definition relies on patient centeredness and on patient needs for particular services, continuous control of the service provided, complete service quality management, and setting quality indicators as the health service endpoints. The health service provided to the patient has certain costs. Thus, one can ask the following: "To what extent does the increasing cost of patient care with changes in elimination improve the quality of health care and what costs are justifiable?" As stroke is the third leading cause of morbidity and mortality in Europe and worldwide, attention has been increasingly focused on stroke prevention and providing quality care for stroke patients. One of the most common medical/nursing problems in these patients is change in elimination, which additionally affects their mental health.

  15. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way

    Directory of Open Access Journals (Sweden)

    Sarit Sharma

    2015-01-01

    Full Text Available Varicella-zoster virus (VZV causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella is the disease that results from primary infection with the VZV. Herpes zoster (HZ results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs in the Intensive Care Unit (ICU of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination for susceptible employees are important to prevent such outbreaks.

  16. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way.

    Science.gov (United States)

    Sarit, Sharma; Shruti, Sharma; Deepinder, Chhina; Chhina, R S

    2015-12-01

    Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination) for susceptible employees are important to prevent such outbreaks. PMID:26816447

  17. Perceptions and experiences with nursing care: a study of Pakistani (Urdu) communities in the United Kingdom.

    Science.gov (United States)

    Cortis, J D

    2000-04-01

    The population of the United Kingdom reflects rich cultural diversity. Hence, nursing must respond to the challenges of meeting the needs of different ethnic groups and fulfilL the requirements of the Code of Professional Conduct. This article presents the findings of a study using grounded theory to explore the lived experience of Pakistani (Urdu-speaking) communities that received nursing care in a hospital setting in the United Kingdom. The study reflects national initiatives toward "consumer led" health care delivery. The findings illustrate a lack of congruence between the group's expectations and their experiences. Nurses were perceived to have a poor understanding of ethnic needs, portraying ethnocentric attitudes and behaviour. The participants attributed the lack of congruence mainly to the presence of racism in British health care systems. The author suggests possible changes at the strategic, managerial, and educational levels of health care delivery. PMID:11982043

  18. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

    Directory of Open Access Journals (Sweden)

    Reed Peter

    2012-12-01

    Full Text Available Abstract Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets

  19. Nosocomial infection in a Danish Neonatal Intensive Care Unit: a prospective study

    DEFF Research Database (Denmark)

    Olsen, Anne L; Reinholdt, Jes; Jensen, Anders Mørup;

    2009-01-01

    AIM: The aim of this study was to estimate the incidence and identify independent risk factors for nosocomial infections in a Danish Neonatal Intensive Care Unit and to compare these findings with international results. METHODS: The study was performed prospectively from January 1, 2005 to December...... 31, 2005 in the Neonatal Intensive Care Unit at Rigshospitalet, Copenhagen. Specific criteria for blood stream infection and respiratory tract infection adapted for neonates in our ward were worked out. RESULTS: Six hundred and eighty-three patients were included. The overall incidence of nosocomial...... and respiratory tract infection, and central venous catheter and parenteral nutrition risk factors for first time blood stream infection. CONCLUSION: This first prospective study of nosocomial infection in a Danish Neonatal Intensive Care Unit found an overall incidence of 8.8/1000 hospital days, which is low...

  20. 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.

  1. 10 CFR 455.141 - Grant awards for units of local government, public care institutions, and coordinating agencies.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Grant awards for units of local government, public care... CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Grant Awards § 455.141 Grant awards for units of local government, public...

  2. Speaking about dying in the intensive care unit, and its implications for multidisciplinary end-of-life care.

    Science.gov (United States)

    Iedema, Rick; Sorensen, Ros; Braithwaite, Jeffrey; Turnbull, Elizabeth

    2004-01-01

    This article addresses how professionals working in an intensive care unit in Australia speak about dying, with particular reference to the contradictions and complexities that characterize their work in this setting. The article reflects on the incommensurabilities in these clinicians' talk, and the consequences of this for how different professionals work together and care for extremely ill patients. Examples are drawn from talk recorded during ward rounds and focus groups. The article argues that intensive care units are settings where being reflexive about one's work and assumptions is especially difficult because it involves negotiating decisions and taking moral responsibility for decisions affecting very sick patients. These decisions and responsibilities put into sharp relief the 'wicked problems and tragic choices' of end-of-life existence and of intensive care in specific. This article shows some of the complex ways in which specific clinicians' discourse absorbs and manifests these tensions and responsibilities. The article concludes that these kinds of complexities are unlikely to be resolved with reference to formal knowledge or in-principle conviction, and that a new interactive basis needs to be found where clinicians can rehearse alternative ways of speaking with which to approach each other, the dying, and their families.

  3. Healthcare Providers’ Perceptions of Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit

    OpenAIRE

    Rossman, Beverly; Engstrom, Janet L.; Meier, Paula P.

    2012-01-01

    In this qualitative descriptive study we examined the perceptions of 17 neonatal intensive care unit (NICU) healthcare providers (nurses, neonatologists, lactation consultants, and dietitians) about the role of breastfeeding peer counselors who were mothers of former NICU infants and who provided primary lactation care in the NICU. Findings revealed that the healthcare providers respected the peer counselors’ lactation expertise and identified three critical elements that contributed to the e...

  4. Are We Being Informed Correctly During the Patient Transfer to the Intensive Care Units?

    OpenAIRE

    Münire Babayiğit; Zehra Baykal Tutal; Necla Dereli; Handan Güleç; Mustafa Alparslan Babayiğit; Eyüp Horasanlı

    2016-01-01

    Objective: We aimed to demonstrate to what extent do the right information in patients’ inter-hospital transfers due to the intensive care indications Material and Method: In this study, 38 patients who applied to our general intensive care unit (ICU) from the other hospitals were included. The demographic data of patients, declarations before ICU admission and diagnosis after admission, the reason and accuracy of the transfer, the overall stay time and the treatments in ICU were recorded....

  5. Educational Needs of Nurses in Intensive Care Unit for Poisoned Patients

    OpenAIRE

    Dadpour B; Soltani Gh; Peivandi Yazdi A; Zirak N; AR Sedaghat; Sabzevari AR; Eftekharzadeh Mashhadi S; Ariayee N; Amini Sh

    2013-01-01

    Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU) for poisoned patients in Imam Reza (p) hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire....

  6. How to compare adequacy of algorithms to control blood glucose in the intensive care unit?

    OpenAIRE

    Van den Berghe , Greet

    2004-01-01

    Vogelzang et al. retrospectively assessed a derivative marker of blood glucose control over time in the intensive care unit (ICU), "the hyperglycemic index" (HGI), in relation to outcome. The HGI predicted mortality better than other indices of blood glucose control that do not take the duration of hyperglycemia into account. This provided further support to the concept of maintaining normoglycemia with insulin throughout intensive care in order to improve outcome. The HGI was also proposed a...

  7. Early Rehabilitation in the Intensive Care Unit: Preventing Physical and Mental Health Impairments

    OpenAIRE

    Parker, Ann; Sricharoenchai, Thiti; Needham, Dale M.

    2013-01-01

    Survivors of critical illness often experience new or worsening impairments in physical, cognitive and/or mental health, referred to as post-intensive care syndrome (PICS). Such impairments can be long-lasting and negatively impact survivors’ quality of life. Early rehabilitation in the intensive care unit (ICU), while patients remain on life-support therapies, may reduce the complications associated with PICS. This article addresses evidence-based rehabilitation interventions to reduce the p...

  8. Dental Care Use Among Pregnant Women in the United States Reported in 1999 and 2002

    OpenAIRE

    Peggy Timothé, DDS, MPH; Paul I. Eke, PhD, MPH, PhD; Scott M. Presson, DDS, MPH; Dolores M. Malvitz, DrPH

    2004-01-01

    Introduction The purpose of this study was to determine national and state-specific estimates of dental care use among adult pregnant women in the United States using data from two 12-month periods. The study also determined person-level characteristics that may predict a lack of dental care use within this subgroup. Methods Responses were analyzed from 4619 pregnant women aged 18 to 44 years who participated in the 1999 and 2002 state-based Behavioral Risk Factor Surveillance System. De...

  9. Patients with diabetes in the intensive care unit; not served by treatment, yet protected?

    OpenAIRE

    Siegelaar, S.E.; DeVries, J. H.; Hoekstra, J.B.

    2010-01-01

    Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ( ICU), despite larger severity of illness in the diabetes group at admission. This study contributes to the growing evidence that diabetes in itself is not a risk factor for ICU mortality, although the mech...

  10. Terminal care in older patients in hospital: development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital

    OpenAIRE

    Cools, Annelies; Vaneechoutte, Delphine; Van Den Noortgate, Nele; VERSLUYS, KAREN; De Laat, Martine; Petrovic, Mirko; Piers, Ruth

    2015-01-01

    Background: Care at the end-of-life of geriatric inpatients is of increasing importance. Nevertheless, limited research has been conducted on this subject so far. Objectives: To compose a set of quality indicators (QIs) which measure the quality of terminal care for geriatric inpatients and to compare the quality of end-of-life care between the Acute Geriatric Unit (AGU) and the Palliative Care Unit (PCU). Design: Retrospective case study. Setting: Belgian university hospital. Par...

  11. The prevalence of vitamin D deficiency in intensive care unit and its influence on prognosis

    Institute of Scientific and Technical Information of China (English)

    胡杰妤

    2013-01-01

    Objective To investigate the prevalence of vitamin D deficiency in medical intensive care unit (ICU) and its relationship with severity of disease and prognosis.Methods A prospective study was performed to evaluate vitamin D status in 216 patients admitted to the medical intensive care unit.The incidence of hypovitaminosis D was observed.Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score,days kept in ICU and on ventilator,main laboratory findings,and mortality rate were compared among patients with different serum 25-hydroxyvi-

  12. Expressive Laboratory for parents in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Rocco Agostino

    2013-04-01

    Full Text Available Introduction: The admittance of a baby in NICU is a chocking and stressful experience for parents that need support to comprehend and accept circumstances and help to start the relation with their baby. Expressive Laboratory (EL is a counseling activity that offers parents the possibility to explore their emotional experience by participating with other parents in meetings with a counselor and a psychologist. Materials and method: The EL includes a set of nine meetings, planned in three moments: pre-contact, contact and post-contact, each meeting is focusing on a particular theme and at the end parents fill out an anonymous feedback form where they can show their appreciation of the activities performed, the benefit obtained and the emotions experienced. Results: From May 2009 to September 2010 seven sets of meetings were organized in which 142 parents participated and they filled out 286 feedback forms. The main results from this descriptive study concerned feelings as: sharing the experience, ability to express oneself, finding resources. Some comments go beyond the activities of EL. Conclusions: The major benefits of EL reported by the parents are the sharing of the experience; not to feel lonely during the hospital stay. The experience to share allows a full understanding of the stories, promoting the creation of a support net that lasts even after the discharge of the baby with self-aid groups. 

  13. Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption.

    Science.gov (United States)

    Stuck, Amy; Clark, Mary Jo; Connelly, Cynthia D

    2011-01-01

    Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep? PMID:21983504

  14. Delivery of surgical care in a district general hospital without high dependency unit facilities

    OpenAIRE

    Coggins, R

    2000-01-01

    BACKGROUND—Many hospitals lack the facilities for high dependency care, and patients requiring this level of care are nursed on the surgical ward. The aim of this study was to assess the extent of this problem in a district general hospital, looking at the impact of providing high dependency unit (HDU) care at ward level.
METHODS—A 28 bed surgical ward was studied for 39 consecutive days. Patients were assessed as being either appropriately placed (routine) or inappropriately placed (HDU). Nu...

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

    Science.gov (United States)

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

    2015-04-01

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

  16. Successful introduction of a daily checklist to enhance compliance with accepted standards of care in the medical intensive care unit.

    Science.gov (United States)

    Nama, A; Sviri, S; Abutbul, A; Stav, I; van Heerden, P V

    2016-07-01

    We introduced a simple checklist to act as an aid to memory for our junior medical staff to ensure that every patient in the intensive care unit (ICU) received every appropriate element of a bundle of care every day. The checklist was developed in consultation with our junior doctors and was designed to be completed every morning for every patient by the junior doctor reviewing the patient. The completed checklist was then checked again by the attending intensivist on the main daily ward round to ensure all the appropriate elements of the checklist had been applied to the patient. It was also noted each day which of the elements of the checklist had been forgotten and was therefore prompted to be completed by use of the checklist. Of the 75 patients surveyed there were 99 occasions, in 48 patients, when the checklist detected a forgotten element of the bundle of care (i.e. in 64% of patients). There was a decrease in the incidence of missed elements of the bundle of care the longer the patient stayed in the ICU. Types of missed elements varied with the duration of the ICU stay. We found that the introduction of a simple checklist, developed in collaboration with the junior medical staff who would be using the checklist every day in the ICU, resulted in the detection and correction of missed elements of a bundle of care we had previously introduced in the ICU.

  17. Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review

    Directory of Open Access Journals (Sweden)

    Jeroen S. Kok

    2013-10-01

    Full Text Available Background: Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care facilities with respect to their effects on behavior, cognition, functional status and quality of life is lacking. Results: Our literature search resulted in 32 studies published until October 2012. Overall, patients with dementia who lived at special care units (SCUs showed a significantly more challenging behavior, more agitation/aggression, more depression and anxiety, more cases of global cognitive impairment and a better psychosocial functioning. There was a tendency towards a better functional status in specialized care facilities, and a better quality of life was found in favor of the SCU group compared to the traditional nursing home (n-SCU group. Longitudinal studies showed an increased number of neuropsychiatric cases, more patients displaying deteriorating behavior and resistance to care as well as less decline in activities of daily living (ADL in the SCU group compared to the n-SCU group. Patients in small-scale, homelike SCUs showed more agitation and less ADL decline compared to SCU patients. Conclusion: This review shows that the patient characteristics in SCU and n-SCU settings and, to a minor extent, in SCU and small-scale, homelike SCU settings are different. Over time, there are differences between n-SCU, SCU and small-scale, homelike SCU facilities for some variables.

  18. Can we learn anything from health care in the United States?

    Science.gov (United States)

    Anstey, Matthew H R; Elshaug, Adam G; Russell, Lesley M; Wells, Susan

    2014-05-19

    Some aspects of health care in the United States would be beneficial to Australia and New Zealand, but others should be avoided. Positive aspects, which should be emulated, include: •health care reform that is focused on the continuum of care and patient-centred care •trials of new models to organise, deliver and pay for health care services, where quality of care is rewarded over quantity of services •an integral view of, and strong support for, health services research as a means of evaluating reforms aimed at improving patient outcomes and systems-level efficiencies •physician engagement in reforms--for example, participating in the Choosing Wisely initiative, and trialling and implementing new payment models that are not fee-for-service. Negative aspects, which should be avoided, include: •increasingly fragmented provider and financing structures (funding provided by state and federal governments, private insurance and out-of-pocket costs) that cause frustration in terms of access and care coordination and increase administrative waste •an overemphasis on technological solutions, with insufficient acknowledgment of the importance of addressing value in health care •a focus on hospital and doctor-based health care rather than environmental and social inputs into health.

  19. [ANMCO/SIC Consensus document: The heart failure network: organization of outpatient care].

    Science.gov (United States)

    Aspromonte, Nadia; Gulizia, Michele Massimo; Di Lenarda, Andrea; Mortara, Andrea; Battistoni, Ilaria; De Maria, Renata; Gabriele, Michele; Iacoviello, Massimo; Navazio, Alessandro; Pini, Daniela; Di Tano, Giuseppe; Marini, Marco; Ricci, Renato Pietro; Alunni, Gianfranco; Radini, Donatella; Metra, Marco; Romeo, Francesco

    2016-01-01

    Changing demographics and an increasing burden of multiple chronic comorbidities in western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of-hospital phases of HF. The needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for hospitalized HF and those followed up at HF clinics.The Working Group on Heart Failure of the Italian Association of Hospital Cardiologists (ANMCO) has drafted a consensus document for the organization of a national HF care network. The aims of this document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among healthcare professionals. In this document, HF clinics are classified into three groups: 1) community HF clinics, devoted to the management of stable patients in strict liaison with primary care, regular re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, 2) hospital HF clinics, that target both new-onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for medicine units and community clinics; 3) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. These different types of HF clinics are integrated in a dedicated network for the management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multiprofessional providers to ensure continuity of care. This consensus document is expected to

  20. Early Efforts By Medicare Accountable Care Organizations Have Limited Effect On Mental Illness Care And Management.

    Science.gov (United States)

    Busch, Alisa B; Huskamp, Haiden A; McWilliams, J Michael

    2016-07-01

    People with mental illness use more health care and have worse outcomes than those without such illnesses. In response to incentives to reduce spending, accountable care organizations (ACOs) may therefore attempt to improve their management of mental illness. We examined changes in mental health spending, utilization, and quality measures associated with ACO contracts in the Medicare Shared Savings Program and Pioneer model for beneficiaries with mental illness, using Medicare claims for the period 2008-13 and difference-in-differences comparisons with local non-ACO providers. Pioneer contracts were associated with lower spending on mental health admissions in the first year of the contract, an effect that was attenuated in the second year. Otherwise, ACO contracts were associated with no changes in mental health spending or readmissions, outpatient follow-up after mental health admissions, rates of depression diagnosis, or mental health status. These results suggest that ACOs have not yet focused on mental illness or have been largely unsuccessful in early efforts to improve their management of it. PMID:27385241

  1. 8 CFR 319.6 - United States nonprofit organizations engaged abroad in disseminating information which...

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false United States nonprofit organizations... following have been determined to be U.S. incorporated nonprofit organizations principally engaged in... PERSONS WHO MAY BE NATURALIZED: SPOUSES OF UNITED STATES CITIZENS § 319.6 United States...

  2. Parental rejection of homosexuals in a family primary health care unit

    OpenAIRE

    Donovan Casas Patiño; Alejandra Rodríguez Torres; Camila Pereira Abagaro

    2014-01-01

    Objective: To know the frequency of parental rejection in homosexual patients in a family primary health care unit. Methods: A descriptive study carried out by the application of the Family Rejection instrument by Lozano-Díaz (2010) to 39 parents of homosexual patients assigned to the Family Medicine Unit no 195 in Chalco, Mexico. The non-probabilistic convenience sample was obtained in family medicine consultations and appointments with the parents of patients recognized as homosexuals were ...

  3. Importance of asymptomatic shedding of Clostridium difficile in environmental contamination of a neonatal intensive care unit.

    Science.gov (United States)

    Faden, Howard S; Dryja, Diane

    2015-08-01

    A survey of C. difficle in a neonatal intensive care unit (NICU) was conducted. Approximately 25% of infants in the NICU were colonized with Clostridium difficle. Environmental surface cultures were obtained from the NICU and compared with cultures taken from infant, adolescent, and hematology/oncology units. From 150 surface cultures, C difficle was recovered exclusively from the NICU. Of the 16 different types of surfaces cultured, diaper scales and the surrounding area were contaminated most often at 50%.

  4. The logic of transaction cost economics in health care organization theory.

    Science.gov (United States)

    Stiles, R A; Mick, S S; Wise, C G

    2001-01-01

    Health care is, at its core, comprised of complex sequences of transactions among patients, providers, and other stakeholders; these transactions occur in markets as well as within systems and organizations. Health care transactions serve one of two functions: the production of care (i.e., the laying on of hands) or the coordination of that care (i.e., scheduling, logistics). Because coordinating transactions is integral to care delivery, it is imperative that they are executed smoothly and efficiently. Transaction cost economics (TCE) is a conceptual framework for analyzing health care transactions and quantifying their impact on health care structures (organizational forms), processes, and outcomes. PMID:11293015

  5. Unit managers' role in improving nursing teamwork in a mental health care facility / Mariska Elizabeth Oosthuizen–Van Tonder

    OpenAIRE

    Oosthuizen–Van Tonder, Mariska Elizabeth

    2014-01-01

    The nursing team in a mental health care facility is a known dynamic at every hospital, rehabilitation centre and out-patient unit which enables these units to be functional. Currently nursing teams function in a challenged environment in mental health care facilities. The National Department of Health in South Africa states that one of the priority areas in the core standards of health care is to improve values and attitudes of health care professionals. One of the ways to accomplish this is...

  6. Distribution of soil organic carbon in the conterminous United States

    Science.gov (United States)

    Bliss, Norman B.; Waltman, Sharon W.; West, Larry T.; Neale, Anne; Mehaffey, Megan; Hartemink, Alfred E.; McSweeney, Kevin M.

    2014-01-01

    The U.S. Soil Survey Geographic (SSURGO) database provides detailed soil mapping for most of the conterminous United States (CONUS). These data have been used to formulate estimates of soil carbon stocks, and have been useful for environmental models, including plant productivity models, hydrologic models, and ecological models for studies of greenhouse gas exchange. The data were compiled by the U.S. Department of Agriculture Natural Resources Conservation Service (NRCS) from 1:24,000-scale or 1:12,000-scale maps. It was found that the total soil organic carbon stock in CONUS to 1 m depth is 57 Pg C and for the total profile is 73 Pg C, as estimated from SSURGO with data gaps filled from the 1:250,000-scale Digital General Soil Map. We explore the non-linear distribution of soil carbon on the landscape and with depth in the soil, and the implications for sampling strategies that result from the observed soil carbon variability.

  7. Patients with hematological disorders requiring admission to medical intensive care unit: Characteristics, survival and prognostic factors

    Directory of Open Access Journals (Sweden)

    Subhash H

    2003-01-01

    Full Text Available Background: This retrospective chart review assessed the characteristics and outcome of patients with hematological disorders who required admission to medical intensive care unit over a 4 year period (January 1998 to December 2001. Results: There were a total of 104 patients, 67 (64% male, 37 (36% female subjects, with a mean age of 36.3 ± 15.3 years (range 10 to 65 years. The mean duration from hospital admission to ICU transfer was 11 days. Sixty-nine (66% had malignant and 35 (34% had non-malignant conditions. Respiratory distress was the commonest reason for ICU admission 58 (56%. The other indications were hemodynamic instability 38 (36%, low sensorium 22 (21%, following cardio-pulmonary arrest 12 (11.5% and generalized tonic-clonic seizures 5 (5%. Forty-three (42% patients had absolute neutophil count (ANC less than 500, 48 (47.5% had platelet count < 20000. The mean duration of ICU stay was 4 days (range < 24 hours to 28 days. Sixty-nine (66% patients required mechanical ventilation, 61 (59% required hemodynamic support. Pneumonia or sepsis was diagnosed in 71 (68%. Twenty-five (24% survived ICU stay and 20 (19% survived to hospital discharge. ICU admission following cardio-pulmonary arrest, advanced malignancy, requirement of mechanical ventilation, vasopressor support, ANC count < 500 and platelet count < 20000 were the predictors of adverse outcome. Associated organ dysfunction further increases the mortality.

  8. The role and importance of fungal infections in intensive care units, ICU

    Directory of Open Access Journals (Sweden)

    Tatić Milanka R.

    2003-01-01

    Full Text Available Introduction The incidence of fungal infections is constantly increasing, especially in Intensive Care Units (ICU. On the one hand ICU are places for treatment of most difficult, often immunodeficient patients, and on the other hand their treatment often requires invasive procedures, support of vital organs and adequate monitoring. Epidemiology In approximately 78% of patients the cause of infection are Candida species with mortality rate of 57%. Less common causative agents are Aspergillus species, but with very high mortality rate of up to 100%. Pathogenesis Candida albicans is a normal inhabitant of the oropharingeal and digestive systems. Hospitalization, trauma, loss of immunity and use of strong antibiotics facilitate fungal colonization. Inadequate nutrition, poor perfusion, ischemia and corticosteroids therapy lead to damage of intestinal mucosa. Combined with improper production of IG A, it predisposes to translocation of fungi through mucosa and invasion of the blood stream. Clinical manifestations Most common forms are urinary tract infections, intraabdominal candidiasis, disseminated candidiasis and candidemia. Diagnosis Diagnosis of fungal infections is very difficult. It is based on clinical picture, microbiological, histological, radiological, serologic and molecular examinations. Treatment Treatment is usually based on systemic antimycotic agents (Amphotericin B, Azoles: Fluconazole, Flucytosine. Prophylactic treatment is still a matter of debate. It is not routinely recommended in ICU, but is commonly used in transplant patients.

  9. Emergence of non-albicans Candida species and antifungal resistance in intensive care unit patients

    Institute of Scientific and Technical Information of China (English)

    Ravinder Kaur; Megh Singh Dhakad; Ritu Goyal; Rakesh Kumar

    2016-01-01

    Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit (ICU) patients. Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed. Identification and speciation of the isolates was conducted by the biochemical tests. Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document. Results: Ninety Candida isolates were isolated from the different clinical samples:urine (43.3%), tracheal aspirate (31.1%), urinary catheter (12.2%), endotracheal tube (7.8%), abdominal drains (3.3%), sputum (2.2%). The incidence of candidiasis caused by non-albicans Candida (NAC) species (63.3%) was higher than Candida albicans (36.7%). The various NAC species were isolated as: Candida tropicalis (41.1%), Candida glab-rata (10%), Candida parapsilosis (6.7%), Candida krusei (3.3%) and Candida kefyr (2.2%). The overall isolation rate of Candida species from samples was 53.3%. Anti-fungal susceptibility indicated that 37.8%and 7.8%of the Candida isolates were resistant to fluconazole and amphotericin B, respectively. Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.

  10. Parent Misidentification Leading to the Breastfeeding of the Wrong Baby in a Neonatal Intensive Care Unit.

    Science.gov (United States)

    Sauer, Charles W; Marc-Aurele, Krishelle L

    2016-01-01

    BACKGROUND Because there are clear benefits to breast milk over formula for infants, the goal of the World Health Organization is to increase breastfeeding rates. As more women are breastfeeding and providing breast milk to newborns in hospitals, there is increased risk for administration error. CASE REPORT A hospitalized preterm infant was breastfed by the wrong mother when the Neonatal Intensive Care Unit Nurse failed to properly identify the mother. An infectious disease workup done on the donor mother was negative, but the recipient infant was positive for cytomegalovirus (CMV). Since the donor mother who accidentally breastfed the wrong infant was CMV-negative, the baby in our case had likely been exposed to CMV from his biological mother. The attending physician apologized to all of the family members involved, but the father of one infant continued to express anger. CONCLUSIONS To our knowledge, this is the first case of accidental breastfeeding in a hospital setting to be described in the literature. Parental misidentification and a language barrier led to the error. An infectious disease workup did not find any evidence of disease transmission from this event. Increased attention to minimize breast milk errors is needed. Despite a long history of wet nursing, unregulated breast milk sharing and cross nursing is not recommended. Instead, if a mother cannot provide breast milk herself, pasteurized donor breast milk from breast milk banks is encouraged. PMID:27515898

  11. 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

  12. Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit-a pilot study

    NARCIS (Netherlands)

    Roehr, C. C.; te Pas, A. B.; Dold, Simone K.; Breindahl, M.; Blennow, M.; Ruediger, M.; Gupta, Samir

    2013-01-01

    Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers

  13. What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

    Directory of Open Access Journals (Sweden)

    Eva K Masel

    Full Text Available The aims of the study were to examine a patients' knowledge of palliative care, b patients' expectations and needs when being admitted to a palliative care unit, and c patient's concept of a good palliative care physician.The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques.The results revealed four themes: (1 information about palliative care, (2 supportive care needs, (3 being treated in a palliative care unit, and (4 qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient's language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment.The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient's needs will enable medical teams to improve professional and individualized care.

  14. Patients on state organ donor registries receive similar levels of intensive care compared to those who are not: an opportunity to increase public intent to donate.

    Science.gov (United States)

    Patel, Madhukar S; Raza, Shariq S; Bhakta, Akash; Ewing, Tyler; Bukur, Marko; Vagefi, Parsia A; Salim, Ali; Malinoski, Darren J

    2016-06-01

    The intent to donate organs is affected by the public perception that patients on state registries receive less aggressive life-saving care in order to allow organ donation to proceed. However, the association between first person authorization to donate organs and the actual care received by eventual organ donors in hospitals is unknown. From August 2010 to April 2011, all eight organ procurement organizations in United Network for Organ Sharing Region 5 prospectively recorded demographic data and organ utilization rates on all donors after neurologic determination of death (DNDDs). Critical care and physiologic parameters were also recorded at referral for imminent neurologic death and prior to authorization for donation to reflect the aggressiveness of provided care. There were 586 DNDDs and 23% were on a state registry. Compared to non-registered DNDDs, those on state registries were older but were noted to have similar critical care parameters at both referral and authorization. Furthermore, there was no significant difference in organs procured per donor or organs transplanted per donor between registered and non-registered DNDDs. Thus, DNDDs who are on state donor registries receive similar levels of intensive care compared to non-registered donors. The association noted in this study may therefore help to dispel a common misperception that decreases the intent to donate. PMID:26992655

  15. The Australian experiment: how primary health care organizations supported the evolution of a primary health care system.

    Science.gov (United States)

    Nicholson, Caroline; Jackson, Claire L; Marley, John E; Wells, Robert

    2012-03-01

    Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system. PMID:22403246

  16. 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.

  17. Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units.

    Science.gov (United States)

    Paradis, Elise; Leslie, Myles; Gropper, Michael A

    2016-10-01

    Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed. PMID:26704051

  18. Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units.

    Science.gov (United States)

    Paradis, Elise; Leslie, Myles; Gropper, Michael A

    2016-10-01

    Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed.

  19. Physical and Visual Accessibilities in Intensive Care Units: A Comparative Study of Open-Plan and Racetrack Units.

    Science.gov (United States)

    Rashid, Mahbub; Khan, Nayma; Jones, Belinda

    2016-01-01

    This study compared physical and visual accessibilities and their associations with staff perception and interaction behaviors in 2 intensive care units (ICUs) with open-plan and racetrack layouts. For the study, physical and visual accessibilities were measured using the spatial analysis techniques of Space Syntax. Data on staff perception were collected from 81 clinicians using a questionnaire survey. The locations of 2233 interactions, and the location and length of another 339 interactions in these units were collected using systematic field observation techniques. According to the study, physical and visual accessibilities were different in the 2 ICUs, and clinicians' primary workspaces were physically and visually more accessible in the open-plan ICU. Physical and visual accessibilities affected how well clinicians' knew their peers and where their peers were located in these units. Physical and visual accessibilities also affected clinicians' perception of interaction and communication and of teamwork and collaboration in these units. Additionally, physical and visual accessibilities showed significant positive associations with interaction behaviors in these units, with the open-plan ICU showing stronger associations. However, physical accessibilities were less important than visual accessibilities in relation to interaction behaviors in these ICUs. The implications of these findings for ICU design are discussed. PMID:27575795

  20. The outcomes of patients with severe dengue admitted to intensive care units

    Science.gov (United States)

    Chen, Chin-Ming; Chan, Khee-Siang; Yu, Wen-Liang; Cheng, Kuo-Chen; Chao, Hui-Chun; Yeh, Chiu-Yin; Lai, Chih-Cheng

    2016-01-01

    Abstract Outcomes of adult patients with dengue infections requiring intensive care unit (ICU) admissions remain unclear. We assessed the clinical manifestations and prognostic factors of patients critically ill with severe dengue. This retrospective study was done in a tertiary referral hospital with 96 adult ICU beds. All of the patients with laboratory-confirmed severe dengue infections and admitted to the ICU were enrolled between July 31 and November 31, 2015, during the large outbreak period. The medical records of all the recruited patients were reviewed for the following information: age, gender, clinical manifestations, disease severity scores, underlying conditions, laboratory examinations, and outcomes. The primary endpoint was to find the predictors of ICU mortality. During the study period, 4787 patients with dengue infections required ICU admission. One hundred forty-three (2.99%) were critically ill (mean age: 69.7 years). Hypertension (n = 90, 62.9%) and diabetes mellitus (n = 70, 49.0%) were the 2 most common underlying diseases. Eighty critically ill patients (55.9%) had cobacterial infections, and 33 had cobacteremia. The hematologic system failed most often, followed by thoracic and cardiovascular systems. Fever was the most common presentation (n = 112; 78.3%), followed by anorexia (n = 47; 32.9%) and abdominal pain (n = 46; 32.2%). Overall, 33 patients died (mortality rate: 23.1%). Multivariate analysis showed that ICU mortality was significantly associated with lower Glasgow Coma Scale (GCS) scores, lower platelet counts before ICU discharge, and more organ failures. The number of severe dengue patients who require ICU admission remains high. The mortality rate was associated with lower GCS scores, lower platelet counts, and more organ failures. In addition, more than half of the critically ill dengue patients had comorbid bacterial infections. PMID:27495047