Sample records for surgical critical care

  1. Surgical Critical Care Initiative (United States)

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

  2. Ethical Issues in Surgical Critical Care: The Complexity of Interpersonal Relationships in the Surgical Intensive Care Unit. (United States)

    Sur, Malini D; Angelos, Peter


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

  3. The consequences of obesity on trauma, emergency surgery, and surgical critical care

    Directory of Open Access Journals (Sweden)

    Velmahos George C


    Full Text Available Abstract The era of the acute care surgeon has arrived and this "new" specialty will be expected to provide trauma care, emergency surgery, and surgical critical care to a variety of patients arriving at their institution. With the exception of practicing bariatric surgeons, many general surgeons have limited experience caring for obese patients. Obese patients manifest unique physiology and pathophysiology, which can influence a surgeon's decision-making process. Following trauma, obese patients sustain different injuries than lean patients and have worse outcomes. Emergency surgery diseases may be difficult to diagnose in the obese patient and obesity is associated with increased complications in the postoperative patient. Caring for an obese patient in the surgical ICU presents a distinctive challenge and may require alterations in care. The following review should act as an overview of the pathophysiology of obesity and how obesity modifies the care of trauma, emergency surgery, and surgical critical care patients.

  4. [Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours]. (United States)

    Dembinski, Rolf; Kauczok, Jens; Deisz, Robert; Pallua, Norbert; Marx, Gernot


    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial wound care comprises topical treatment of less severely injured skin and surgical debridement of severely burned areas. The first 24 hours of intensive care are focused on calculated fluid delivery to provide stable hemodynamics and avoid progression of local edema formation. In the further course wound treatment with split-thickness skin grafts is the major aim of surgical therapy. Critical care is focused on the avoidance of complications like infections and ventilator associated lung injury. Therefore, lung-protective ventilation strategies, weaning and sedation protocols, and early enteral nutrition are important cornerstones of the treatment.

  5. [Surgical therapy and critical care medicine in severely burned patients - Part 2: the basics in definite care]. (United States)

    Deisz, Robert; Kauczok, Jens; Dembinski, Rolf; Pallua, Norbert; Marx, Gernot


    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial stabilization of the burn victim during the first 24 hours (Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours, AINS 9/12) is followed by a long lasting reconstructive period. During this time calculated fluid replacement to compensate evaporative losses by large bourn wounds is as essential as reconstruction of the integrity of the skin and the modulation of metabolic consequences following severe burn injury. Special attention has to be paid to local and systemic infections.

  6. Nonverifiable research publications among applicants to an academic trauma and surgical critical care fellowship program. (United States)

    Branco, Bernardino C; Inaba, Kenji; Gausepohl, Andrew; Okoye, Obi; Teixeira, Pedro G; Breed, Wynne; Lam, Lydia; Talving, Peep; Sullivan, Maura; Demetriades, Demetrios


    The purpose of this study was to determine the incidence and predictors of nonverifiable research publications among applicants to a trauma and surgical critical care fellowship program. All complete applications submitted to our trauma and surgical critical care fellowship program were prospectively collected for 4 application cycles (2009 to 2012). All publications listed by applicants were tabulated and underwent verification using MEDLINE and direct journal search with verification by a team of professional health sciences librarians. Demographics and academic criteria were compared between applicants with nonverifiable and verifiable publications. A total of 100 applicants reported 301 publications. Of those, 20 applicants (20%) listed 32 papers (11%) that could not be verified. These applicants comprised 30% of those with 1 or more peer-reviewed publications. There were no significant differences in sex (male, 55% nonverifiable vs 60% verifiable, p = 0.684) or age (34.3 ± 6.6 years vs 34.2 ± 5.0 years, p = 0.963). There were no differences with regard to citizenship status (foreign medical graduates, 20% nonverifiable vs 28% verifiable, p = 0.495). Applicants with nonverified publications were less likely to be in the military (0% vs 14%, p = 0.079), more likely to have presented their work at surgical meetings (80% vs 58%, p = 0.064), and to be individuals with 3 or more peer-reviewed publications (55% vs 25%, p = 0.009). In this analysis of academic integrity, one-fifth of all applicants applying to a trauma and surgical critical care fellowship program and 30% of those with 1 or more peer-reviewed publications had nonverifiable publications listed in their curricula vitae. These applicants were less likely to be in the military, more likely to have presented their work at surgical meetings and to have 3 or more peer-reviewed publications. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Existential issues among nurses in surgical care--a hermeneutical study of critical incidents. (United States)

    Udo, Camilla; Danielson, Ella; Melin-Johansson, Christina


    To report a qualitative study conducted to gain a deeper understanding of surgical nurses' experiences of existential care situations. Background.  Existential issues are common for all humans irrespective of culture or religion and constitute man's ultimate concerns of life. Nurses often lack the strategies to deal with patients' existential issues even if they are aware of them. This is a qualitative study where critical incidents were collected and analysed hermeneutically. During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1-2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used. The majority of incidents concerned nurses' experiences of caring for patients' dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses' personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care. Findings are interpreted and discussed in the framework of Buber's philosophy of the relationships I-Thou and I-It, emphasizing nurses' different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It. © 2012 Blackwell Publishing Ltd.

  8. Factors affecting ED length-of-stay in surgical critical care patients. (United States)

    Davis, B; Sullivan, S; Levine, A; Dallara, J


    To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated with prolonged ED LOS, such as use of computed tomographic (CT), radiology special procedures, and the number of plain radiographs and consultants. ED LOS was considered to be the time from triage until a decision was made to admit the patient. Using a Cox proportional hazards model, use of CT and special procedures were the strongest independent predictors of prolonged ED length-of-stay. The number of plain radiographs and consultants had only a minimal effect. Use of a protocol-driven trauma evaluation system was associated with a shorter ED LOS. In addition to external factors that affect ED overcrowding, ED patient management decisions may also be associated with prolonged ED length-of-stay. Such ED-based factors may be more important in surgical critical care patients, whose overall ED LOS is affected more by the length of the ED work-up rather than the time spent waiting for a ICU bed or operating suite.

  9. Surgical Critical Care for the Patient with Sepsis and Multiple Organ Dysfunction. (United States)

    Kaml, Gary J; Davis, Kimberly A


    Sepsis and multiple organ dysfunction syndrome (MODS) is common in the surgical intensive care unit. Sepsis involves infection and the patient's immune response. Timely recognition of sepsis and swift application of evidence-based interventions is critical to the success of therapy. This article reviews the nature of the septic process, existing definitions of sepsis, and current evidence-based treatment strategies for sepsis and MODS. An improved understanding of the process of sepsis and its relation to MODS has resulted in clinical definitions and scoring systems that allow for the quantification of disease severity and guidelines for treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. The role of the intensive care unit in the management of the critically ill surgical patient. (United States)

    Cuthbertson, B H; Webster, N R


    Surgical patients make up 60-70% of the work load of intensive care units in the UK. There is a recognised short fall in the resource allocation for high dependency units (HDUs) and intensive care units (ICUs) in this country, despite repeated national audits urging that this resource be increased. British ICUs admit patients later and with higher severity of illness scores than elsewhere and this leads to higher ICU mortality. How can this situation be improved? Scoring systems that allow selection of appropriate patients for admission to ICU and avoid inappropriate admission are still in development. Pre-operative admission and optimisation in ICU is rare in this country despite increasing evidence to support this practice in high risk surgical patients. Early admission to ICU, with potential improvement in outcomes, could also be achieved using multi-disciplinary medical emergency teams. These teams would be alerted by ward staff in response to set specific conditions and physiological criteria. These proposals are still under trial but may offer benefit by reducing mortality in critically ill surgical patients.

  11. Critical Care (United States)

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

  12. A Simulation Curriculum for Management of Trauma and Surgical Critical Care Patients. (United States)

    Miyasaka, Kiyoyuki W; Martin, Niels D; Pascual, Jose L; Buchholz, Joseph; Aggarwal, Rajesh


    Expectations continue to rise for residency programs to provide integrated simulation training to address clinical competence. How to implement such training sustainably remains a challenge. We developed a compact module for first-year surgery residents integrating theory with practice in high-fidelity simulations, to reinforce the preparedness and confidence of junior residents in their ability to manage common emergent patient care scenarios in trauma and critical care surgery. The 3-day module features a combination of simulated patient encounters using standardized patients and electronic manikins, didactic sessions, and hands-on training. Manikin-based scenarios developed in-house were used to teach trauma and critical care management concepts and skills. Separate scenarios in collaboration with the regional organ donation program addressed communication in difficult situations such as brain death. Didactic material based on contemporary evidence, as well as skills stations, was developed to complement the scenarios. Residents were surveyed before and after training on their confidence in meeting the 14 learning objectives of the curriculum on a 5-point Likert scale. Data from 15 residents who underwent this training show an overall improvement in confidence across all learning objectives defined for the module, with confidence scores before to after training improving significantly from 2.8 (σ = 0.85, median = 3) to 3.9 (σ = 0.87, median = 4) of 5, p higher posttraining confidence scores compared with male residents (average 4.2 female vs 3.8 male, p = 0.002), there were no other significant differences in confidence scores or changes to scores owing to resident sex or program status (categorical or preliminary). We successfully implemented a multimodal simulation-based curriculum that provides skills training integrated with the clinical context of managing trauma and critical care patients, simultaneously addressing a range of clinical competencies

  13. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review. (United States)

    Meyer, Zainna C; Schreinemakers, Jennifer M J; de Waal, Ruud A L; van der Laan, Lijckle


    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in PubMed from inception to July 2013 that met the following inclusion criteria: evaluation of the above parameters, describing their diagnostic accuracy and the risk stratification for surgical complications in surgical patients admitted to an intensive care unit. No difference in the Sequential Organ Failure Assessment scores was seen between patients with or without complications. The D-lactate levels were significantly higher in those who developed colonic ischemic complications after a ruptured abdominal aortic aneurysm. After gastro-intestinal surgery, contradictory data were reported, with both positive and negative use of C-reactive protein and procalcitonin in the diagnosis of septic complications. However, in trauma patients, the C-reactive protein levels may help to discriminate between those with and without infectious causes. We conclude that the Sequential Organ Failure Assessment score, lactate concentration and C-reactive protein level have no significant predictive value for early postoperative complications in critically ill post-surgery patients. However, procalcitonin seems to be a useful parameter for diagnosing complications in specific patient populations after surgery and/or after trauma.

  14. Lung Injury Prediction Score Is Useful in Predicting Acute Respiratory Distress Syndrome and Mortality in Surgical Critical Care Patients

    Directory of Open Access Journals (Sweden)

    Zachary M. Bauman


    Full Text Available Background. Lung injury prediction score (LIPS is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS. This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients. Methods. IRB approved, prospective observational study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary center over 6 months. ARDS was defined using the Berlin criteria. LIPS were calculated for all patients and analyzed. Logistic regression models evaluated the ability of LIPS to predict development of ARDS and mortality. A receiver operator characteristic (ROC curve demonstrated the optimal LIPS value to statistically predict development of ARDS. Results. 268 ventilated patients were observed; 141 developed ARDS and 127 did not. The average LIPS for patients who developed ARDS was 8.8±2.8 versus 5.4±2.8 for those who did not (p<0.001. An ROC area under the curve of 0.79 demonstrates LIPS is statistically powerful for predicting ARDS development. Furthermore, for every 1-unit increase in LIPS, the odds of developing ARDS increase by 1.50 (p<0.001 and odds of ICU mortality increase by 1.22 (p<0.001. Conclusion. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients.

  15. Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Christoph Sponholz


    Full Text Available Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC. Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P=0.001. Femoral vascular access was associated with reduced filter life span (P=0.012, especially under heparin anticoagulation (P=0.015. Patients on RAC had higher rates of metabolic alkalosis (P=0.001, required more transfusions (P=0.045, and showed higher illness severity measured by SOFA scores (P=0.001. RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.

  16. Care of critically ill surgical patients using the 80-hour Accreditation Council of Graduate Medical Education work-week guidelines: a survey of current strategies. (United States)

    Gordon, Chad R; Axelrad, Alex; Alexander, James B; Dellinger, R Phillip; Ross, Steven E


    As a result of the recently mandated work-hour restrictions, it has become more difficult to provide 24-hour intensive care unit (ICU) in-house coverage by the general surgical residents. To assess the current state of providing appropriate continuous care to surgical critical care patients during the era of resident work-hour constraints, a national survey was conducted by the Association of Program Directors of Surgery. The results revealed that 37 per cent of programs surveyed have residents other than general surgery housestaff providing cross-coverage and writing orders for surgical ICU patients. Residents in emergency medicine, anesthesia, family medicine, otorhinolaryngology, obstetrics/gynecology, internal medicine, urology, and orthopedic surgery have provided this cross-coverage. Some found it necessary to use physician extenders (i.e., nurse practitioners or physician assistants), thereby decreasing the burden of surgical housestaff coverage. The results indicated that 30 per cent use physician extenders to help cover the ICU during daytime hours and 11 per cent used them during nighttime hours. In addition, 24 per cent used a "night-float" system in an attempt to maintain continuous care, yet still adhere to the mandated guidelines. In conclusion, our survey found multiple strategies, including the use of physician extenders, a "night-float" system, and the use of nongeneral surgical residents in an attempt to provide continuous coverage for surgical ICU patients. The overall outcome of these new strategies still needs to be assessed before any beneficial results can be demonstrated.

  17. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review

    NARCIS (Netherlands)

    Meyer, Z.C.; Schreinemakers, J.M.J.; Waal, R.A. de; Laan, L. van der


    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in

  18. Critical Care Team (United States)

    ... Patients and Families > About Critical Care > Team Tweet Team Page Content ​The critical care team is a group of specially trained caregivers who ... help very ill patients get better. The care team often teach the patient and family strategies that ...

  19. Surgical wound care (United States)

    ... again after you take off the old dressing. Caring for the Wound You may use a gauze ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  20. Opportunities for pharmaceutical care with critical pathways. (United States)

    Koch, K E


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

  1. TQM in critical care. (United States)

    Massarweh, L J


    No consistently accepted methods reliably measure quality differences among and within critical care units (CCUs). With total quality management, physicians and nurses have the framework to accurately assess the organizational climate of their CCU. A study asks nurses to identify organizational components in their CCU.

  2. Nursing the critically ill surgical patient in Zambia. (United States)

    Carter, Chris; Snell, David


    Critical illness in the developing world is a substantial burden for individuals, families, communities and healthcare services. The management of these patients will depend on the resources available. Simple conditions such as a fractured leg or a strangulated hernia can have devastating effects on individuals, families and communities. The recent Lancet Commission on Global Surgery and the World Health Organization promise to strengthen emergency and essential care will increase the focus on surgical services within the developing world. This article provides an overview of nursing the critically ill surgical patient in Zambia, a lower middle income country (LMIC) in sub-Saharan Africa.

  3. Critical care transport. (United States)

    Williams, Kenneth A; Sullivan, Francis M


    Critical care transport (CCT) is the segment of the Emergency Medical Services (EMS) system that transports patients who are critically ill or injured. Nearly 1,000 medical helicopters affiliated with over 300 transport programs, hundreds of fixed-wing aircraft, and many, many ground ambulances assisting adult, pediatric and neonatal CCT teams are operating in the United States.1 This article reviews the history of and indications for CCT, team qualifications, vehicle options, safety, CCT system design, and physician involvement in CCT. It concludes with a brief review of CCT services in Rhode Island.

  4. Society of Critical Care Medicine (United States)

    ... Critical Care Medicine Podcasts Hosts iCritical Care App Social Media Critical Care Statistics eCommunity Media Relations SmartBrief SCCM App Education Center Annual Congress Program Abstracts Registration and Hotel Exhibits-Sponsorship Sightseeing Activities Past and Future Critical ...

  5. Clinical application of real-time PCR to screening critically ill and emergency-care surgical patients for methicillin-resistant Staphylococcus aureus: a quantitative analytical study. (United States)

    Herdman, M Trent; Wyncoll, Duncan; Halligan, Eugene; Cliff, Penelope R; French, Gary; Edgeworth, Jonathan D


    The clinical utility of real-time PCR screening assays for methicillin (methicillin)-resistant Staphylococcus aureus (MRSA) colonization is constrained by the predictive values of their results: as MRSA prevalence falls, the assay's positive predictive value (PPV) drops, and a rising proportion of positive PCR assays will not be confirmed by culture. We provide a quantitative analysis of universal PCR screening of critical care and emergency surgical patients using the BD GeneOhm MRSA PCR system, involving 3,294 assays over six months. A total of 248 PCR assays (7.7%) were positive; however, 88 failed to be confirmed by culture, giving a PPV of 65%. Multivariate analysis was performed to compare PCR-positive culture-positive (P+C+) and PCR-positive culture-negative (P+C-) assays. P+C- results were positively associated with a history of methicillin-sensitive Staphylococcus aureus infection or colonization (odds ratio [OR], 3.15; 95% confidence interval [CI], 1.32 to 7.54) and high PCR thresholds of signal intensity, indicative of a low concentration of target DNA (OR, 1.19 per cycle; 95% CI, 1.11 to 1.26). P+C- results were negatively associated with a history of MRSA infection or colonization (OR, 0.19; 95% CI, 0.09 to 0.42) and male sex (OR, 0.40; 95% CI, 0.20 to 0.81). P+C+ patients were significantly more likely to have subsequent positive MRSA culture assays and microbiological evidence of clinical MRSA infection. The risk of subsequent MRSA infection in P+C- patients was not significantly different from that in case-matched PCR-negative controls. We conclude that, given the low PPV and poor correlation between a PCR-positive assay and the clinical outcome, it would be prudent to await culture confirmation before altering infection control measures on the basis of a positive PCR result.

  6. Quality of pharmaceutical care in surgical patients.

    Directory of Open Access Journals (Sweden)

    Monica de Boer

    Full Text Available BACKGROUND: Surgical patients are at risk for preventable adverse drug events (ADEs during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. OBJECTIVE: To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. METHODS: For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. RESULTS: Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and 'sensitivity to change'. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate. The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%. Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%. CONCLUSIONS: This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.

  7. Access to Specialized Surgical Care

    African Journals Online (AJOL)

    to reduce the global burden of disease (GBD), it is ... global players have supported efforts to improve access and safety of surgery ... (i) strengthening surgical services at district hospitals ... of the surrounding community and a model for other.

  8. Integrating palliative care in the surgical and trauma intensive care unit: a report from the Improving Palliative Care in the Intensive Care Unit (IPAL-ICU) Project Advisory Board and the Center to Advance Palliative Care. (United States)

    Mosenthal, Anne C; Weissman, David E; Curtis, J Randall; Hays, Ross M; Lustbader, Dana R; Mulkerin, Colleen; Puntillo, Kathleen A; Ray, Daniel E; Bassett, Rick; Boss, Renee D; Brasel, Karen J; Campbell, Margaret; Nelson, Judith E


    Although successful models for palliative care delivery and quality improvement in the intensive care unit have been described, their applicability in surgical intensive care unit settings has not been fully addressed. We undertook to define specific challenges, strategies, and solutions for integration of palliative care in the surgical intensive care unit. We searched the MEDLINE database from inception to May 2011 for all English language articles using the term "surgical palliative care" or the terms "surgical critical care," "surgical ICU," "surgeon," "trauma" or "transplant," and "palliative care" or "end-of- life care" and hand-searched our personal files for additional articles. Based on review of these articles and the experiences of our interdisciplinary expert Advisory Board, we prepared this report. We critically reviewed the existing literature on delivery of palliative care in the surgical intensive care unit setting focusing on challenges, strategies, models, and interventions to promote effective integration of palliative care for patients receiving surgical critical care and their families. Characteristics of patients with surgical disease and practices, attitudes, and interactions of different disciplines on the surgical critical care team present distinctive issues for intensive care unit palliative care integration and improvement. Physicians, nurses, and other team members in surgery, critical care and palliative care (if available) should be engaged collaboratively to identify challenges and develop strategies. "Consultative," "integrative," and combined models can be used to improve intensive care unit palliative care, although optimal use of trigger criteria for palliative care consultation has not yet been demonstrated. Important components of an improvement effort include attention to efficient work systems and practical tools and to attitudinal factors and "culture" in the unit and institution. Approaches that emphasize delivery of

  9. Evidence-based surgical wound care on surgical wound infection. (United States)

    Reilly, Jaqueline


    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  10. Teamwork in obstetric critical care


    Guise, Jeanne-Marie; Segel, Sally


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

  11. Surgical care in the Solomon Islands: a road map for universal surgical care delivery. (United States)

    Natuzzi, Eileen S; Kushner, Adam; Jagilly, Rooney; Pickacha, Douglas; Agiomea, Kaeni; Hou, Levi; Houasia, Patrick; Hendricks, Phillip L; Ba'erodo, Dudley


    Access to surgical care and emergency obstetrical care is limited in low-income countries. The Solomon Islands is one of the poorest countries in the Pacific region. Access to surgical care in Solomon Islands is limited and severely affected by a country made up of islands. Surgical care is centralized to the National Referral Hospital (NRH) on Guadalcanal, leaving a void of care in the provinces where more than 80% of the people live. To assess the ability to provide surgical care to the people living on outer islands in the Solomon Islands, the provincial hospitals were evaluated using the World Health Organization's Global Initiative for Emergency and Essential Surgical Care Needs Assessment Tool questionnaire. Data on infrastructure, workforce, and equipment available for treating surgical disease was collected at each provincial hospital visited. Surgical services are centralized to the NRH on Guadalcanal in Solomon Islands. Two provincial hospitals provide surgical care when a surgeon is available. Six of the hospitals evaluated provide only very basic surgical procedures. Infrastructure problems exist at every hospital including lack of running water, electricity, adequate diagnostic equipment, and surgical supplies. The number of surgeons and obstetricians employed by the Ministry of Health is currently inadequate for delivering care at the outer island hospitals. Shortages in the surgical workforce can be resolved in Solomon Islands with focused training of new graduates. Training surgeons locally, in the Pacific region, can minimize the "brain drain." Redistribution of surgeons and obstetricians to the provincial hospitals can be accomplished by creating supportive connections between these hospitals, the NRH, and international medical institutions.

  12. Critical care cardiology. (United States)

    Marks, S L; Abbott, J A


    Emergency management of the patient with cardiac disease is an important part of veterinary practice. Although the causes of cardiac disease may be diverse, the understanding of basic pathophysiology will enable the clinician to formulate a rational diagnostic and therapeutic plan. The veterinary clinician must be able to triage the emergency patient, assess the clinical condition, and provide appropriate therapy. Close monitoring of the critically ill patient is crucial to patient survival and will help tailor therapy.

  13. Clinical informatics in critical care. (United States)

    Martich, G Daniel; Waldmann, Carl S; Imhoff, Michael


    Health care information systems have the potential to enable better care of patients in much the same manner as the widespread use of the automobile and telephone did in the early 20th century. The car and phone were rapidly accepted and embraced throughout the world when these breakthroughs occurred. However, the automation of health care with use of computerized information systems has not been as widely accepted and implemented as computer technology use in all other sectors of the global economy. In this article, the authors examine the need, risks, and rewards of clinical informatics in health care as well as its specific relationship to critical care medicine.

  14. Critical Care of Pet Birds. (United States)

    Jenkins, Jeffrey Rowe


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

  15. Controversies in neurosciences critical care. (United States)

    Chang, Tiffany R; Naval, Neeraj S; Carhuapoma, J Ricardo


    Neurocritical care is an evolving subspecialty with many controversial topics. The focus of this review is (1) transfusion thresholds in patients with acute intracranial bleeding, including packed red blood cell transfusion, platelet transfusion, and reversal of coagulopathy; (2) indications for seizure prophylaxis and choice of antiepileptic agent; and (3) the role of specialized neurocritical care units and specialists in the care of critically ill neurology and neurosurgery patients.

  16. Teamwork in obstetric critical care. (United States)

    Guise, Jeanne-Marie; Segel, Sally


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

  17. What Is a Pediatric Critical Care Specialist? (United States)

    ... Text Size Email Print Share What is a Pediatric Critical Care Specialist? Page Content Article Body If ... in the PICU. What Kind of Training Do Pediatric Critical Care Specialists Have? Pediatric critical care specialists ...

  18. Glucose control in critical care

    Institute of Scientific and Technical Information of China (English)


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

  19. Noteworthy Articles in 2015 for Cardiothoracic Critical Care. (United States)

    Evans, Adam S; Mazzeffi, Michael; Ivascu, Natalia S; Dickerson, Shane; Gutsche, Jacob T


    In 2015, the demand for the presence of cardiothoracic anesthesiologists outside of the cardiac operating rooms continues to expand. Most notably, cardiothoracic anesthesiologists now find themselves called on to care for patients postoperatively in the cardiothoracic surgical intensive care unit. This article is the first in this annual series to review relevant contributions in postoperative cardiac critical care that may influence the cardiac anesthesiologist. We explore the use of extracorporeal membrane oxygenation, management of postoperative atrial fibrillation and coagulopathy, metabolic support of the critically ill cardiothoracic surgical patient, and new insights into delirium and acute kidney injury.

  20. Critical issues in burn care. (United States)

    Holmes, James H


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

  1. A Study to Determine the Best Method of Improving the Flow of Patients Through the Surgical Critical Care Units at Letterman Army Medical Center (United States)


    wellness), all canidates for intensive care are either ’appropriate’, ’too well’, or "too sick’ ( Civetta 39 and Hudson- Civetta 1987, 13). The...Care: How Do We Know it Works?" Archives of Internal <m z Medicine. Vol 148(June): 1270-1271. mz -4 Civetta , Joseph M., and Judith Hudson- Civetta . 1987

  2. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring

    Directory of Open Access Journals (Sweden)

    Luis Rafael Moscote-Salazar


    Full Text Available Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.

  3. Delirium in Pediatric Critical Care. (United States)

    Patel, Anita K; Bell, Michael J; Traube, Chani


    Delirium occurs frequently in the critically ill child. It is a syndrome characterized by an acute onset and fluctuating course, with behaviors that reflect a disturbance in awareness and cognition. Delirium represents global cerebral dysfunction due to the direct physiologic effects of an underlying medical illness or its treatment. Pediatric delirium is strongly associated with poor outcomes, including increased mortality, prolonged intensive care unit length of stay, longer time on mechanical ventilation, and increased cost of care. With heightened awareness, the pediatric intensivist can detect, treat, and prevent delirium in at-risk children. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Palliative care and pediatric surgical oncology. (United States)

    Inserra, Alessandro; Narciso, Alessandra; Paolantonio, Guglielmo; Messina, Raffaella; Crocoli, Alessandro


    Survival rate for childhood cancer has increased in recent years, reaching as high as 70% in developed countries compared with 54% for all cancers diagnosed in the 1980s. In the remaining 30%, progression or metastatic disease leads to death and in this framework palliative care has an outstanding role though not well settled in all its facets. In this landscape, surgery has a supportive actor role integrated with other welfare aspects from which are not severable. The definition of surgical palliation has moved from the ancient definition of noncurative surgery to a group of practices performed not to cure but to alleviate an organ dysfunction offering the best quality of life possible in all the aspects of life (pain, dysfunctions, caregivers, psychosocial, etc.). To emphasize this aspect a more modern definition has been introduced: palliative therapy in whose context is comprised not only the care assistance but also the plans of care since the onset of illness, teaching the matter to surgeons in training and share paths. Literature is very poor regarding surgical aspects specifically dedicated and all researches (PubMed, Google Scholar, and Cochrane) with various meshing terms result in a more oncologic and psychosocial effort. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Family experience survey in the surgical intensive care unit. (United States)

    Twohig, Bridget; Manasia, Anthony; Bassily-Marcus, Adel; Oropello, John; Gayton, Matthew; Gaffney, Christine; Kohli-Seth, Roopa


    The experience of critical care is stressful for both patients and their families. This is especially true when patients are not able to make their own care decisions. This article details the creation of a Family Experience Survey in a surgical intensive care unit (SICU) to capture and improve overall experience. Kolcaba's "Enhanced Comfort Theory" provided the theoretical basis for question formation, specifically in regards to the four aspects of comfort: "physical," "psycho-spiritual," "sociocultural" and "environmental." Survey results were analyzed in real-time to identify and implement interventions needed for issues raised. Overall, there was a high level of satisfaction reported especially with quality of care provided to patients, communication and availability of nurses and doctors, explanations from staff, inclusion in decision making, the needs of patients being met, quality of care provided to patients and cleanliness of the unit. It was noted that 'N/A' was indicated for cultural needs and spiritual needs, a chaplain now rounds on all patients daily to ensure these services are more consistently offered. In addition, protocols for doctor communication with families, palliative care consults, daily bleach cleaning of high touch areas in patient rooms and nurse-led progressive mobility have been implemented. Enhanced comfort theory enabled the opportunity to identify and provide a more 'broad' approach to care for patients and families. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. August 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Seth H


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

  7. Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness. (United States)

    Peters, Jessica S


    Transitioning from the critical care unit to the medical-surgical care area is vital to patients' recovery and resolution of critical illness. Such transitions are necessary to optimize use of available hospital resources to meet patient care needs. One in 10 patients discharged from the intensive care unit are readmitted to the unit during their hospitalization. Critical care readmission is associated with significant increases in illness acuity, overall length of stay, and health care costs as well as a potential 4-fold increased risk of mortality. Patients with complex illness, multiple comorbid conditions, and a prolonged initial stay in the critical care unit are at an increased risk of being readmitted to the critical care unit and experiencing poor outcomes. Implementing nurse-driven measures that support continuity of care and consistent communication practices such as critical care outreach services, transitional communication tools, discharge planning, and transitional care units improves transitions of patients from the critical care environment and reduces readmission rates.

  8. Candida colonization and subsequent infections in critically ill surgical patients. (United States)

    Pittet, D; Monod, M; Suter, P M; Frenk, E; Auckenthaler, R


    OBJECTIVE. The authors determined the role of Candida colonization in the development of subsequent infection in critically ill patients. DESIGN. A 6-month prospective cohort study was given to patients admitted to the surgical and neonatal intensive care units in a 1600-bed university medical center. METHODS. Patients having predetermined criteria for significant Candida colonization revealed by routine microbiologic surveillance cultures at different body sites were eligible for the study. Risk factors for Candida infection were recorded. A Candida colonization index was determined daily as the ratio of the number of distinct body sites (dbs) colonized with identical strains over the total number of dbs tested; a mean of 5.3 dbs per patient was obtained. All isolates (n = 322) sequentially recovered were characterized by genotyping using contour-clamped homogeneous electrical field gel electrophoresis that allowed strain delineation among Candida species. RESULTS. Twenty-nine patients met the criteria for inclusion; all were at high risk for Candida infection; 11 patients (38%) developed severe infections (8 candidemia); the remaining 18 patients were heavily colonized, but never required intravenous antifungal therapy. Among the potential risk factors for candida infection, three discriminated the colonized from the infected patients--i.e., length of previous antibiotic therapy (p < 0.02), severity of illness assessed by APACHE II score (p < 0.01), and the intensity of Candida spp colonization (p < 0.01). By logistic regression analysis, the latter two who were the independent factors that predicted subsequent candidal infection. Candida colonization always preceded infection with genotypically identical Candida spp strain. The proposed colonization indexes reached threshold values a mean of 6 days before Candida infection and demonstrated high positive predictive values (66 to 100%). CONCLUSIONS. The intensity of Candida colonization assessed by systematic

  9. Developing a Business Plan for Critical Care Pharmacy Services. (United States)

    Erstad, Brian L; Mann, Henry J; Weber, Robert J


    Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients.

  10. Self-reported barriers to pediatric surgical care in Guatemala. (United States)

    Nguyen, Karissa; Bhattacharya, Syamal D; Maloney, Megan J; Figueroa, Ligia; Taicher, Brad M; Ross, Sherry; Rice, Henry E


    Access to pediatric surgical care is limited in low- and middle-income countries. Barriers must be identified before improvements can be made. This pilot study aimed to identify self-reported barriers to pediatric surgical care in Guatemala. We surveyed 78 families of Guatemalan children with surgical conditions who were seen at a pediatric surgical clinic in Guatemala City. Spanish translators were used to complete questionnaires regarding perceived barriers to surgical care. Surgical conditions included hernias, rectal prolapse, anorectal malformations, congenital heart defects, cryptorchidism, soft tissue masses, and vestibulourethral reflux. Average patient age was 8.2 years (range, 1 month to 17 years) with male predominance (62%). Families reported an average symptom duration of 3.7 years before clinic evaluation. Families traveled a variety of distances to obtain surgical care: 36 per cent were local (less than 10 km), 17 per cent traveled 10 to 50 km, and 47 per cent traveled greater than 50 km. Other barriers to surgery included financial (58.9%), excessive wait time in the national healthcare system (10. 2%), distrust of local surgeons (37.2%), and geographic inaccessibility to surgical care (10.2%). The majority of study patients required outpatient procedures, which could improve their quality of life. Many barriers to pediatric surgical care exist in Guatemala. Interventions to remove these obstacles may enhance access to surgery and benefit children in low- and middle-income countries.

  11. November 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA


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

  12. Open access in the critical care environment. (United States)

    South, Tabitha; Adair, Brigette


    Open access has become an important topic in critical care over the last 3 years. In the past, critical care had restricted access and set visitation guidelines to protect patients. This article provides a review of the literature related to open access in the critical care environment, including the impact on patients, families, and health care providers. The ultimate goal is to provide care centered on patients and families and to create a healing environment to ensure safe passage of patients through their hospital stays. This outcome could lead to increased patient/family satisfaction.

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

    Directory of Open Access Journals (Sweden)

    Raj John


    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.

  14. MEDEVAC: critical care transport from the battlefield. (United States)

    Higgins, R A


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

  15. Critical Advances in Wound Care (United States)


    Analysis : – 1 visit / month inappropriate for most complex wound patients – Visit frequency inadequate to meet rehabilitation needs – Variable...wound pain Preventive skin care Burn wound care NPWT application and management Wound assessment and documentation Ostomy and fistula care Wound

  16. Critical Care Organizations: Business of Critical Care and Value/Performance Building. (United States)

    Leung, Sharon; Gregg, Sara R; Coopersmith, Craig M; Layon, A Joseph; Oropello, John; Brown, Daniel R; Pastores, Stephen M; Kvetan, Vladimir


    New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care. Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report. The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice. Two phases of critical care organizations care integration are described: "horizontal," within the system and regionalization of care as an initial phase, and "vertical," with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed. A critical care organization that incorporates functional clinical horizontal and

  17. Mentoring: nurturing the critical care nurse. (United States)

    Caine, R M


    Mentoring is an active process that is currently receiving widespread attention in education, in the corporate world, and increasingly in health care. Job satisfaction of the critical care nurse may be related to the fulfillment of personal needs and goals. The attainment of these needs and goals ultimately will lead to increased job productivity, which in turn will promote cost-effectiveness, an outcome cherished by management. Therefore, recognizing the worth of job satisfaction to the institution and the possibility that mentoring may have an effect on it among the professional staff may be a key to the future of improved health care and cost reduction in an increasingly specialized and technologic health care environment. Certainly, the nursing shortage is no longer news to the lay public or those of us engaged in the practice of nursing. In critical care that shortage is acutely apparent. Attrition of qualified critical care nurses is increasing and various solutions to the shortage have been proposed, some being met with more enthusiasm than others. A more basic solution might be to answer the question, "How can we maintain a high quality of patient care while promoting job satisfaction and instilling a sense of self-worth within the critical care nurse?" Critical care nurses need to play a pivotal role in nurturing and developing other critical care nurses as a means to retain those individuals. How can they do that effectively? Mentoring is one answer.

  18. Medicare Payment: Surgical Dressings and Topical Wound Care Products. (United States)

    Schaum, Kathleen D


    Medicare patients' access to surgical dressings and topical wound care products is greatly influenced by the Medicare payment system that exists in each site of care. Qualified healthcare professionals should consider these payment systems, as well as the medical necessity for surgical dressings and topical wound care products. Scientists and manufacturers should also consider these payment systems, in addition to the Food and Drug Administration requirements for clearance or approval, when they are developing new surgical dressings and topical wound care products. Due to the importance of the Medicare payment systems, this article reviews the Medicare payment systems in acute care hospitals, long-term acute care hospitals, skilled nursing facilities, home health agencies, durable medical equipment suppliers, hospital-based outpatient wound care departments, and qualified healthcare professional offices.

  19. Emerging trends in the outsourcing of medical and surgical care. (United States)

    Boyd, Jennifer B; McGrath, Mary H; Maa, John


    As total health care expenditures are expected to constitute an increasing portion of the US gross domestic product during the coming years, the US health care system is anticipating a historic spike in the need for care. Outsourcing medical and surgical care to other nations has expanded rapidly, and several ethical, legal, and financial considerations require careful evaluation. Ultimately, the balance between cost savings, quality, and patient satisfaction will be the key determinant in the future of medical outsourcing.

  20. Do hospitals need oncological critical care units?


    Koch, Abby; Checkley, William


    Since the inception of critical care as a formal discipline in the late 1950s, we have seen rapid specialization to many types of intensive care units (ICUs) to accommodate evolving life support technologies and novel therapies in various disciplines of medicine. Indeed, the field has expanded such that specialized ICUs currently exist to address critical care problems in medicine, cardiology, neurology and neurosurgery, trauma, burns, organ transplant and cardiothoracic surgeries. Specializa...

  1. Gender Parity in Critical Care Medicine. (United States)

    Mehta, Sangeeta; Burns, Karen E A; Machado, Flavia R; Fox-Robichaud, Alison E; Cook, Deborah J; Calfee, Carolyn S; Ware, Lorraine B; Burnham, Ellen L; Kissoon, Niranjan; Marshall, John C; Mancebo, Jordi; Finfer, Simon; Hartog, Christiane; Reinhart, Konrad; Maitland, Kathryn; Stapleton, Renee D; Kwizera, Arthur; Amin, Pravin; Abroug, Fekri; Smith, Orla; Laake, Jon H; Shrestha, Gentle S; Herridge, Margaret S


    Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. These documents inform and shape patient care around the world. In this perspective we discuss the importance of diversity on guideline panels, the disproportionately low representation of women on critical care guideline panels, and existing initiatives to increase the representation of women in corporations, universities and government. We propose five strategies to ensure gender parity within critical care medicine.

  2. Critical palliative care: intensive care redefined. (United States)

    Civetta, J M


    In the area of end-of-life bioethical issues, patients, families, and health care providers do not understand basic principles, often leading to anguish, guilt, and anger. Providers lack communication skills, concepts, and practical bedside information. Linking societal values of the sanctity of life and quality of life with medical goals of preservation of life and alleviation of suffering respectively provides an essential structure. Medical care focuses on cure when possible but when the patient is dying, the focus switches to caring for patients and their families. Clinicians need to learn how to balance the benefits and burdens of medications and treatments, control symptoms, and orchestrate withdrawal of treatment. Finally, all need to learn more about the dying process to benefit society, their own families, and themselves.

  3. Value innovation: an important aspect of global surgical care

    National Research Council Canada - National Science Library

    Cotton, Michael; Henry, Jaymie Ang; Hasek, Lauren


    .... Surgical care around the world stands much to gain from these innovations. In this paper, we provide a short review of some of these successful innovations and their origins that have had an important impact in healthcare delivery worldwide...

  4. [Severe infection in critical emergency care]. (United States)

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


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

  5. Critical care nursing: Embedded complex systems. (United States)

    Trinier, Ruth; Liske, Lori; Nenadovic, Vera


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

  6. The role of the surgical care practitioner within the surgical team. (United States)

    Quick, Julie

    Changes to the surgical workforce and the continued development of health policy have perpetuated the requirement for innovative perioperative roles. The surgical care practitioner is a nurse or allied health professional who works within a surgical team and has advanced perioperative skills, including the ability to undertake surgical interventions.With only limited literature evaluating this role, any benefits of their inclusion to a surgical team are largely anecdotal. This article presents the findings of an autoethnographic inquiry that explored the experiences of surgical team members who worked with the nurse researcher in her role as surgical care practitioner. Surgeons identified the provision of a knowledgeable, competent assistant and operator who enhanced patient care, helped maintain surgical services and supported the training of junior doctors. The professional, ethical and legal obligations of advanced perioperative practice were upheld. Interprofessional collaboration was improved, as was service provision. This further enhanced the patient experience. The traditional viewpoint that nurses who undertake tasks previously associated with medicine should be working to the standard of a doctor is challenged but requires further examination.

  7. Surviving sepsis in the critical care environment. (United States)

    Benedict, Lara


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

  8. Predictors of pulmonary critical care recidivism

    Directory of Open Access Journals (Sweden)

    Mohsen Elshafey


    Conclusion: Age above 50 years, obesity, non recovered AKI, presence of type II respiratory failure, nocturnal and hot day discharge, need for pressors and tracheostomy are considered to be predictors of recidivism to pulmonary critical care unit.

  9. American Association of Critical-Care Nurses (United States)

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

  10. [Wound prevention in the surgical intensive care unit]. (United States)

    Le Moel, Carole; Mounier, Roman; Ardic-Pulas, Taline


    Literature reports a high prevalence of wounds in the hospital environment. A study devoted to wounds encountered in post-surgical intensive care has been carried out in a university hospital. This work highlighted the diversity of acute wounds mainly observed in intensive care and the difficulties nurses have in managing them.

  11. The Professionalism of Critical Care Nurse Fellows After Completion of the Critical Care Nurse Fellowship Program. (United States)

    Castro, Emily; Click, Elizabeth; Douglas, Sara; Friedman, Isabel


    Professionalism is paramount to the formation and functioning of new graduate critical care nurses. In this project, a sample of 110 new graduate nurses used a descriptive self-report electronic survey with Hall's Professionalism Inventory Scale. A great percentage of these new graduate critical care nurse fellows with high professionalism scores may be related to their participation in the Critical Care Nurse Fellowship orientation program. Perhaps, Nursing Professional Development specialists should incorporate classes on professional advancement planning for new graduate nurses.

  12. Implementation Science: A Neglected Opportunity to Accelerate Improvements in the Safety and Quality of Surgical Care. (United States)

    Hull, Louise; Athanasiou, Thanos; Russ, Stephanie


    The aim of this review was to emphasize the importance of implementation science in understanding why efforts to integrate evidence-based interventions into surgical practice frequently fail to replicate the improvements reported in early research studies. Over the past 2 decades, numerous patient safety initiatives have been developed to improve the quality and safety of surgical care. The surgical community is now faced with translating "promising" initiatives from the research environment into clinical practice-the World Health Organization (WHO) has described this task as one of the greatest challenges facing the global health community and has identified the importance of implementation science in scaling up evidence-based interventions. Using the WHO surgical safety checklist, a prominent example of a rapidly and widely implemented surgical safety intervention of the past decade, a review of literature, spanning surgery, and implementation science, was conducted to identify and describe a broad range of factors affecting implementation success, including contextual factors, implementation strategies, and implementation outcomes. Our current approach to conceptualizing and measuring the "effectiveness" of interventions has resulted in factors critical to implementing surgical safety interventions successfully being neglected. Improvements in the safety and quality of surgical care can be accelerated by drawing more heavily upon implementation science and that until this rapidly evolving field becomes more firmly embedded into surgical research and implementation efforts, our understanding of why interventions such as the checklist "work" in some settings and appear "not to work" in other settings will be limited.

  13. National Surgical Quality Improvement Program-Pediatric (NSQIP) and the Quality of Surgical Care in Pediatric Orthopaedics. (United States)

    Brighton, Brian K


    In recent years, the safety, quality, and value of surgical care have become increasingly important to surgeons and hospitals. Quality improvement in surgical care requires the ability to collect, measure, and act upon reliable and clinically relevant data. One example of a large-scale quality effort is the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Pediatric), the only nationwide, risk-adjusted, outcomes-based program evaluating pediatric surgical care.

  14. Critical Care Glucose Point-of-Care Testing. (United States)

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

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

  15. Standardising fast-track surgical nursing care in Denmark

    DEFF Research Database (Denmark)

    Hjort Jakobsen, Dorthe; Rud, Kirsten; Kehlet, Henrik;


    guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN......-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.......Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical...

  16. Communication as a core skill of palliative surgical care. (United States)

    Miner, Thomas J


    Excellence as a surgeon requires not only the technical and intellectual ability to effectively take care of surgical disease but also an ability to respond to the needs and questions of patients. This article provides an overview of the importance of communication skills in optimal surgical palliation and offers suggestions for a multidisciplinary team approach, using the palliative triangle as the ideal model of communication and interpersonal skills. This article also discusses guidelines for advanced surgical decision making and outlines methods to improve communication skills.

  17. Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients

    Directory of Open Access Journals (Sweden)

    Ugas Mohamed


    Full Text Available Abstract Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive.

  18. Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy. (United States)

    Hager, David R; Persaud, Rosemary A; Naseman, Ryan W; Choudhary, Kavish; Carter, Kristen E; Hansen, Amanda


    Background: While hospital beds continue to decline as patients previously treated as inpatients are stabilized in ambulatory settings, the number of critical care beds available in the United States continues to rise. Growth in pharmacy student graduation, postgraduate year 2 critical care (PGY2 CC) residency programs, and positions has also increased. There is a perception that the critical care trained pharmacist market is saturated, yet this has not been evaluated since the rise in pharmacy graduates and residency programs. Purpose: To describe the current perception of critical care residency program directors (CC RPDs) and directors of pharmacy (DOPs) on the critical care pharmacist job market and to evaluate critical care postresidency placement and anticipated changes in PGY2 CC programs. Methods: Two electronic surveys were distributed from October 2015 to November 2015 through Vizient/University HealthSystem Consortium, American Society of Health-System Pharmacists (ASHP), Society of Critical Care Medicine, and American College of Clinical Pharmacy listservs to target 2 groups of respondents: CC RPDs and DOPs. Questions were based on the ASHP Pharmacy Forecast and the Pharmacy Workforce Center's Aggregate Demand Index and were intended to identify perceptions of the critical care market of the 2 groups. Results: Of 116 CC RPDs, there were 66 respondents (56.9% response rate). Respondents have observed an increase in applicants; however, they do not anticipate increasing the number of positions in the next 5 years. The overall perception is that there is a balance in supply and demand in the critical care trained pharmacist market. A total of 82 DOPs responded to the survey. Turnover of critical care pharmacists within respondent organizations is expected to be low. Although a majority of DOPs plan to expand residency training positions, only 9% expect to increase positions in critical care PGY2 training. Overall, DOP respondents indicated a balance of

  19. Higher Plasma Pyridoxal Phosphate Is Associated with Increased Antioxidant Enzyme Activities in Critically Ill Surgical Patients

    Directory of Open Access Journals (Sweden)

    Chien-Hsiang Cheng


    Full Text Available Critically ill patients experience severe stress, inflammation and clinical conditions which may increase the utilization and metabolic turnover of vitamin B-6 and may further increase their oxidative stress and compromise their antioxidant capacity. This study was conducted to examine the relationship between vitamin B-6 status (plasma and erythrocyte PLP oxidative stress, and antioxidant capacities in critically ill surgical patients. Thirty-seven patients in surgical intensive care unit of Taichung Veterans General Hospital, Taiwan, were enrolled. The levels of plasma and erythrocyte PLP, serum malondialdehyde, total antioxidant capacity, and antioxidant enzyme activities (i.e., superoxide dismutase (SOD, glutathione S-transferase, and glutathione peroxidase were determined on the 1st and 7th days of admission. Plasma PLP was positively associated with the mean SOD activity level on day 1 (r=0.42, P<0.05, day 7 (r=0.37, P<0.05, and on changes (Δ (day 7 − day 1 (r=0.56, P<0.01 after adjusting for age, gender, and plasma C-reactive protein concentration. Higher plasma PLP could be an important contributing factor in the elevation of antioxidant enzyme activity in critically ill surgical patients.

  20. Surgical audit in day care myringoplasty. (United States)

    Subramaniam, S; Abdul, R


    Day-case surgery is preferred for adults, allowing post-operative fast recovery in family environment and support. Myringoplasty using the traditional method of underlay temporalis fascia or tragal perichondrium is usually performed as an in-patient. From 2003 to 2004, 22 myringoplasty procedures were performed in a dedicated day surgery unit at the Hospital Melaka. We report the retrospectively review of the outcome results of these procedures. None of the patients need admission overnight. There were no surgical or anesthetic complications noted and this series suggests that day-case surgery is a safe and desirable practice for patients undergoing myringoplasty. However, there should be the facility for admission if required.

  1. Critical Care Implications of the Affordable Care Act. (United States)

    Dogra, Anjali P; Dorman, Todd


    To provide an overview of key elements of the Affordable Care Act. To evaluate ways in which the Affordable Care Act will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the Affordable Care Act. Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office. As all of the Affordable Care Act's provisions will not be fully implemented until 2019, we also drew upon cost, population, and utilization projections, as well as the experience of existing state-based healthcare reforms. The Affordable Care Act represents the furthest reaching regulatory changes in the U.S. healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The Affordable Care Act aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the Affordable Care Act outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-Affordable Care Act era.

  2. Acute-care surgical service: a change in culture. (United States)

    Parasyn, Andrew D; Truskett, Philip G; Bennett, Michael; Lum, Sharon; Barry, Jennie; Haghighi, Koroush; Crowe, Philip J


    The provision of acute surgical care in the public sector is becoming increasingly difficult because of limitation of resources and the unpredictability of access to theatres during the working day. An acute-care surgical service was developed at the Prince of Wales Hospital to provide acute surgery in a more timely and efficient manner. A roster of eight general surgeons provided on-site service from 08.00 to 18.00 hours Monday to Friday and on-call service in after-hours for a 79-week period. An acute-care ward of four beds and an operating theatre were placed under the control of the rostered acute-care surgeon (ACS). At the end of each ACS roster period all patients whose treatment was undefined or incomplete were handed over to the next rostered ACS. Patient data and theatre utilization data were prospectively collected and compared to the preceding 52-week period. Emergency theatre utilization during the day increased from 57 to 69%. There was a 11% reduction in acute-care operating after hours and 26% fewer emergency cases were handled between midnight and 08.00 hours. There was more efficient use of the entire theatre block, suggesting a significant cultural change. Staff satisfaction was high. On-site consultant-driven surgical leadership has provided significant positive change to the provision of acute surgical care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency.

  3. [Perspective technologies of surgical care to the wounded]. (United States)

    Samokhvalov, I M; Badalov, V I; Reva, V A; Golovko, K P; Petrov, A N; Kaznacheev, M V; Rozov, A I


    A goal of this study is to review perspective technologies of surgical care to the wounded on the basis of an analysis of the experience in medical support in local armed conflicts and a study of the achievements of modern trauma surgery. The study is based on the analysis of personal experience, results of scientific researches being carried out in the Military Medical Academy and a comparison review of available papers and works in the field of our study. Perspective technologies of surgical care to the wounded are strongly dependent on the pre-hospital care: high technologies in personal medical equipment, special disposable devices used in case of life-threatening consequences of injuries and traumas during emergency medical care and advanced trauma management. The main innovation of the last ten years in war surgery is considered to be damage control surgery. Wide application of abbreviated surgical operations (the first phase of damage control surgery) makes the use of remote surgery (telesurgery) for treatment of the wounded more practicable. Increasing effectiveness of military surgeon education is based on the use of all possible achievements in education and information technologies. Feedback in surgical care to the wounded is supplied with analysis of its results in the medical Register of the wounded military.

  4. A leadership programme for critical care. (United States)

    Crofts, Linda


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

  5. Aeromedical Evacuation Enroute Critical Care Validation Study (United States)


    percentile TP, suggesting that TPs assumed complex postures to accomplish patient care tasks. The findings suggest that ergonomic specifications...critical care, and (2) Current medical interiors contributed to crewmember fatigue and back injuries. This is a plausible concern, as posture been...long spine board 6530-01-490-2487 GoPro® Hero3 cameras The GoPro® Hero3 cameras provided a small form factor combined with a wide field-of

  6. Barriers and facilitators of surgical care in rural Uganda: a mixed methods study. (United States)

    Nwanna-Nzewunwa, Obieze C; Ajiko, Mary-Margaret; Kirya, Fred; Epodoi, Joseph; Kabagenyi, Fiona; Batibwe, Emmanuel; Feldhaus, Isabelle; Juillard, Catherine; Dicker, Rochelle


    Surgical care delivery is poorly understood in resource-limited settings. To effectively move toward universal health coverage, there is a critical need to understand surgical care delivery in developing countries. This study aims to identify the barriers and facilitators of surgical care delivery at Soroti Regional Referral Hospital in Uganda. In this mixed methods study, we (1) applied the Surgeons OverSeas' Personnel, Infrastructure, Procedures, Equipment, and Supplies tool to assess surgical capacity; (2) retrospectively reviewed inpatient records; (3) conducted four semistructured focus group discussions with 18 purposively sampled providers involved in perioperative care; and (4) observed the perioperative process of care using a time and motion approach. Descriptive statistics were generated from quantitative data. Qualitative data were thematically analyzed. The Personnel, Infrastructure, Procedures, Equipment, and Supplies survey revealed severe deficiencies in workforce (P-score = 14) and infrastructure (I-score = 5). Equipment, supplies, and procedures were generally available. Male and female wards were overbooked 83% and 60% of the time, respectively. Providers identified lack of space, patient overload, and superfluous patients' attendants as barriers to surgical care. Workforce challenges were tackled using teamwork and task sharing. Inadequate equipment and processes were addressed using improvisations. All observed subjects (n = 31) received interventions. The median decision-to-intervention time was 2.5 h (Interquartile Range [IQR], 0.4, 21.4). However, 48% of subjects experienced delays. Median decision-to-intervention delay was 14.8 h (IQR, 0.9, 26.6). Despite severe workforce and physical infrastructural deficiencies at Soroti Regional Referral Hospital, providers are adjusting and innovating to deliver surgical care. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. [Surgical Center environment and its elements: implications for nursing care]. (United States)

    Silva, Denise Conceição; Alvim, Neide Aparecida Titonelli


    The purpose of this qualitative research was to characterize the elements that constitute the environment of the Surgical Center and to analyze its implications for dynamic of care and nursing care. Based on the Environmental Theory's principals. Participated twelve nurses from the Surgical Center of a College Hospital in Rio de Janeiro. Data were gathered through the creativity and sensitivity technique "Map-Speaker", semi-structered interviews and participant observation, and were analyzed by thematic categories. The results showed that care can happen directly and indirectly in favor of full client recovery, counting the environment that the integrate in purpose to maintain harmonic and balanced. The nurse interventions aim to maintain the environment in favorable conditions so that a higher standard of care can be promoted.

  8. Providing surgical care in Somalia: A model of task shifting

    Directory of Open Access Journals (Sweden)

    Ford Nathan P


    Full Text Available Abstract Background Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. Methods In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Results Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65% were male and the median age was 22 (interquartile range, 17-30. 1460 (70% of interventions were emergent. Trauma accounted for 76% (1585 of all surgical pathology; gunshot wounds accounted for 89% (584 of violent injuries. Operative mortality (0.5% of all surgical interventions was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. Conclusions The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully

  9. [Care and implications for caregivers of surgical patients at home]. (United States)

    Chirveches-Pérez, Emilia; Roca-Closa, Josep; Puigoriol-Juvanteny, Emma; Ubeda-Bonet, Inmaculada; Subirana-Casacuberta, Mireia; Moreno-Casbas, María Teresa


    To identify the care given by informal caregivers to patients who underwent abdominal surgery in the Consorci Hospitalari of Vic (Barcelona). To compare the responsibility burden for those caregivers in all the different stages of the surgical process. To determine the consequences of the care itself on the caregiver's health and to identify the factors that contribute to the need of providing care and the appearance of consequences for the caregivers in the home. A longitudinal observational study with follow-up at admission, at discharge and 10 days, of 317 non-paid caregivers of patients who suffer underwent surgery. The characteristics of caregivers and surgical patients were studied. The validated questionnaire, ICUB97-R based on the model by Virginia Henderson, was used to measure the care provided by informal caregivers and its impact on patient quality of life. Most of the caregivers were women, with an average age of 52.9±13.7 years without any previous experience as caregivers. The greater intensity of care and impact was observed in the time when they arrived home after hospital discharge (p<0.05). The predictive variables of repercussions were being a dependent patient before the surgical intervention (β=2.93, p=0.007), having a cancer diagnosis (β=2.87, p<.001) and time dedicated to the care process (β=0.07, p=0.018). Caregivers involved in the surgical process provide a great amount of care at home depending on the characteristics of patients they care for, and it affects their quality of life. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  10. Ethical aspects of care in the newborn surgical patient

    NARCIS (Netherlands)

    Hazebroek, F.W.J.; Tibboel, D.; Wijnen, R.M.H.


    This article places focus on three main subjects that are all related to the ethical aspects of care of newborns undergoing major surgical interventions. The first concerns the communication between the surgeon, as a representative of the treatment team, and the parents. The second is the way to

  11. Pharmaceutical care in surgical patients: Tools for measurement and intervention

    NARCIS (Netherlands)

    de Boer, M.


    Assessing and improving the quality of pharmaceutical care is a major issue in hospitals nowadays. Medication safety strategies are being developed and widely introduced in hospitals to reduce medication-related harm. Surgical patients are at risk for medication-related harm, also called adverse

  12. Reimbursement for critical care services in India

    Directory of Open Access Journals (Sweden)

    Raja Jayaram


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

  13. Dopamine in heart failure and critical care

    NARCIS (Netherlands)

    Smit, AJ

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

  14. Dopamine in heart failure and critical care

    NARCIS (Netherlands)

    Smit, AJ


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

  15. Impact of Late Fluid Balance on Clinical Outcomes in the Critically Ill Surgical and Trauma Population (United States)

    Elofson, Kathryn A.; Eiferman, Daniel A.; Porter, Kyle; Murphy, Claire V.


    Purpose Management of fluid status in critically ill patients poses a significant challenge due to limited literature. This study aimed to determine the impact of late fluid balance management following initial adequate fluid resuscitation on in-hospital mortality for critically ill surgical and trauma patients. Materials and Methods This single center retrospective cohort study included 197 patients who underwent surgical procedure within 24 hours of surgical intensive care unit (SICU) admission. Patients with high fluid balance on post-operative day 7 (>5L) were compared to those with a low fluid balance (≤5L) with a primary endpoint of in-hospital mortality. Subgroup analyses were performed based on diuretic administration, diuretic response and type of surgery. Results High fluid balance was associated with a significantly higher in-hospital mortality (30.2 vs 3%, p<0.001) compared to low fluid balance; this relationship remained after multivariable regression analysis. High fluid balance was associated with increased mortality, independent of diuretic administration, diuretic response and type of surgery. Conclusions Consistent with previous literature, high fluid balance on post-operative day 7 was associated with increased in-hospital mortality. Patients who received and responded to diuretic therapy did not demonstrate improved clinical outcomes which questions their use in the post-operative period. PMID:26341457

  16. Adherence to surgical care improvement project measures and post-operative surgical site infections. (United States)

    Awad, Samir S


    Surgical site infection (SSI) is unequivocally morbid and costly. The estimated 300,000 SSIs annually in the United States represent the second most common infection among surgical patients, prolong hospitalization by 7-10 days, and have an estimated annual incremental cost of $1 billion. The mortality rate associated with SSI is 3%, with about three quarters of deaths being attributable directly to the infection. Prevention is possible for the most part, and concerted effort has been made to limit these infections, arguably to little effect. Review of pertinent English-language literature. Numerous risk factors for SSI and tactics for prevention have been described, but efforts to bundle these tactics into an effective, comprehensive prevention program have been disappointing. Numerous studies now demonstrate that the Surgical Care Improvement Program (SCIP), which focused on process improvement rather than outcomes, has been ineffective despite governmental support, financial penalties for non-compliance, and consequent widespread implementation. Required reporting has increased awareness of the problem of SSI, but just as the complexity of SSI risk, pathogenesis, and preventions reflects the complexity of the disease, many other factors must be taken into account, including the skill and knowledge of the surgical team and promulgation of a culture of quality and safety in surgical patient care.

  17. Perioperative Care Coordination Measurement: A Tool to Support Care Integration of Pediatric Surgical Patients. (United States)

    Ferrari, Lynne R; Ziniel, Sonja I; Antonelli, Richard C


    The relationship of care coordination activities and outcomes to resource utilization and personnel costs has been evaluated for a number of pediatric medical home practices. One of the first tools designed to evaluate the activities and outcomes for pediatric care coordination is the Care Coordination Measurement Tool (CCMT). It has become widely used as an instrument for health care providers in both primary and subspecialty care settings. This tool enables the user to stratify patients based on acuity and complexity while documenting the activities and outcomes of care coordination. We tested the feasibility of adapting the CCMT to a pediatric surgical population at Boston Children's Hospital. The tool was used to assess the preoperative care coordination activities. Care coordination activities were tracked during the interval from the date the patient was scheduled for a surgical or interventional procedure through the day of the procedure. A care coordination encounter was defined as any task, whether face to face or not, supporting the development or implementation of a plan of care. Data were collected to enable analysis of 5675 care coordination encounters supporting the care provided to 3406 individual surgical cases (patients). The outcomes of care coordination, as documented by the preoperative nursing staff, included the elaboration of the care plan through patient-focused communication among specialist, facilities, perioperative team, and primary care physicians in 80.5% of cases. The average time spent on care coordination activities increased incrementally by 30 minutes with each additional care coordination encounter for a surgical case. Surgical cases with 1 care coordination encounter took an average of 35.7 minutes of preoperative care coordination, whereas those with ≥4 care coordination encounters reported an average of 121.6 minutes. We successfully adapted and implemented the CCMT for a pediatric surgical population and measured nonface

  18. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel


    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie...

  19. The use of finger-stick blood to assess lactate in critically ill surgical patients. (United States)

    Sabat, Joseph; Gould, Scott; Gillego, Ezra; Hariprashad, Anita; Wiest, Christine; Almonte, Shailyn; Lucido, David J; Gave, Asaf; Leitman, I Michael; Eiref, Simon D


    Using finger-stick capillary blood to assess lactate from the microcirculation may have utility in treating critically ill patients. Our goals were to determine how finger-stick capillary lactate correlates with arterial lactate levels in patients from the surgical intensive care unit, and to compare how capillary and arterial lactate trend over time in patients undergoing resuscitation for shock. Capillary whole blood specimens were obtained from finger-sticks using a lancet, and assessed for lactate via a handheld point-of-care device as part of an "investigational use only" study. Comparison was made to arterial blood specimens that were assessed for lactate by standard laboratory reference methods. 40 patients (mean age 68, mean APACHEII 18, vasopressor use 62%) were included. The correlation between capillary and arterial lactate levels was 0.94 (p < 0.001). Capillary lactate measured slightly higher on average than paired arterial values, with a mean difference 0.99 mmol/L. In patients being resuscitated for septic and hemorrhagic shock, capillary and arterial lactate trended closely over time: rising, peaking, and falling in tandem. Clearance of capillary and arterial lactate mirrored clinical improvement, normalizing in all patients except two that expired. Finger-stick capillary lactate both correlates and trends closely with arterial lactate in critically ill surgical patients, undergoing resuscitation for shock.

  20. Factors determining the patients' care intensity for surgeons and surgical nurses: a conjoint analysis. (United States)

    van Oostveen, Catharina J; Vermeulen, Hester; Nieveen van Dijkum, Els J M; Gouma, Dirk J; Ubbink, Dirk T


    Surgeons and nurses sometimes perceive a high workload on the surgical wards, which may influence admission decisions and staffing policy. This study aimed to explore the relative contribution of various patient and care characteristics to the perceived patients' care intensity and whether differences exist in the perception of surgeons and nurses. We invited surgeons and surgical nurses in the Netherlands for a conjoint analysis study through internet and e-mail invitations. They rated 20 virtual clinical scenarios regarding patient care intensity on a 10-point Likert scale. The scenarios described patients with 5 different surgical conditions: cholelithiasis, a colon tumor, a pancreas tumor, critical leg ischemia, and an unstable vertebral fracture. Each scenario presented a mix of 13 different attributes, referring to the patients' condition, physical symptoms, and admission and discharge circumstances. A total of 82 surgeons and 146 surgical nurses completed the questionnaire, resulting in 4560 rated scenarios, 912 per condition. For surgeons, 6 out of the 13 attributes contributed significantly to care intensity: age, polypharmacy, medical diagnosis, complication level, ICU-stay and ASA-classification, but not multidisciplinary care. For nurses, the same six attributes contributed significantly, but also BMI, nutrition status, admission type, patient dependency, anxiety or delirium during hospitalization, and discharge type. Both professionals ranked 'complication level' as having the highest impact. The differences between surgeons and nurses on attributes contributing to care intensity may be explained by differences in professional roles and daily work activities. Surgeons have a medical background, including technical aspects of their work and primary focus on patient curation. However, nurses are focused on direct patient care, i.e., checking vital functions, stimulating self-care and providing woundcare. Surgeons and nurses differ in their perception of

  1. A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action. (United States)

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


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

  2. Critical care of traumatic spinal cord injury. (United States)

    Jia, Xiaofeng; Kowalski, Robert G; Sciubba, Daniel M; Geocadin, Romergryko G


    Approximately 11 000 people suffer traumatic spinal cord injury (TSCI) in the United States, each year. TSCI incidences vary from 13.1 to 52.2 per million people and the mortality rates ranged from 3.1 to 17.5 per million people. This review examines the critical care of TSCI. The discussion will focus on primary and secondary mechanisms of injury, spine stabilization and immobilization, surgery, intensive care management, airway and respiratory management, cardiovascular complication management, venous thromboembolism, nutrition and glucose control, infection management, pressure ulcers and early rehabilitation, pharmacologic cord protection, and evolving treatment options including the use of pluripotent stem cells and hypothermia.

  3. Emergent interfacility evacuation of critical care patients in combat. (United States)

    Franco, Yvonne E; De Lorenzo, Robert A; Salyer, Steven W


    During the Second Iraq War (Operation Iraqi Freedom), high-intensity, low-utilization medical and surgical services, such as neurosurgical care, were consolidated into a centralized location within the combat zone. This arrangement necessitated intra-theater air medical evacuation of critically ill or injured patients from outlying combat support hospitals (CSH) to another combat zone facility having the needed services. A case series is presented of intratheater transfer of neurosurgical patients in Iraq during 2005-06. Ninety-eight patients are included in the series, with typical transfer distances of 40 miles (approximately 20-25 minutes of flight time). All patients were transported with a CSH nurse in addition to the standard Army EMT-B flight medic. Seventy-six percent of cases were battle injury, 17% were non-battle injuries, and the balance were classified as non-injury mechanisms. Seventy-six percent of cases were head injuries, with the balance involving burns, stroke, and other injuries. At 30 days, 12% of the patients had died, and 9% remained hospitalized in a critical care setting. None of the patients died during evacuation. Intratheater and interfacility transfer of critical care patients in the combat theater often involves severely head-injured and other neurosurgical cases. Current Army staffing for helicopter transport in these case requires a nurse or other advanced personnel to supplement the standard EMT-B flight medic. Copyright © 2012 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  4. Nutritional requirements of surgical and critically-ill patients: do we really know what they need? (United States)

    Reid, Clare L


    Malnutrition remains a problem in surgical and critically-ill patients. In surgical patients the incidence of malnutrition ranges from 9 to 44%. Despite this variability there is a consensus that malnutrition worsens during hospital stay. In the intensive care unit (ICU), 43% of the patients are malnourished. Although poor nutrition during hospitalisation may be attributable to many factors, not least inadequacies in hospital catering services, there must also be the question of whether those patients who receive nutritional support are being fed appropriately. Indirect calorimetry is the 'gold standard' for determining an individual's energy requirements, but limited time and financial resources preclude the use of this method in everyday clinical practice. Studies in surgical and ICU patient populations have been reviewed to determine the 'optimal' energy and protein requirements of these patients. There are only a small number of studies that have attempted to measure energy requirements in the various surgical patient groups. Uncomplicated surgery has been associated with energy requirements of 1.0-1.15 x BMR whilst complicated surgery requires 1.25-1.4 x BMR in order to meet the patient's needs. Identifying the optimal requirements of ICU patients is far more difficult because of the heterogeneous nature of this population. In general, 5.6 kJ (25 kcal)/kg per d is an acceptable and achievable target intake, but patients with sepsis or trauma may require almost twice as much energy during the acute phase of their illness. The implications of failing to meet and exceeding the requirements of critically-ill patients are also reviewed.

  5. Year in review 2010: Critical Care - infection

    DEFF Research Database (Denmark)

    Pagani, Leonardo; Afshari, Arash; Harbarth, Stephan


    ABSTRACT: Infections remain among the most important concerns in critically ill patients. Early and reliable diagnosis of infection still poses difficulties in this setting but also represents a crucial step toward appropriate antimicrobial therapy. Increasing antimicrobial resistance challenges...... established approaches to the optimal management of infections in the intensive care unit. Rapid infection diagnosis, antibiotic dosing and optimization through pharmacologic indices, progress in the implementation of effective antimicrobial stewardship and infection control programs, and management of fungal...

  6. Pulmonary Hypertension in Pregnancy: Critical Care Management


    Bassily-Marcus, Adel M.; Carol Yuan; John Oropello; Anthony Manasia; Roopa Kohli-Seth; Ernest Benjamin


    Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Im...

  7. Critical thinking in health care supervision. (United States)

    McKenzie, L


    Henry Ford is reputed to have said that thinking is the hardest work there is, which is probably why so few people engage in it. Perhaps many people have felt this way sometimes, especially when they viewed the foibles of the human race displayed prominently on the evening television news. Some people do stupid things; some people seem to be mindless in what they do. This applies also to some in managerial and supervisory positions in health care organizations. The percentage of these thoughtless managers and supervisors is probably comparable to the percentage of the thoughtless people in the general population. Fortunately every normal functioning human being is capable of becoming a more critical thinker. Of course, no amount of effort is adequate to the development of critical thinking when a person lacks fundamental good sense. On the other hand, no amount of genius suffices when someone does not put forth adequate effort to become a more critical thinker.

  8. Critical care in the emergency department.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle


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

  9. Paroxysmal sympathetic hyperactivity in neurological critical care

    Directory of Open Access Journals (Sweden)

    Rajesh Verma


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

  10. Management of paroxysmal atrioventricular nodal reentrant tachycardia in the critically ill surgical patient. (United States)

    Kirton, O C; Windsor, J; Wedderburn, R; Gomez, E; Shatz, D V; Hudson-Civetta, J; Komanduri, S; Civetta, J M


    Paroxysmal atrioventricular nodal reentrant tachycardia is an infrequently encountered supraventricular arrhythmia that continues to present difficult management problems in the critically ill surgical patient. The purpose of this study was to evaluate the efficacy of a new treatment algorithm involving the sequential administration of different classes of antiarrhythmic agents until conversion to sinus rhythm was achieved. Nonrandomized, consecutive, protocol-driven descriptive cohort. University hospital surgical and trauma intensive care unit (ICU). During an 11-month period, we prospectively evaluated all hemodynamically stable patients who sustained new-onset atrioventricular nodal reentrant tachycardia. Vagal maneuver, followed by the rapid, sequential infusion of antiarrhythmic agents (i.e., adenosine, verapamil, and esmolol, respectively) until the arrhythmia was terminated. Twenty-seven patients (4% of all admissions) were evaluated, including 16 trauma patients (injury Severity Score of 20 +/- 8) and 11 general surgical patients (Acute Physiology and Chronic Health Evaluation II score of 17 +/- 7). Time from ICU admission to onset of atrioventricular nodal reentrant tachycardia was 4.5 +/- 5 days (median 2.5). Arrhythmia termination was achieved in all patients within minutes (mean 13 +/- 10 [SD]). Incremental sequential adenosine administration alone, however, was successful in affecting conversion to sinus rhythm in only 44% of initial episodes of atrioventricular nodal reentrant tachycardia (95% confidence interval 21% to 67%). A total of 14 (52%) patients developed 38 relapses of paroxysmal supraventricular tachycardia in the ICU after initial conversion to sinus rhythm. These relapses required additional antiarrhythmic therapy. Adenosine was only effective in 34% of the relapses (95% confidence interval 17% to 53%). Seven (50%) of these 14 patients developed multiple relapses. However, only two patients were receiving suppressive calcium-channel or

  11. Abdominal CT scanning in critically ill surgical patients. (United States)

    Norwood, S H; Civetta, J M


    Clinical parameters, intensive care unit (ICU) course, abdominal computed tomography (CT) scans, and the clinical decisions of 53 critically ill patients were reviewed to determine the influence of the CT scan. No scans were positive before the eighth day. Sensitivity was 48% and specificity, 64%. Seventeen (23%) scans of the 72 provided beneficial results: eight localized abscesses that were drained; nine were negative and not operated on. Five (7%) scans provided detrimental information: scan negative with abscess discovered or scan positive but negative laparotomy. Fifty (70%) scans were either of no help or not used in management. The mortality rate was 50% when CT led to an intervention, and 47% in the entire group. Hospital charges were +33,408. Personnel time and cost were 497 hours and +3658; of the total +37,066, 77% (+28,541) could be considered wasted. From these data, it was concluded that CT scans should be used to confirm abscesses, not to search for a source of sepsis. PMID:4015222

  12. Levetiracetam use in the critical care setting

    Directory of Open Access Journals (Sweden)

    Jerzy P Szaflarski


    Full Text Available Intravenous (IV levetiracetam (LEV is currently approved as an alternative or replacement therapy for patients unable to take the oral form of this antiepileptic drug (AED. The oral form has Food and Drug Administration (FDA indications for adjunctive therapy in the treatment of partial onset epilepsy ages 1 month or more, myoclonic seizures associated with juvenile myoclonic epilepsy starting with the age of 12 and primary generalized tonic-clonic seizures in people 6 years and older. Since the initial introduction, oral and IV LEV has been evaluated in various studies conducted in the critical care setting for the treatment of status epilepticus, stroke-related seizures, seizures following subarachnoid or intracerebral hemorrhage, post-traumatic seizures, tumor-related seizures, and seizures in critically ill patients. Additionally, studies evaluating rapid infusion of IV LEV and therapeutic monitoring of serum LEV levels in different patient populations have been performed. In this review we present the current state of knowledge on LEV use in the critical care setting focusing on the IV uses and discuss future research needs.

  13. Exploiting big data for critical care research. (United States)

    Docherty, Annemarie B; Lone, Nazir I


    Over recent years the digitalization, collection and storage of vast quantities of data, in combination with advances in data science, has opened up a new era of big data. In this review, we define big data, identify examples of critical care research using big data, discuss the limitations and ethical concerns of using these large datasets and finally consider scope for future research. Big data refers to datasets whose size, complexity and dynamic nature are beyond the scope of traditional data collection and analysis methods. The potential benefits to critical care are significant, with faster progress in improving health and better value for money. Although not replacing clinical trials, big data can improve their design and advance the field of precision medicine. However, there are limitations to analysing big data using observational methods. In addition, there are ethical concerns regarding maintaining confidentiality of patients who contribute to these datasets. Big data have the potential to improve medical care and reduce costs, both by individualizing medicine, and bringing together multiple sources of data about individual patients. As big data become increasingly mainstream, it will be important to maintain public confidence by safeguarding data security, governance and confidentiality.

  14. Improving verbal communication in critical care medicine. (United States)

    Brindley, Peter G; Reynolds, Stuart F


    Human errors are the most common reason for planes to crash, and of all human errors, suboptimal communication is the number 1 issue. Mounting evidence suggests the same for errors during short-term medical care. Strong verbal communication skills are key whether for establishing a shared mental model, coordinating tasks, centralizing the flow of information, or stabilizing emotions. However, in contrast to aerospace, most medical curricula rarely address communication norms during impending crises. Therefore, this article offers practical strategies borrowed from aviation and applied to critical care medicine. These crisis communication strategies include "flying by voice," the need to combat "mitigating language," the uses of "graded assertiveness" and "5-step advocacy," and the potential role of Situation, Background, Assessment, and Recommendation communication. We also outline the "step-back method," the concept of communication "below ten thousand feet," the impetus behind "closed-loop communication," and the closely related "repeat-back method." The goal is for critical care practitioners to develop a "verbal dexterity" to match their procedural dexterity and factual expertise. Copyright © 2011. Published by Elsevier Inc.

  15. Critical Care In Korea: Present and Future. (United States)

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


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

  16. Surgical site infection prevention: time to move beyond the surgical care improvement program. (United States)

    Hawn, Mary T; Vick, Catherine C; Richman, Joshua; Holman, William; Deierhoi, Rhiannon J; Graham, Laura A; Henderson, William G; Itani, Kamal M F


    The objective of this study was to evaluate whether the Surgical Care Improvement Project (SCIP) improved surgical site infection (SSI) rates using national data at the patient level for both SCIP adherence and SSI occurrence. The SCIP was established in 2006 with the goal of reducing surgical complications by 25% in 2010. National Veterans' Affairs (VA) data from 2005 to 2009 on adherence to 5 SCIP SSI prevention measures were linked to Veterans' Affairs Surgical Quality Improvement Program SSI outcome data. Effect of SCIP adherence and year of surgery on SSI outcome were assessed with logistic regression using generalized estimating equations, adjusting for procedure type and variables known to predict SSI. Correlation between hospital SCIP adherence and SSI rate was assessed using linear regression. There were 60,853 surgeries at 112 VA hospitals analyzed. SCIP adherence ranged from 75% for normothermia to 99% for hair removal and all significantly improved over the study period (P Surgical site infection occurred after 6.2% of surgeries (1.6% for orthopedic surgeries to 11.3% for colorectal surgeries). None of the 5 SCIP measures were significantly associated with lower odds of SSI after adjusting for variables known to predict SSI and procedure type. Year was not associated with SSI (P = 0.71). Hospital SCIP performance was not correlated with hospital SSI rates (r = -0.06, P = 0.54). Adherence to SCIP measures improved whereas risk-adjusted SSI rates remained stable. SCIP adherence was neither associated with a lower SSI rate at the patient level, nor associated with hospital SSI rates. Policies regarding continued SCIP measurement and reporting should be reassessed.

  17. Update on the critical care management of severe burns. (United States)

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


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

  18. Nursing outcomes content validation according to Nursing Outcomes Classification (NOC) for clinical, surgical and critical patients. (United States)

    Seganfredo, Deborah Hein; Almeida, Miriam de Abreu


    The objective of this study was to validate the Nursing Outcomes (NO) from the Nursing Outcomes Classification (NOC) for the two Nursing Diagnoses (ND) most frequent in hospitalized surgical, clinical and critical patients. The content validation of the REs was performed adapting the Fehring Model. The sample consisted of 12 expert nurses. The instrument for data collection consisted of the NOs proposed by NOC for the two NDs in the study, its definition and a five-point Likert scale. The data were analyzed using descriptive statistics. The NOs that obtained averages of 0.80 or higher were validated. The ND Risk for Infection was the most frequent, being validated eight (38.1%) of 21 NOs proposed by the NOC. The ND Self-Care Deficit: Bathing/Hygiene was the second most frequent and five (14.28%) out of 35 NOs were validated.

  19. Critical care ultrasonography in acute respiratory failure. (United States)

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


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

  20. Effectiveness of a Critical Care Ultrasonography Course. (United States)

    Greenstein, Yonatan Y; Littauer, Ross; Narasimhan, Mangala; Mayo, Paul H; Koenig, Seth J


    Widespread use of critical care ultrasonography (CCUS) for the management of patients in the ICU requires an effective training program. The effectiveness of national and regional CCUS training courses is not known. This study describes a national-level, simulation-based, 3-day CCUS training program and evaluates its effectiveness. Five consecutive CCUS courses, with a total of 363 people, were studied. The 3-day CCUS training program consisted of didactic lectures, ultrasonography interpretation sessions, and hands-on modules with live models. Thoracic, vascular, and abdominal ultrasonography were taught in addition to goal-directed echocardiography. Learners rotated between hands-on training and interpretation sessions. The teacher-to-learner ratio was 1:3 during hands-on training. Interpretation sessions were composed of interactive small groups that reviewed normal and abnormal ultrasonography images. Learners completed a video-based examination before and after completion of the courses. Hands-on image acquisition skills were tested at the completion of the course. Average scores on the pretest and posttest were 57% and 90%, respectively (P training. This 3-day course is an effective method to train large groups of critical care clinicians in the skills requisite for CCUS (image acquisition and image interpretation). Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  1. Necrotizing fasciitis: A decade of surgical intensive care experience

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar


    Full Text Available Necrotizing fasciitis is a rare disease, potentially limb and life-threatening infection of fascia, subcutaneous tissue with occasionally muscular involvement. Necrotizing faciitis is surgical emergency with high morbidity and mortality. Aim: Aim of this study was to analyze presentation, microbiology, surgical, resuscitative management and outcome of this devastating soft tissue infection. Materials and Methods: The medical records of necrotizing fasciitis patients treated in surgical intensive care unit (SICU of our hospital from Jan 1995 to Feb 2005 were reviewed retrospectively. Results: Ninety-four patients with necrotizing fasciitis were treated in the surgical intensive care unit during the review period. Necrotizing fasciitis accounted for 1.15% of total admissions to our SICU. The mean age of our patients was 48.6 years, 75.5% of the cases were male. Diabetes mellitus was the most common comorbid disease (56.4%, 24.5% patients had hypertension, 14.9% patients had coronary artery disease, 9.6% had renal disease and 6.4% cases were obese. History of operation (11.7% was most common predisposing factor in our patients. All patients had leucocytosis at admission to the hospital. Mean duration of symptoms was 3.4 days. Mean number of surgical debridement was 2.1, mean sequential organ failure assessment (SOFA score at admission to SICU was 8.6, 56.38% cases were type 1 necrotizing fasciitis and 43.61% had type 2 infection. Streptococci were most common bacteria isolated (52.1%, commonest regions of the body affected by necrotizing fasciitis were the leg and the foot. Mean intubated days and intensive care unit (ICU stay were 4.8 and 7.6 days respectively. Mean fluid, blood, fresh frozen plasma and platelets concentrate received in first 24 hours were 4.8 liters, 2.0 units, 3.9 units and 1.6 units respectively. Most commonly used antibiotics were tazocin and clindamycin. Common complication was ventricular tachycardia (6.4. 46.8% patients had

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

    Directory of Open Access Journals (Sweden)

    Agela A.Elbadri


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

  3. Pulmonary Hypertension in Pregnancy: Critical Care Management

    Directory of Open Access Journals (Sweden)

    Adel M. Bassily-Marcus


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

  4. Empiric therapy for pneumonia in the surgical intensive care unit. (United States)

    Fabian, T C


    Empiri c therapy of ventilator-associated pneumonia (VAP) in surgical patients should be based on intensive care unit (ICU)-specific surveillance data, because microbial flora patterns vary widely between geographic regions as well as within hospitals. Surgical ICUs have higher VAP rates than other units. Data from the National Nosocomial Infection Surveillance (NNIS) System report Pseudomonas aeruginosa and Staphylococcus aureus to be the most frequent isolates (each 17.4%). Data from the NNIS documents high resistance patterns in ICUs compared with hospitals at large, as well as unit-specific patterns. VAP risk factors for surgical patients include thoracoabdominal surgery, altered level of consciousness, advanced age, diabetes mellitus, malnutrition, chronic obstructive pulmonary disease, and prior antibiotic administration. Promising prevention strategies include restricting ventilator circuit changes, in-line heat moisture exchange filters, semi-recumbant positioning, and continuous subglottic aspiration. Pharmacodynamics should be considered when choosing antibiotic regimens. Postantibiotic effect and time-dependent versus concentration-dependent killing should be studied in clinical trials. Current guidelines for choosing regimens have been well developed by the American Thoracic Society.

  5. Family satisfaction with patient care in critical care units in Pakistan: a descriptive cross-sectional study. (United States)

    Ahtisham, Younas; Subia, Parveen; Gideon, Victor


    To assess family satisfaction with care provided to patients in critical care units in Islamabad. A descriptive cross-sectional study was conducted in 11 medical and surgical critical care units at two private hospitals in Islamabad, Pakistan. The purposive sample consisted of 323 immediate family members and other relatives and friends (referred to as family members in this article) of 323 patients admitted to the critical care units for at least 24 hours. The revised Critical Care Family Satisfaction Survey was used for data collection. Descriptive statistics were used for data analysis. A total of 149/323 (46%) family members were 'very satisfied' with the honesty (openness) of staff in explaining the patient's condition, and 137/323 (42%) family members were 'very satisfied' with the nurses' availability to speak to them. A total of 143/323 (44%) family members were 'satisfied' with the honesty (openness) of staff in explaining the patient's condition, and 131/323 (41%) were 'satisfied' with the nurses' availability to speak to them. A few family members (21/323, 6%) were 'very dissatisfied' with the flexibility of the visiting hours and a few (20/323, 6%) were 'very dissatisfied' with the noise level in the critical care units. Some family members (38/323, 12%) were 'not satisfied' with the flexibility of the visiting hours, and some (18/323, 6%) were 'not satisfied' with the noise level in the critical care units. The majority of family members (244/323, 75%) were 'satisfied' or 'very satisfied' that their relatives' needs were being met in the critical care units. However, qualitative data indicate that most family members wanted greater involvement in decision making. These findings should be considered by staff working in critical care settings to ensure high-quality patient care.

  6. Surgical Management of Severe Colitis in the Intensive Care Unit. (United States)

    Halaweish, Ihab; Alam, Hasan B


    Severe colitis, an umbrella encompassing several entities, is one of the most common acute gastrointestinal disorders resulting in critical illness. Clostridium difficile infection is responsible for the majority of nosocomial diarrhea with fulminant C difficile colitis (CDC) carrying a high mortality. Optimal outcomes can be achieved by early identification and treatment of fulminant CDC, with appropriate surgical intervention when indicated. Ischemic colitis, on the other hand, is uncommon with a range of etiological factors including abdominal aortic surgery, inotropic drugs, rheumatoid diseases, or often no obvious triggering factor. Most cases resolve with nonsurgical management; however, prompt recognition of full-thickness necrosis and gangrene is crucial for good patient outcomes. Fulminant colitis is a severe disease secondary to progressive ulcerative colitis with systemic deterioration. Surgical intervention is indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease. Although, failure of medical management is the most common indication, it can be difficult to define objectively and requires a collaborative multidisciplinary approach. This article proposes some simple management algorithms for these clinical entities, with a focus on critically ill patients.

  7. Critical Care Management of Cerebral Edema in Brain Tumors. (United States)

    Esquenazi, Yoshua; Lo, Victor P; Lee, Kiwon


    Cerebral edema associated with brain tumors is extremely common and can occur in both primary and metastatic tumors. The edema surrounding brain tumors results from leakage of plasma across the vessel wall into the parenchyma secondary to disruption of the blood-brain barrier. The clinical signs of brain tumor edema depend on the location of the tumor as well as the extent of the edema, which often exceeds the mass effect induced by the tumor itself. Uncontrolled cerebral edema may result in increased intracranial pressure and acute herniation syndromes that can result in permanent neurological dysfunction and potentially fatal herniation. Treatment strategies for elevated intracranial pressure consist of general measures, medical interventions, and surgery. Alhough the definitive treatment for the edema may ultimately be surgical resection of the tumor, the impact of the critical care management cannot be underestimated and thus patients must be vigilantly monitored in the intensive care unit. In this review, we discuss the pathology, pathophysiology, and clinical features of patients presenting with cerebral edema. Imaging findings and treatment modalities used in the intensive care unit are also discussed.

  8. French validation of the critical care family needs inventory. (United States)

    Coutu-Wakulczyk, G; Chartier, L


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

  9. Surgical procedure of Free Flap. Main nursing care

    Directory of Open Access Journals (Sweden)

    Manuel Molina López


    Full Text Available The free flap surgical technique is used to cover extensive skin loss areas and situations where no flap is available, or in axial zones. The great breackthrough in the field of reconstructive surgical techniques and the creation of new units where these complex techniques are used, means that the nursing staff who work in these hospital units are adquiring greater protagonism in caring for, and the subsequent success of this type of surgery in which the problems of collaboration in all the perioperative phases depend entirely on the nursing team.The collaborative nursing problems could be defined as real or potential health problems, where users need nursing staff to follow the treatment and control procedures prescribed by other professional, generally doctors, who control and are responsible for the final outcome.While planning collaborative objectives and activities it should be taken into account that the function of the nursing staff is twofold: on the one hand, the patient must be taken care of as prescribed by other professionals and, on the other hand, it should bring into play cognitive elements (knowledge and know-how and clinical judgment when executing these in controlling the patients evolution.In this article our intention is to give an interesting and comprehensive description of the free flap surgical technique, its pros and cons, and identify the principal collaborative problems which nursing will have to deal with in each one of the perioperative phases, the number and specific nature of such oblige nursing on many occasions, to update and/or acquire new skills.

  10. April 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA


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

  11. Medical errors recovered by critical care nurses. (United States)

    Dykes, Patricia C; Rothschild, Jeffrey M; Hurley, Ann C


    : The frequency and types of medical errors are well documented, but less is known about potential errors that were intercepted by nurses. We studied the type, frequency, and potential harm of recovered medical errors reported by critical care registered nurses (CCRNs) during the previous year. : Nurses are known to protect patients from harm. Several studies on medical errors found that there would have been more medical errors reaching the patient had not potential errors been caught earlier by nurses. : The Recovered Medical Error Inventory, a 25-item empirically derived and internally consistent (alpha =.90) list of medical errors, was posted on the Internet. Participants were recruited via e-mail and healthcare-related listservs using a nonprobability snowball sampling technique. Investigators e-mailed contacts working in hospitals or who managed healthcare-related listservs and asked the contacts to pass the link on to others with contacts in acute care settings. : During 1 year, 345 CCRNs reported that they recovered 18,578 medical errors, of which they rated 4,183 as potentially lethal. : Surveillance, clinical judgment, and interventions by CCRNs to identify, interrupt, and correct medical errors protected seriously ill patients from harm.

  12. Perceptions of complementary therapies among Swedish registered professions in surgical care. (United States)

    Bjerså, Kristofer; Forsberg, Anna; Fagevik Olsén, Monika


    There is increasing interest in complementary and alternative medicine (CAM) among healthcare professions. However, no studies have been conducted in Sweden or in a surgical context. The aim of this study is to describe different perceptions of complementary therapies among registered healthcare professions in Swedish surgical care. Sixteen interviews were conducted with registered physicians, nurses, physiotherapists and clinical dieticians at a Swedish university hospital. Analysis was made with a phenomenographic research approach. The findings showed variations in perceptions of the definition of complementary therapies. A constructive approach toward use was observed, but there was a conflict in matters of indications and contraindications, and also criticism over a lack of knowledge. There was seen to be a need for education to be able to act professionally. Scepticism over high costs of treatment was highlighted. In conclusion, a need for policies on management, education and research in the field of CAM should be addressed.

  13. Diagnostic value of procalcitonin for hospital-acquired pneumonia in patients receiving surgical critical care%降钙素原对重症患者医院获得性肺炎的诊断价值

    Institute of Scientific and Technical Information of China (English)

    孙广正; 周其林; 戴华卫


    目的:研究降钙素原(PC T )对外科重症患者医院获得性肺炎的病情评估作用,为临床治疗提供参考依据。方法前瞻性纳入2011-2012年60例外科重症患者,入院后给予PCT、C‐反应蛋白(CRP)等检查,根据肺炎严重程度和预后分成发生肺炎组34例与未发生肺炎组26例,分别比较重症组与轻症组PC T 表达水平的差异,分析PCT与医院获得性肺炎发生的相关性,采用SPSS 12.0进行统计处理。结果纳入的60例患者中死亡8例,病死率13.33%;发生医院获得性肺炎患者共34例,发生率为56.66%;发生医院获得性肺炎的患者PC T峰值平均为(136.56±57.6)μg/L ,病程中的平均值为(66.59±20.9)μg/L ;未发生医院获得性肺炎的患者PC T峰值平均为(34.21±11.5)μg/L,病程中的平均值为(14.7±6.91)μg/L ;两组相比,差异有统计学意义(P<0.05)。结论 PC T可以有效的用于外科重症患者医院获得性肺炎的诊断,具有临床推广价值。%OBJECTIVE To study procalcitonin (PCT ) for evaluation of hospital‐acquired pneumonia in patients with severe diseases in the surgical department and to provide reference for clinical treatment .METHODS Totally 60 patients with severe diseases in the surgical department were prospectively enrolled ,and given PCT ,CRP and other tests after admission .They were divided into the pneumonia group (n=34) and the non‐pneumonia group (n=26) according to the pneumonia severity and prognosis .The differences in the expression levels of PCT between the two groups were compared .The correlation of PCT and the occurrence of hospital‐acquired pneumonia were analyzed .RESULTS Among the total of 60 patients ,8 patients died ,the mortality rate was 13 .33% .Hospital‐ac‐quired pneumonia occurred in a total of 34 cases ,the rate was 56 .66% .The average PCT peak value for patients with hospital

  14. Standards for nurse staffing in critical care units determined by: The British Association of Critical Care Nurses, The Critical Care Networks National Nurse Leads, Royal College of Nursing Critical Care and In-flight Forum. (United States)

    Bray, Kate; Wren, Ian; Baldwin, Andrea; St Ledger, Una; Gibson, Vanessa; Goodman, Sheila; Walsh, Dominic


    Since 1967 the gold standard for nurse staffing levels in intensive care and subsequently critical care units has been one nurse for each patient. However, critical care has changed substantially since that time and in recent years this standard has been challenged. Previously individual nursing organisations such as the British Association of Critical Care Nurses (BACCN) and the Royal College of Nursing have produced guidance on staffing levels for critical care units. This paper represents the first time all three UK Professional Critical Care Associations have collaborated to produce standards for nurse staffing in critical care units. These standards have evolved from previous works and are endorsed by BACCN, Critical Care Networks National Nurse Leads Group (CC3N) and the Royal College of Nursing Critical Care and In-flight Forum. The aim of this paper is to provide an overview of the much more detailed document 'Standards for Nurse Staffing in Critical Care', which can be found on the BACCN web site at The full paper has extensively reviewed the evidence, whereas this short paper provides essential detail and the 12 standard statements. Representation was sort from each of the critical care associations. The authors extensively reviewed the literature using the terms: (1) critical care nursing, (2) nursing, (3) nurse staffing, (4) skill mix, (5) adverse events, (6) health care assistants and critical care, (7) length of stay, (8) critical care, (9) intensive care, (10) technology, (11) infection control. Comprehensive review of the evidence has culminated in 12 standard statements endorsed by BACCN, CC3N and the Royal College of Nursing Critical Care and In-flight Forum. The standards act as a reference for nursing staff, managers and commissioners associated with critical care to provide and support safe patient care. The review of the evidence has shown that the contribution of nursing can be difficult to measure and consequently support

  15. The effect of Surgical Care Improvement Project (SCIP) compliance on surgical site infections (SSI). (United States)

    Cataife, Guido; Weinberg, Daniel A; Wong, Hui-Hsing; Kahn, Katherine L


    The Surgical Care Improvement Project (SCIP) has developed a set of process compliance measures in an attempt to reduce the incidence of surgical site infections (SSIs). Previous research has been inconclusive on whether compliance with these measures is associated with lower SSI rates. To determine whether hospitals with higher levels of compliance with SCIP measures have lower incidence of SSIs and to identify the measures that are most likely to drive this association. Analysis of linked SCIP compliance rates and SSIs on 295 hospital groups observed annually over the study period 2007-2010. A hospital group comprises all hospitals sharing identical categories for location by state, teaching status, bed size, and urban/rural location. We used a generalized linear model regression with logistic link and binomial family to estimate the association between 3 SCIP measures and SSI rates. Hospital groups with higher compliance rates had significantly lower SSI rates for 2 SCIP measures: antibiotic timing and appropriate antibiotic selection. For a hospital group of median characteristics, a 10% improvement in the measure provision of antibiotic 1 hour before intervention led to a 5.3% decrease in the SSI rates (PSSI rates, supporting the validity of the 2 publicly available healthcare-associated infection metrics.

  16. Análise crítica dos pacientes cirúrgicos internados na unidade de terapia intensiva Critical analysis of hospital surgical patients in intensive care unit

    Directory of Open Access Journals (Sweden)

    Cristina Sayuri Nakano


    ,1 a 84,9 com média de 38,8; enquanto no grupo dos sobreviventes a média foi de 7,5 Neste estudo foi calculada a Standardized Mortality Rate (SMR razão da mortalidade observada pela predita, que teve como resultado 1,22. CONCLUSÕES: Os pacientes não sobreviventes apresentaram APACHE II significativamente maior que os sobreviventes; maior tempo de internação dos pacientes não sobreviventes em relação aos sobreviventes; a SMR encontrou-se dentro da observada na literatura; não houve diferença estatística em relação ao IMC nos dois grupos.BACKGROUND AND OBJECTIVES: Each intensive care units result has to be observed in the context of medical care, as well as the institution witch it belongs. There are many types of prognostic index in intensive care. The APACHE II was introduced by Knaus et al. in 1985, being a widely used system to evaluate the illness severity in intensive care patients. This objective was evaluated the prognostic index (APACHE II in patients submitted to elective or emergency gastrointestinal surgery admitted to the ICU. METHODS: Medical school intensive care unit. It was collected the following data: age, sex, length of stay, intensive care indication, type of surgery (elective or emergency, body mass index (BMI APACHE II and predicted mortality. RESULTS: A total of 38 patients data were collected during the period of April 2005 to April 2006. Eighteen patients died and twenty survived. The age of the non-survivors varied from 44 to 92 (mean age 66.6; while the age of the survivors varied from 28 to 78 (mean age 59. 1. The BMI of the non-survivors varied from 22 to 29 (mean body mass index 26 while in the other group the mean body mass index was 25. 6. No significant difference was noted in the age and body mass index of both groups. The length of stay varied from 2 to 52 days in the non-survivors group (mean 11.3 days, while in the survivors group varied from 1 to 30 days (mean 4.9. The APACHE II varied from 5 to 32 in the non

  17. The Critical Care Obesity Paradox and Implications for Nutrition Support. (United States)

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


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

  18. Accounting for care: Healthcare Resource Groups for paediatric critical care. (United States)

    Murphy, Janet; Morris, Kevin


    Healthcare Resource Groups are a way of grouping patients in relation to the amount of healthcare resources they consume. They are the basis for implementation of Payment by Results by the Department of Health in England. An expert working group was set up to define a dataset for paediatric critical care that would in turn support the derivation of Healthcare Resource Groups. Three relevant classification systems were identified and tested with data from ten PICUs, including data about diagnoses, number of organ systems supported, interventions and nursing activity. Each PICU provided detailed costing for the financial year 2005/2006. Eighty-three per cent of PICU costs were found to be related to staff costs, with the largest cost being nursing costs. The Nursing Activity Score system was found to be a poor predictor of staff resource use, as was the adult HRG model based on the number of organ systems supported. It was decided to develop the HRGs based on a 'levels of care' approach; 32 data items were defined to support HRG allocation. From October 2007, data have been collected daily to identify the HRGs for each PICU patient and are being used by the Department of Health to estimate reference costs for PICU services. The data can also be used to support improved audit of PICU activity nationally as well as comparison of workload across different units and modelling of staff requirements within a unit.

  19. February 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA


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

  20. July 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA


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

  1. Physical Restraint in Critical Care Settings: Will They Go Away? (United States)

    Mion, Lorraine C.


    The critical care setting is perhaps the last major health care setting in which physical restraint remains a common, and oftentimes unquestioned, practice. This is despite the numerous regulations and accrediting standards that have limited or even eliminated practitioners’ use of physical restraints in other health care settings. The decision to use physical restraint in the care of critically ill patients can be complex and is influenced by characteristics of the patient, the practitioner, and the environment. What do we know about physical restraint practice in critical care settings, and what steps must we take if we are, indeed, to become “restraint-free” environments? PMID:19064141

  2. Burnout in critical care nurses: a literature review. (United States)

    Epp, Kirstin


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

  3. [The development of strategic management of high-tech surgical medical care]. (United States)

    Nechaev, V S; Krasnov, A V


    The high-tech surgical medical care is one of the most effective types of medical care in Russia. However high-tech surgical treatment very often is inaccessible for patients. The development of basics of strategic management of high-tech surgical care makes it possible to enhance availability of this type of care and to shorten the gap between volumes of rendered care and population needs. This approach can be resulted in decrease of disability and mortality of the most prevalent diseases of cardio-vascular diseases, malignant neoplasms, etc. The prerequisites can be developed to enhance life quality and increase longevity of population.

  4. Spiritual Experiences of Muslim Critical Care Nurses. (United States)

    Bakir, Ercan; Samancioglu, Sevgin; Kilic, Serap Parlar


    The purpose of this study was to determine the experiences and perceptions of intensive care nurses (ICNs) about spirituality and spiritual care, as well as the effective factors, and increase the sensitivity to the subject. In this study, we examined spiritual experiences, using McSherry et al. (Int J Nurs Stud 39:723-734, 2002) Spirituality and spiritual care rating scale (SSCRS), among 145 ICNs. 44.8% of the nurses stated that they received spiritual care training and 64.1% provided spiritual care to their patients. ICNs had a total score average of 57.62 ± 12.00 in SSCRS. As a consequence, it was determined that intensive care nurses participating in the study had insufficient knowledge about spirituality and spiritual care, but only the nurses with sufficient knowledge provided the spiritual care to their patients.

  5. Surgical patients travel longer distances than non-surgical patients to receive care at a rural hospital in Mozambique. (United States)

    Faierman, Michelle L; Anderson, Jamie E; Assane, Americo; Bendix, Peter; Vaz, Fernando; Rose, John A; Funzamo, Carlos; Bickler, Stephen W; Noormahomed, Emilia V


    Surgical care is increasingly recognised as an important component of global health delivery. However, there are still major gaps in knowledge related to access to surgical care in low-income countries. In this study, we compare distances travelled by surgical patients with patients seeking other medical services at a first-level hospital in rural Mozambique. Data were collected on all inpatients at Hospital Rural de Chókwè in rural Mozambique between 20 June 2012 and 3 August 2012. Euclidean distances travelled by surgical versus non-surgical patients using coordinates of each patient's city of residence were compared. Data were analysed using ArcGIS 10 and STATA. In total, 500 patients were included. Almost one-half (47.6%) lived in the city where the hospital is based. By hospital ward, the majority (62.0%) of maternity patients came from within the hospital's city compared with only 35.2% of surgical patients. The average distance travelled was longest for surgical patients (42 km) compared with an average of 17 km for patients on all other wards. Patients seeking surgical care at this first-level hospital travel farther than patients seeking other services. While other patients may have access to at community clinics, surgical patients depend more heavily on the services available at first-level hospitals. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail:

  6. An evaluation of inpatient morbidity and critical care provision in Zambia. (United States)

    Dart, P J; Kinnear, J; Bould, M D; Mwansa, S L; Rakhda, Z; Snell, D


    The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48-h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One-hundred and twenty medical and surgical admissions were studied. Fifty-four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, according to the Royal College of Physicians (UK) guidelines. A greater than expected HIV rate was also noted; 53 of 75 tested patients (71%). When applied to the estimated 17,496 annual acute admissions, this would equate to 7873 patients requiring critical care input annually at this hospital alone. In contrast to this demand, we identified 109 critical care beds nationally, and only eight at this institution.

  7. Mortality risk factors in critical post-surgical patients treated using continuous renal replacement techniques. (United States)

    Estupiñán-Jiménez, J C; Castro-Rincón, J M; González, O; Lora, D; López, E; Pérez-Cerdà, F


    To determine the influence of demographics, medical, and surgical variables on 30-day mortality in patients who need continuous renal replacement therapy (CRRT). A retrospective-following study was conducted using the data of 112 patients admitted to the postoperative intensive care unit who required CRRT, between August 2006 and August 2011, and followed-up for 30 days. The following information was collected: age, gender, history of HBP, DM, cardiovascular disease, and CKD, urgent surgery, surgical speciality, organic dysfunction according to the SOFA scale, the number of organs with dysfunction, use of mechanical ventilation, diagnostic and origin of sepsis, type of CRRT, and 30-day mortality. General linear models were used for estimating the strength of association (relative risk [RR], and 95% confidence interval [CI] between variables and 30-day mortality. In the univariant analysis, the following variables were identified as risk factors for 30-day mortality: age (RR 1.04; 95% CI 1.01-1.06; P=.0005), and history of cardiovascular disease (RR 1.57; 95% CI 1.02-2.41; P=.039). Among the variables included in the multivariable analysis (age, history of cardiovascular disease, sepsis, and number of organs with dysfunction), only age was identified as an independent risk factor for 30-day mortality (RR 1.03; 95% CI 1.00-1.05; P=.007). Thirty-day mortality in postoperative, critically ill patients who require CRRT is high (41.07%). Age has been identified as an independent risk factor, with renal failure as the most common indication for the use of these therapies. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Critical Caring for People and Place (United States)

    Schindel, Alexandra; Tolbert, Sara


    What role does caring play in environmental education? The development of caring relationships in formal school settings remains a foundational yet underexamined concept in environmental education research. This study examines the role of caring relationships between people and place in an urban high school in the United States. We draw upon…

  9. Nursing practice models for acute and critical care: overview of care delivery models. (United States)

    Shirey, Maria R


    This article provides a historical overview of nursing models of care for acute and critical care based on currently available literature. Models of care are defined and their advantages and disadvantages presented. The distinctive differences between care delivery models and professional practice models are explained. The historical overview of care delivery models provides a foundation for the introduction of best practice models that will shape the environment for acute and critical care in the future.

  10. [The organization of surgical care in Russian army during 1812 Great Patriotic War]. (United States)

    Gliantsev, S P


    The article considers the characteristics of surgical care to warriors of Russian army during 1812 Great Patriotic War. Such conditions are analyzed as damaging action of French weapons, types of combat wounds, organization and forces of military sanitary service of Russian troops, surgeons' support with means of supplying surgical care to the wounded and arsenal of surgical aids. On the basis of given materials analysis a preliminary conclusion is made that surgical care in Russian army in 1812 not only was on the sufficiently high level but it played a specified role in the victory of Russian weapon.

  11. Enhancing critical thinking in clinical practice: implications for critical and acute care nurses. (United States)

    Shoulders, Bridget; Follett, Corrinne; Eason, Joyce


    The complexity of patients in the critical and acute care settings requires that nurses be skilled in early recognition and management of rapid changes in patient condition. The interpretation and response to these events can greatly impact patient outcomes. Nurses caring for these complex patients are expected to use astute critical thinking in their decision making. The purposes of this article were to explore the concept of critical thinking and provide practical strategies to enhance critical thinking in the critical and acute care environment.

  12. The Evolution of Critical Care Nephrology in Edmonton. (United States)

    Bagshaw, Sean M; Gibney, R T Noel


    The University of Alberta (UofA) in Edmonton, Canada has a rich and productive history supporting the development of critical care medicine, nephrology and the evolving subspecialty of critical care nephrology. The first hemodialysis program for patients with chronic renal failure in Canada was developed at the University of Alberta Hospital. The UofA is also recognized for its early pioneering work on the diagnosis, etiology and outcomes associated with acute kidney injury (AKI), the development of a diagnostic scheme renal allograft rejection (Banff classification), and contributions to the Renal Disaster Relief Task Force. Edmonton was one of the first centers in Canada to provide continuous renal replacement therapy. This has grown into a comprehensive clinical, educational and research center for critical care nephrology. Critical care medicine in Edmonton now leads and participates in numerous critical care nephrology initiatives dedicated to AKI, renal replacement therapy, renal support in solid organ transplantation, and extracorporeal blood purification. Critical care medicine in Edmonton is recognized across Canada and across the globe as a leading center of excellence in critical care nephrology, as an epicenter for research innovation and for training a new generation of clinicians with critical care nephrology expertise.

  13. Patient Outcomes of an International Telepediatric Cardiac Critical Care Program (United States)

    Otero, Andrea Victoria; Welchering, Nils; Bermon, Anderson; Castillo, Victor; Duran, Álvaro; Castro, Javier; Muñoz, Ricardo


    Abstract Background: An optimal model for telemedicine use in the international care setting has not been established. Our objective was to describe variables associated with patient outcome during the implementation of an international pediatric cardiac critical care (PCCC) telemedicine program. Materials and Methods: A retrospective review was performed of clinical records and a telemedicine database of patients admitted to the cardiac intensive care unit (CICU) at the Fundacion Cardiovascular de Colombia, Bucaramanga, Colombia, during the initial 10 months of our program, compared with patients admitted during a previous period. Information collected included demographic data, cardiac diagnosis and associated factors, Risk Adjustment for Congenital Heart Surgery (RACHS)-1 classification, and perioperative events. Primary outcome was composed of CICU and hospital mortality. Secondary outcomes were CICU and hospital length of stay (LOS). Results: Of the 553 patients who were included, teleconsultation was done for 71 (12.4%), with a total of 156 encounters, including 19 for patients on extracorporeal membrane oxygenation. Three hundred twenty-one recommendations were given, and 42 real-time interventions were documented. RACHS-1 distribution was similar between study periods (p=0.427). Teleconsulted patients were significantly younger (44 versus 24 months; p=0.03) and had higher surgical complexity than nonteleconsulted patients (p=0.01). RACHS-1 adjusted hospital survival was similar between study periods. CICU and hospital LOS intervals were significantly shorter in the telemedicine period (10 versus 17 days [p=0.02] and 22 versus 28 days [p<0.001]). In surgical cases, preoperative CICU LOS was significantly shorter (3 versus 6 days; p<0.001). Variables associated with hospital mortality were higher RACHS-1 categories, lower weight, bypass time longer than 150 min, and use of circulatory arrest, as well as the presence of sepsis or necrotizing enterocolitis

  14. Current approach to burn critical care. (United States)

    Sakallioglu, A E; Haberal, M


    Burn trauma is a frequent cause of morbidity and mortality all over the world. Advancements in resuscitation, surgical tecniques, infection control and nutritional/metaolic support decreased mortality and morbidity. This article intends to review current outlines for initial treatment and resuscitation nutritional/metabolic support and wound management peculiar to burn patients.

  15. Critical care clinical trials: getting off the roller coaster. (United States)

    Goodwin, Andrew J


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

  16. Should critical care nurses be ACLS-trained? (United States)

    Hagyard-Wiebe, Tammy


    The aim of resuscitation is to sustain life with intact neurological functioning and the same quality of life previously experienced by the patient. Advanced cardiac life support (ACLS) was designed to achieve this aim. However the requirement for ACLS training for critical care nurses working in Canadian critical care units is inconsistent across the country. The purposes of this article are to explore the evidence surrounding ACLS training for critical care nurses and its impact on resuscitation outcomes, and to review the evidence surrounding ACLS knowledge and skill degradation with strategies to support code blue team efficiency for an effective resuscitation. Using the search terms ACLS training, resuscitation, critical care, and nursing, two databases, CINAHL and MEDLINE, were used. The evidence supports the need for ACLS training for critical care nurses. The evidence also supports organized ongoing refresher courses, multidisciplinary mock code blue practice using technologically advanced simulator mannequins, and videotaped reviews to prevent knowledge and skill degradation for effective resuscitation efforts.

  17. Web-based resources for critical care education. (United States)

    Kleinpell, Ruth; Ely, E Wesley; Williams, Ged; Liolios, Antonios; Ward, Nicholas; Tisherman, Samuel A


    To identify, catalog, and critically evaluate Web-based resources for critical care education. A multilevel search strategy was utilized. Literature searches were conducted (from 1996 to September 30, 2010) using OVID-MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature with the terms "Web-based learning," "computer-assisted instruction," "e-learning," "critical care," "tutorials," "continuing education," "virtual learning," and "Web-based education." The Web sites of relevant critical care organizations (American College of Chest Physicians, American Society of Anesthesiologists, American Thoracic Society, European Society of Intensive Care Medicine, Society of Critical Care Medicine, World Federation of Societies of Intensive and Critical Care Medicine, American Association of Critical Care Nurses, and World Federation of Critical Care Nurses) were reviewed for the availability of e-learning resources. Finally, Internet searches and e-mail queries to critical care medicine fellowship program directors and members of national and international acute/critical care listserves were conducted to 1) identify the use of and 2) review and critique Web-based resources for critical care education. To ensure credibility of Web site information, Web sites were reviewed by three independent reviewers on the basis of the criteria of authority, objectivity, authenticity, accuracy, timeliness, relevance, and efficiency in conjunction with suggested formats for evaluating Web sites in the medical literature. Literature searches using OVID-MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature resulted in >250 citations. Those pertinent to critical care provide examples of the integration of e-learning techniques, the development of specific resources, reports of the use of types of e-learning, including interactive tutorials, case studies, and simulation, and reports of student or learner satisfaction, among other general

  18. Reiki therapy: a nursing intervention for critical care. (United States)

    Toms, Robin


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

  19. Accountable primary care a critical investment. (United States)

    Halley, Marc D; Anderson, Peter


    Primary care physicians today can be expected to capture between 2,000 and 5,000 active patients who consider that physician to be "my physician." The geographic location of primary care physicians affects the payer mix of the hospital and its affiliated subspecialists. Hospital and health system CFOs would be wise to advocate investment in primary care physicians to secure market share. They should also develop compensation plans with a value-volume balance and establish ways to actively manage referrals.

  20. Personal reflection: death brokering for critical care nurses. (United States)

    Bajer, Lorena


    End-of-life care and the dying patient have been an area lightly covered in my nursing school experience. While I expected the topics to surface in more detail in conjunction with the critical care nursing unit, this was not the case. This article is a personal reflection on my experience in critical care nursing and the deficits involving death and dying education in both institutional and professional settings.

  1. The factors influencing burnout and job satisfaction among critical care nurses: a study of Saudi critical care nurses. (United States)

    Alharbi, Jalal; Wilson, Rhonda; Woods, Cindy; Usher, Kim


    The aim of the study was to explore the prevalence of burnout and job satisfaction among Saudi national critical care nurses. Burnout is caused by a number of factors, including personal, organisational and professional issues. Previous literature reports a strong relationship between burnout and job satisfaction among critical care nurses. Little is known about this phenomenon among Saudi national critical care nurses. A convenience sample of 150 Saudi national critical care nurses from three hospitals in Hail, Saudi Arabia were included in a cross-sectional survey. Saudi national critical care registered nurses reported moderate to high levels of burnout in the areas of emotional exhaustion and depersonalisation. Participants also reported a feeling of ambivalence and dissatisfaction with their jobs but were satisfied with the nature of their work. Saudi national critical care nurses experience moderate to high levels of burnout and low levels of job satisfaction. Burnout is a predictor of job satisfaction for Saudi national critical care nurses. These results provide clear evidence of the need for nurse managers and policy makers to devise strategies to help nurses better cope with a stressful work environment, thereby also improving job satisfaction among Saudi national critical care nurses. © 2016 John Wiley & Sons Ltd.

  2. Diversity in the Emerging Critical Care Workforce: Analysis of Demographic Trends in Critical Care Fellows From 2004 to 2014. (United States)

    Lane-Fall, Meghan B; Miano, Todd A; Aysola, Jaya; Augoustides, John G T


    Diversity in the physician workforce is essential to providing culturally effective care. In critical care, despite the high stakes and frequency with which cultural concerns arise, it is unknown whether physician diversity reflects that of critically ill patients. We sought to characterize demographic trends in critical care fellows, who represent the emerging intensivist workforce. We used published data to create logistic regression models comparing annual trends in the representation of women and racial/ethnic groups across critical care fellowship types. United States Accreditation Council on Graduate Medical Education-approved residency and fellowship training programs. Residents and fellows employed by Accreditation Council on Graduate Medical Education-accredited training programs from 2004 to 2014. None. From 2004 to 2014, the number of critical care fellows increased annually, up 54.1% from 1,606 in 2004-2005 to 2,475 in 2013-2014. The proportion of female critical care fellows increased from 29.5% (2004-2005) to 38.3% (2013-2014) (p workforce reflect underrepresentation of women and racial/ethnic minorities. Trends highlight increases in women and Hispanics and stable or decreasing representation of non-Hispanic underrepresented minority critical care fellows. Further research is needed to elucidate the reasons underlying persistent underrepresentation of racial and ethnic minorities in critical care fellowship programs.

  3. Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care? (United States)

    Friedman, James M; Hagander, Lars; Hughes, Christopher D; Nash, Katherine A; Linden, Allison F; Blossom, Jeff; Meara, John G


    An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti. We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care. The highest annual surgical utilization rate was 184 operations/100,000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (rs = -0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care. Copyright © 2012 John Wiley & Sons, Ltd.

  4. Selective decontamination of the oral and digestive tract in surgical versus non-surgical patients in intensive care in a cluster-randomized trial.

    NARCIS (Netherlands)

    Melsen, W.G.; Smet, A.M. de; Kluytmans, J.A.; Bonten, M.J.; Pickkers, P.


    BACKGROUND: Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) are effective in improving survival in patients under intensive care. In this study possible differential effects in surgical and non-surgical patients were investigated. METHODS: This was a post

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

    Directory of Open Access Journals (Sweden)

    Castro Maria A


    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

  6. Critical care in resource-poor settings: lessons learned and future directions. (United States)

    Riviello, Elisabeth D; Letchford, Stephen; Achieng, Loice; Newton, Mark W


    Critical care faces the same challenges as other aspects of healthcare in the developing world. However, critical care faces an additional challenge in that it has often been deemed too costly or complicated for resource-poor settings. This lack of prioritization is not justified. Hospital care for the sickest patients affects overall mortality, and public health interventions depend on community confidence in healthcare to ensure participation and adherence. Some of the most effective critical care interventions, including rapid fluid resuscitation, early antibiotics, and patient monitoring, are relatively inexpensive. Although cost-effectiveness studies on critical care in resource-poor settings have not been done, evidence from the surgical literature suggests that even resource-intensive interventions can be cost effective in comparison to immunizations and human immunodeficiency virus care. In the developing world, where many critically ill patients are younger and have fewer comorbidities, critical care presents a remarkable opportunity to provide significant incremental benefit, arguably much more so than in the developed world. Key areas of consideration in developing critical care in resource-poor settings include: Personnel and training, equipment and support services, ethics, and research. Strategies for training and retaining skilled labor include tying education to service commitment and developing protocols for even complex processes. Equipment and support services need to focus on technologies that are affordable and sustainable. Ethical decision making must be based on data when possible and on transparent articulated policies always. Research should be performed in resource-poor settings and focus on needs assessment, prognostication, and cost effectiveness. The development of critical care in resource-poor settings will rely on the stepwise introduction of service improvements, leveraging human resources through training, a focus on sustainable

  7. Necrotizing fasciitis: A decade of surgical intensive care experience


    Shaikh Nissar


    Necrotizing fasciitis is a rare disease, potentially limb and life-threatening infection of fascia, subcutaneous tissue with occasionally muscular involvement. Necrotizing faciitis is surgical emergency with high morbidity and mortality. Aim: Aim of this study was to analyze presentation, microbiology, surgical, resuscitative management and outcome of this devastating soft tissue infection. Materials and Methods: The medical records of necrotizing fasciitis patients treated in surgical in...

  8. Surgical Exposure Trends and Controversies in Extremity Fracture Care. (United States)

    Kottmeier, Stephen A; Row, Elliot; Tornetta, Paul; Jones, Clifford B; Lorich, Dean G; Watson, J Tracy


    Surgical exposures for the management of extremity fractures continue to evolve. Strategies to achieve satisfactory articular reconstitution require surgeons to have an appreciation and understanding of various conventional and contemporary surgical approaches. The recent literature has witnessed a surge in studies on surgical approaches for the fixation of extremity fractures. This increased interest in surgical exposures resulted from not only a desire to enhance outcomes and minimize complications but also a recognition of the inadequacies of traditionally accepted surgical exposures. Contemporary exposures may be modifications or combinations of existing exposures. All surgical exposures require proper surgical execution and familiarity with regional anatomic structures. Exposures, whether conventional or contemporary, must provide sufficient access for reduction and implant insertion. Proper exposure selection can greatly enhance a surgeon's ability to achieve acceptable reduction and adequate fixation. Unique characteristics of both the patient and his or her fracture pathoanatomy may dictate the surgical approach. Patient positioning, imaging access, and concomitant comorbidities (medical, systemic trauma, and regional extremity related) also must be considered. Minimally invasive methods of reduction and fixation are attractive and have merit; however, adherence to them while failing to achieve satisfactory reduction and fixation will not generate a desirable outcome. Surgeons should be aware of several site-specific anatomic regions in which evolving surgical exposures and strategies for extremity fracture management have had favorable outcomes.

  9. Critical care in acute ischemic stroke. (United States)

    McDermott, M; Jacobs, T; Morgenstern, L


    Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics. In this chapter, we discuss aspects of acute ischemic stroke care that are of particular relevance to a neurointensivist, covering neuropathology, neurodiagnostics and imaging, blood pressure management, glycemic control, temperature management, and the selection and timing of antithrombotics. We also focus on the care of patients who have received intravenous thrombolysis or mechanical thrombectomy. Complex clinical decision making in decompressive hemicraniectomy for hemispheric infarction and urgent management of basilar artery thrombosis are specifically addressed. © 2017 Elsevier B.V. All rights reserved.

  10. Critical care: Are we customer friendly? (United States)

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


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

  11. The Certified Clinical Nurse Leader in Critical Care. (United States)

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


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

  12. Risk factors for aminoglycoside-associated nephrotoxicity in surgical intensive care unit patients (United States)

    Gerlach, Anthony T; Stawicki, Stanislaw P; Cook, Charles H; Murphy, Claire


    Background: Aminoglycosides are commonly used antibiotics in the intensive care unit (ICU), but are associated with nephrotoxicity. This study evaluated the development of aminoglycoside-associated nephrotoxicity (AAN) in a single surgical intensive care unit. Materials and Methods: Adult patients in our surgical ICU who received more than two doses of aminoglycosides were retrospectively reviewed for demographics, serum creatinine, receipt of nephrotoxins [angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers, diuretics, non-steroidal anti-inflammatory drugs, cyclosporine, tacrolimus, vasopressors, vancomycin and intravenous iodinated contrast] and the need for dialysis. AAN was defined as an increase in serum creatinine >0.5 mg/dL on at least 2 consecutive days. Univariate and multiple regression analyses were performed. Results: Sixty-one patients (43 males) receiving aminoglycoside were evaluated. Mean age, weight, initial serum creatinine, and duration of aminoglycoside therapy were 58.7 (±15) years, 83.3 (±24.4) kg, 0.9 (±0.5) mg/dL, and 4 (±2.3) days, respectively. Thirty-one (51%) aminoglycoside recipients also received additional nephrotoxins. Seven aminoglycoside recipients (11.5%) developed AAN, four of whom required dialysis and all had received additional nephrotoxins. Only concurrent use of vasopressors (P = 0.041) and vancomycin (P = 0.002) were statistically associated with AAN. Receipt of vasopressors or vancomycin were independent predictors of acute kidney insufficiency (AKI) with odds ratios of 19.9 (95% CI: 1.6–245, P = 0.019) and 49.8 (95% CI: 4.1–602, P = 0.002), respectively. Four patients (6.6%) required dialysis. Conclusions: In critically ill surgical patients receiving aminoglycosides, AAN occurred in 11.5% of the patients. Concurrent use of aminoglycosides with other nephrotoxins increased the risk of AAN. PMID:22096769

  13. Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala. (United States)

    Roche, Stephanie; Hall-Clifford, Rachel


    Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.

  14. Perceived role of the journal clubs in teaching critical appraisal skills: A survey of surgical trainees in Nigeria

    Directory of Open Access Journals (Sweden)

    Abdulrasheed Ibrahim


    Full Text Available Background: Critical appraisal skills allow surgeons to evaluate the literature in an objective and structured manner, with emphasis on the validity of the evidence. The development of skills in critical acquisition and appraisal of the literature is crucial to delivering quality surgical care. It is also widely accepted that journal clubs are a time-honored educational paradigm for teaching and development of critical appraisal skills. The aim of this study is to determine the perceived role of journal clubs in teaching critical appraisal skills amongst the surgical trainees in Nigeria. Materials and Methods: The West African College of Surgeons and the National Postgraduate College of Nigeria have mandated that all residency programs teach and assess the ability to develop critical appraisal skills when reviewing the scientific literature. Residents at the revision course of the West African College of Surgeons in September 2012 evaluated the role of journal clubs in teaching critical appraisal skills using a 17-item questionnaire. The questionnaire addressed four areas: Format, teaching and development of critical appraisal s kills, and evaluation. Results: Most of the journal clubs meet weekly [39 (59%] or monthly [25 (38%]. Thirty-nine residents (59% perceived the teaching model employed in the development of critical appraisal skills in their institutions was best characterized by "discussion/summary by consultants" and "emphasis on formal suggestion for improvement in research." Rating the importance of development of critical appraisal skills to the objectives of the residency program and practice of evidence-based medicine, majority of the residents [65 (98%] felt it was "very important." The commonest form of feedback was verbal from the consultants and residents [50 (76%]. Conclusion: The perceived importance of journal clubs to the development of critical appraisal skills was rated as very important by the residents. However

  15. Critical incident stress debriefing in health care. (United States)

    Freehill, K M


    Transport team professionals have unique responsibilities and are exposed to powerful demands. They cannot avoid incidents that pose personal threats to their own emotional well being. Contact with dead or severely ill or injured children, for example, can be detrimental to the caregiver. Discussions called debriefings held after these critical incidents can decrease acute and delayed stress reactions.

  16. Attitude and Practices of Sedation amongst Critical Care Nurses ...

    African Journals Online (AJOL)

    Attitude and Practices of Sedation amongst Critical Care Nurses Working in a ... a standardized approach towards sedation management as very important. ... pharmacological agents (75%) had less than five years work experience in the ICU.

  17. Cost of critical care in South Africa

    African Journals Online (AJOL)

    Respiratory Intensive Care Unit, Groote Schuur Hospital, Cape Town. P. D. Potgieter, M.B. CH.B., F.FA .... CVP =central venous pressure. Cost/procedure (R) .... in the processing of samples greatly increases the yield!4. Areas where the high ...

  18. Physiotherapy in Critical Care in Australia



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

  19. Critical care: Are we customer friendly? (United States)

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


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

  20. Critical care: Are we customer friendly?

    Directory of Open Access Journals (Sweden)

    Ramesh Venkataraman


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

  1. Critical care: how should we evaluate our progress? (United States)

    Civetta, J M


    Review of the history and accomplishments of the Society of Critical Care Medicine (SCCM) to determine appropriate directions for the future. Historical documents of the SCCM, Critical Care Medicine, bioethics and healthcare financing literature, Instant Library of Quotations. Identified (by the author) material containing specific statements concerning goals and objectives at the time of the founding of the SCCM and at intervals. Material supporting and criticizing predictive indices were identified and bioethical treatises concerning patient autonomy and quality-of-life decisions were chosen. Presidential addresses of the first three SCCM presidents, material relevant to preservation of life and alleviation of suffering from bioethical and healthcare financing perspectives. Relevant quotations. Initial goals and objectives were identified. Societal and economic factors changing critical care were analyzed for their effect on current and future SCCM directions and objectives. The founding members set important goals for critical care and patient care, research, education, and organization. From a perspective of what was foreseeable, these goals have been accomplished to an admirable degree. The SCCM has responded to these goals by providing educational programs and fostering research, especially in its annual meetings and through the publication of guidelines in Critical Care Medicine. The SCCM members would do well to read the first three presidential addresses to experience the eloquence and foresight firsthand, particularly with respect to the founders' spirit, considerations of training, scope of care, humanism, organization and relations within and outside of critical care, integration of care, and development of the scientific process at the bedside. There have been major changes in society since the SCCM was founded: the maturation of the concept of patient's autonomy; recognition of quality-of-life values; healthcare financing; and legal and ethical

  2. Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review (United States)

    Dellefield, Mary Ellen


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

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

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


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

  4. March 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Stander P


    Full Text Available No abstract available. Article truncated at 150 words. Brill S. Bitter Pill: Why Medical Bills Are Killing Us. Time. February 20, 2013. PDF available at: (accessed 4/2/13. Editor’s Note: We had a special journal club in March. First, we reviewed an article from Time magazine rather than a traditional medical journal. Second, Paul Stander MD, the chief medical officer at Banner Good Samaritan Regional Medical Center, led the discussion and agreed to author the journal club. This seemed appropriate since much of the article focuses on overbilling and administrative costs of care. The recent lengthy cover story article in Time Magazine described in great deal what many of us practicing physicians have realized for a long time – our health care system is highly dysfunctional and much of that dysfunction is a result of an arcane and outmoded financing mechanism. This payment system has a litany of perverse incentives that encourage wasteful and often ineffective care while not …

  5. Optimization of care for the pediatric surgical patient: Why now? (United States)

    Arca, Marjorie J; Goldin, Adam B; Oldham, Keith T


    In 2015, the American College of Surgeons (ACS) has begun to verify hospitals and ambulatory centers which meet consensus based optimal resource standards as "Children׳s Surgical Centers." The intent is to identify children-specific resources available within an institution and using a stratification system similar to the ACS Trauma Program match these to the needs of infants and children with surgical problems. This review briefly summarizes the history, supporting data and processes which drove this initiative.

  6. The low therapeutic efficacy of postoperative chest radiographs for surgical intensive care unit patients

    NARCIS (Netherlands)

    A. Kröner; E. van Iperen; J. Horn; J.M. Binnekade; P.E. Spronk; J. Stoker; M.J. Schultz


    Background. The clinical value of postoperative chest radiographs (CXRs) for surgical intensive care unit (ICU) patients is largely unknown. In the present study, we determined the diagnostic and therapeutic efficacy of postoperative CXRs for different surgical subgroups and related their efficacy t

  7. Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Zijlstra Felix


    Full Text Available Abstract Background Tight glucose control by intensive insulin therapy has become a key part of critical care and is an important field of study in acute coronary care. A balance has to be found between frequency of measurements and the risk of hypoglycemia. Current nurse-driven protocols are paper-based and, therefore, rely on simple rules. For safety and efficiency a computer decision support system that employs complex logic may be superior to paper protocols. Methods We designed and implemented GRIP, a stand-alone Java computer program. Our implementation of GRIP will be released as free software. Blood glucose values measured by a point-of-care analyzer were automatically retrieved from the central laboratory database. Additional clinical information was asked from the nurse and the program subsequently advised a new insulin pump rate and glucose sampling interval. Results Implementation of the computer program was uneventful and successful. GRIP treated 179 patients for a total of 957 patient-days. Severe hypoglycemia ( Conclusion A computer driven protocol is a safe and effective means of glucose control at a surgical ICU. Future improvements in the recommendation algorithm may further improve safety and efficiency.

  8. The human factor: the critical importance of effective teamwork and communication in providing safe care. (United States)

    Leonard, M; Graham, S; Bonacum, D


    Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

  9. Basic Shock Physiology and Critical Care. (United States)

    Roberts, Brian K


    Veterinarians practicing emergency medicine and/or working with exotic animals must be well versed in the pathophysiology of shock because many exotic pets present with an acute crisis or an acute manifestation of a chronic process causing poor organ perfusion. This article discusses the pathophysiology of shock and the systemic inflammatory response syndrome, which may lead to organ dysfunction, organ failure, sepsis, and death. The physiology of perfusion, perfusion measurements, categories of shock, and altered function of the immune system, gastrointestinal barrier, and coagulation system are discussed. Veterinarians providing emergency care to patients with shock must also be aware of comorbidities. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. May 2016 Phoenix critical care journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA


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

  11. Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality. (United States)

    Anderson, Cheryl I; Nelson, Catherine S; Graham, Corey F; Mosher, Benjamin D; Gohil, Kartik N; Morrison, Chet A; Schneider, Paul D; Kepros, John P


    Performance improvement driven by the review of surgical morbidity and mortality is often limited to critiques of individual cases with a focus on individual errors. Little attention has been given to an analysis of why a decision seemed right at the time or to lower-level root causes. The application of scientific performance improvement has the potential to bring to light deeper levels of understanding of surgical decision-making, care processes, and physician psychology. A comprehensive retrospective chart review of previously discussed morbidity and mortality cases was performed with an attempt to identify areas where we could better understand or influence behavior or systems. We avoided focusing on traditional sources of human error such as lapses of vigilance or memory. An iterative process was used to refine the practical areas for possible intervention. Definitions were then created for the major categories and subcategories. Of a sample of 152 presented cases, the root cause for 96 (63%) patient-related events was identified as uni-factorial in origin, with 51 (34%) cases strictly related to patient disease with no other contributing causes. Fifty-six cases (37%) had multiple causes. The remaining 101 cases (66%) were categorized into two areas where the ability to influence outcomes appeared possible. Technical issues were found in 27 (18%) of these cases and 74 (74%) were related to disorganized care problems. Of the 74 cases identified with disorganized care, 42 (42%) were related to failures in critical thinking, 18 (18%) to undisciplined treatment strategies, 8 (8%) to structural failures, and 6 (6%) were related to failures in situational awareness. On a comprehensive review of cases presented at the morbidity and mortality conference, disorganized care played a large role in the cases presented and may have implications for future curriculum changes. The failure to think critically, to deliver disciplined treatment strategies, to recognize

  12. The emotional intelligence of registered nurses commencing critical care nursing

    Directory of Open Access Journals (Sweden)

    Yvette Nagel


    Full Text Available Background: Critical care is described as complex, detailed healthcare in a unique, technologically rich environment. Critical care nursing requires a strong knowledge base and exceptional clinical and technological skills to cope in this demanding environment. Many registered nurses (RNs commencing work in these areas may lack resilience, and because of the stress of the critical care environment, coping mechanisms need to be developed. To prevent burnout and to enable critical care nurses to function holistically, emotional intelligence (EI is essential in the development of such coping mechanisms.Objective: The aim of this study was to describe the EI of RNs commencing work in critical care units in a private hospital group in Gauteng, South Africa.Method: The design used for this study was a quantitative descriptive survey. The target population were RNs commencing work in critical care units. Data were collected from RNs using the Trait Emotional Intelligence Questionnaire – Short Form and analysed using the Statistical Package for the Social Sciences software.Results: The sample (n = 30 had a mean age of 32 years. Most of the participants (63% qualified through the completion of a bridging course between 2010 and 2012. The majority (62% of the sample had less than 2 years’ experience as RNs.Conclusion: The EI of RNs commencing work in a critical care environment was indicative of a higher range of Global EI, with the well-being factor scoring the highest, followed by the emotionality factor, then self-control, with the sociability factor scoring the lowest.

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

    Directory of Open Access Journals (Sweden)

    Peter Stehle


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

  14. Glutamine: An Obligatory Parenteral Nutrition Substrate in Critical Care Therapy (United States)

    Stehle, Peter; Kuhn, Katharina S.


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

  15. An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action. (United States)

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


    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  16. New media and critical care ultrasound

    Directory of Open Access Journals (Sweden)

    Michał Pawlak


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

  17. November 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA


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

  18. [Burnout's syndrome in critical care nursing professionals]. (United States)

    Solano Ruiz, Ma C; Hernández Vidal, P; Vizcaya Moreno, Ma F; Reig Ferrer, A


    The concept of the "Burnout Syndrome" has come as a result of the chronic work-stress developed in workers involved in human services during their professional activity. The working conditions and the specific characteristics of the job developed at the Intensive Care Units by the nursing staff, involve a high risk for this group to acquire this syndrome. The main objective of this study is to assess the prevalence of the Burnout Syndrome in the nursing staff of the ICUs in different hospitals of the Alicante province, Spain, by means of the Malsach Burnout Inventory questionnaire. This questionnaire is self-administered and was handed to all the nursing staff at the ICUs in the University Hospitals of Alicante and Elche and in the Hospital Marina Baixa of Villajoyosa. form the total of 107 questionnaires, 83 proved to be valid. The average total of MBI was of 55.05, indicating low values of emotional tiredness, low depersonalisation, and an adequate level of personal accomplishment.

  19. Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study. (United States)

    Exarchopoulos, Themistocles; Charitidou, Efstratia; Dedeilias, Panagiotis; Charitos, Christos; Routsi, Christina


    Most scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients. To compare the predictive ability of the most widely used scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Sequential Organ Failure Assessment [SOFA]) and of 2 specialized systems (European System for Cardiac Operative Risk Evaluation [EuroSCORE] II and the cardiac surgery score [CASUS]) for clinical outcome in patients after cardiac surgery. Consecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severity-scoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity. A total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, χ(2) = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ= 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU). CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients. ©2015 American Association of Critical-Care Nurses.

  20. Profile of Congenital Surgical Anomalies in Neonates Admitted to Tertiary Care Neonatal Intensive Care Unit of Saurashtra Region

    Directory of Open Access Journals (Sweden)

    Zalak Shah


    Full Text Available Background: Congenital surgical anomaly is a major indication for admission of a neonate to an intensive care unit. Profile of surgical conditions is variable by system affecting the neonate and outcomes of the individual conditions depending upon treatment and post surgical facilities. This study was undertaken to highlight the surgical conditions, their burden and their prognosis encountered in our newborn care unit. Methodology: This study is a cross sectional study. All information was collected from the case records of all neonates admitted in newborn care unit of our centre between 1st April, 2011 and 31st October, 2014 with congenital surgical conditions and the following information extracted: surgical condition, age, sex, maturity, birth weight, its treatment and outcome, and other associated features were studied. Result: A total of 9213 neonates were admitted in the study period, of which 328 neonates (3.6% had surgical conditions. Surgery was performed in 225 neonates. Commonest congenital surgical condition was of gastrointestinal tract (GIT. Commonest GIT anomalies were tracheo-oesophageal fistula (28.6%, intestinal obstruction (23.7%, anorectal malformation (17.9%, and omphalocoele (7%. The overall mortality in neonates with congenital surgical condition in this study was 51.2%. Significantly, more deaths occurred in preterm than in term neonates (P = 0.00003 and low birth weight babies more than normal weight (p=0.0002. Conclusion: High mortality is found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of Gastrointestinal tract. Prematurity and low birth weight is a significant factor associated with high mortality. [Natl J Med Res 2016; 6(2.000: 168-170


    Directory of Open Access Journals (Sweden)

    Gopal Reddy


    Full Text Available Medication errors are common throughout healthcare system and result in significant morbidity and mortality. Medication related incidents are a common form of reported medical errors. In theory they should never occur. These mistakes are also called “Never events”. Some of these are avoidable and preventable events. 50% of these mistakes are preventable. “India records 5.2 million medical injuries a year”. 1 The UN body quantified the number of surgeries taking place every year globally - 234 million. It said surgeries had become common, with one in every 25 people undergoing it at any given time. China conducted the highest number of surgeries followed by Russia and India. In developing countries, the death rate was nearly 10% for a major surgery. 1 All surgeries need one or other form of anaesthesia. Anaesthetic practice is unique because anaesthetists are personally responsible for al l the steps from drug preparation to drug administration. Therefore, they need to have heightened awareness of the risk factors which create conditions for drug errors to occur. 2 Anaesthesia is unusual in requiring the administration of several potent, dan gerous, rapidly acting drugs in a relatively brief timeframe. These drugs would be harmful if given without considerable care and attention to dose, timing and order of administration. These drugs are almost exclusively administered by Anaesthetists and th e drugs are rarely checked by anyone other than the anaesthetist before administration. Drug error in relation to anaesthesia may therefore be of particular interest both to the specialty and the wider population. 3

  2. Caring for migrant farm workers on medical-surgical units. (United States)

    Anthony, Maureen J


    Over 3 million migrant farm workers are employed in the United States. Many factors place them at risk for work-related disease and injury. Knowledge of workers' health issues can prepare medical-surgical nurses to anticipate and meet the needs of this underserved population.

  3. Standardising fast-track surgical nursing care in Denmark

    DEFF Research Database (Denmark)

    Hjort Jakobsen, Dorthe; Rud, Kirsten; Kehlet, Henrik


    guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN...

  4. Using an age-specific nursing model to tailor care to the adolescent surgical patient. (United States)

    Monahan, Janean Carter


    A surgical experience can be stressful for any patient. When the patient is an adolescent, however, the surgical experience can create significant stress, which is related to normal adolescent development. Perioperative nursing care should address what adolescent patients perceive as stressful and should provide a safe environment so that a successful surgical outcome can be achieved. To accomplish this, a nursing model specific to perioperative nursing practice should be developed to guide nurses when providing care to adolescents. The Adolescent Perioperative System Stability Model based on the Neuman Systems Model provides a framework for defining scope of practice and organizing nursing care that is appropriate for the adolescent during a surgical experience. In addition to guiding nursing practice, this model provides direction and guidance for future studies of adolescents in the perioperative setting.

  5. Mobile Intensive Care Unit: Technical and clinical aspects of interhospital critical care transport

    NARCIS (Netherlands)

    van Lieshout, E.J.


    The Mobile Intensive Care Unit (MICU) is a combination of i) a team of critical care nurse, physician and ambulance driver, ii) a MICU-trolley (i.e. equipped with cardiovascular monitor, mechanical ventilator, syringe pumps etc. indispensable for safe transport and iii) an Intensive Care ambulance.

  6. Mobile Intensive Care Unit: Technical and clinical aspects of interhospital critical care transport

    NARCIS (Netherlands)

    van Lieshout, E.J.


    The Mobile Intensive Care Unit (MICU) is a combination of i) a team of critical care nurse, physician and ambulance driver, ii) a MICU-trolley (i.e. equipped with cardiovascular monitor, mechanical ventilator, syringe pumps etc. indispensable for safe transport and iii) an Intensive Care ambulance.

  7. Critical Thinking in Critical Care: Five Strategies to Improve Teaching and Learning in the Intensive Care Unit. (United States)

    Hayes, Margaret M; Chatterjee, Souvik; Schwartzstein, Richard M


    Critical thinking, the capacity to be deliberate about thinking, is increasingly the focus of undergraduate medical education, but is not commonly addressed in graduate medical education. Without critical thinking, physicians, and particularly residents, are prone to cognitive errors, which can lead to diagnostic errors, especially in a high-stakes environment such as the intensive care unit. Although challenging, critical thinking skills can be taught. At this time, there is a paucity of data to support an educational gold standard for teaching critical thinking, but we believe that five strategies, routed in cognitive theory and our personal teaching experiences, provide an effective framework to teach critical thinking in the intensive care unit. The five strategies are: make the thinking process explicit by helping learners understand that the brain uses two cognitive processes: type 1, an intuitive pattern-recognizing process, and type 2, an analytic process; discuss cognitive biases, such as premature closure, and teach residents to minimize biases by expressing uncertainty and keeping differentials broad; model and teach inductive reasoning by utilizing concept and mechanism maps and explicitly teach how this reasoning differs from the more commonly used hypothetico-deductive reasoning; use questions to stimulate critical thinking: "how" or "why" questions can be used to coach trainees and to uncover their thought processes; and assess and provide feedback on learner's critical thinking. We believe these five strategies provide practical approaches for teaching critical thinking in the intensive care unit.

  8. Surgical nurses' perceptions of ethical dilemmas, moral distress and quality of care. (United States)

    DeKeyser Ganz, Freda; Berkovitz, Keren


    To describe surgical nurses' perceived levels of ethical dilemmas, moral distress and perceived quality of care and the associations among them. Nurses are committed to providing quality care. They can experience ethical dilemmas and moral distress while providing patient care. Little research has focused on the effect of moral distress or ethical dilemmas on perceived quality of care. Descriptive, cross-sectional study. After administration and institutional Research Ethics Committee approval, a researcher requested 119 surgical nurses working in two Israeli hospitals to fill out three questionnaires (personal background characteristics; Ethical Dilemmas in Nursing and Quality of Nursing Care). Data collection took place from August 2007 to January 2008. Participant mean age was 39·7 years. The sample consisted mostly of women, Jewish and married staff nurses. The majority of nurses reported low to moderate levels of ethical dilemma frequency but intermediate levels of ethical dilemma intensity. Frequency of ethical dilemmas was negatively correlated with level of nursing skill, meeting patient's needs and total quality of care. No important correlations were found between intensity of ethical dilemmas and quality of care. Levels of ethical dilemma frequency were higher than intensity. Nurses tended to be satisfied with their level of quality of care. Increased frequency of ethical dilemmas was associated with some aspects of perceived quality of care. Quality of care is related to ethical dilemmas and moral distress among surgical nurses. Therefore, efforts should be made to decrease the frequency of these feelings to improve the quality of patient care. © 2011 Blackwell Publishing Ltd.

  9. Care practices of older people with dementia in the surgical ward: A questionnaire survey

    Directory of Open Access Journals (Sweden)

    Nina Hynninen


    Full Text Available Objectives: The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward. Methods: The data were collected from nursing staff (n = 191 working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items, specific characteristics of older people with dementia in a surgical ward (24 of items, specific characteristics of their care in a surgical ward (66 of items and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items. Results: The questions which measure the nursing staff’s own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient’s state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients’ attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients’ challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything. Conclusion: The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs.

  10. Strategic Planning for Research in Pediatric Critical Care. (United States)

    Tamburro, Robert F; Jenkins, Tammara L; Kochanek, Patrick M


    To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Expert opinion expressed during the Strategic Planning Conference. Not applicable. Chaired by an experienced expert from the field, issues relevant to the conduct of pediatric critical care research were discussed and debated by the invited participants. Common themes and suggested priorities were identified and coalesced. Of the many pathophysiologic conditions discussed, the multiple organ dysfunction syndrome emerged as a topic in need of more study that is most relevant to the field. Additionally, the experts offered that the interrelationship and impact of critical illness on child development and family functioning are important research priorities. Consequently, long-term outcomes research was encouraged. The expert group also suggested that multidisciplinary conferences are needed to help identify key knowledge gaps to advance and direct research in the field. The Pediatric Critical Care and Trauma Scientist Development National K12 Program and the Collaborative Pediatric Critical Care Research Network were recognized as successful and important programs supported by the branch. The development of core data resources including biorepositories with robust phenotypic data using common data elements was also suggested to foster data sharing among investigators and to enhance disease diagnosis and discovery. Multicenter clinical trials and innovative study designs to address understudied and poorly understood conditions were considered important for field advancement. Finally, the growth of the pediatric critical care research workforce was offered as a priority that could be spawned in many ways including by expanded

  11. Poor cataract surgical output: Eye care workers perspective in north ...

    African Journals Online (AJOL)


    Jan 25, 2012 ... why a number of cataract blind encountered at homes or communities are not ... eye care worker: A community health worker placed at the primary level of care with short ... The discussion was recorded by digital voice recorder and also ... of the workers in the tertiary, state, and private respectively agree to ...

  12. The role of technology in critical care nursing. (United States)

    Crocker, Cheryl; Timmons, Stephen


    This paper is a report of a study to identify the meaning for critical care nurses of technology related to weaning from mechanical ventilation and to explore how that technology was used in practice. The literature concerned with the development of critical care (intensive care and high dependency units) focuses mainly on innovative medical technology. Although this use of technology in critical care is portrayed as new, it actually represents a transfer of technology from operating theatres. An ethnographic study was conducted and data were collected on one critical care unit in a large teaching hospital over a 6-month period in 2004. The methods included participant observation, interviews and the collection of field notes. The overall theme 'The nursing-technology relation' was identified. This comprised three sub-themes: definition of technology, technology transferred and technology transformed. Novice nurses took a task-focussed approach to weaning, treating it as a 'medical' technology transferred to them from doctors. Expert nurses used technology differently and saw its potential to become a 'nursing technology'. Nurses need to examine how they can adapt and to 'reconfigure' technology so that it can be transformed into a nursing technology. Those technologies that do not fit with nursing may have no place there. Rather than simply extending and expanding their roles through technology transfer, nurses should transform those technologies that preserve the essence of nursing and can contribute to a positive outcome for patients.

  13. Elective pediatric surgical care in a forward deployed setting: What is feasible vs. what is reasonable. (United States)

    Neff, Lucas P; Cannon, Jeremy W; Charnock, Kathryn M; Farmer, Diana L; Borgman, Matthew A; Ricca, Robert L


    To describe the scope and outcomes of elective pediatric surgical procedures performed during combat operations. The care of patients in Operation Enduring Freedom (OEF) includes elective humanitarian surgery on Afghan children. Unlike military reports of pediatric trauma care, there is little outcome data on elective pediatric surgical care during combat operations to guide treatment decisions. All elective surgical procedures performed on patients≤16years of age from May 2012 through April 2014 were reviewed. Procedures were grouped by surgical specialty and were further classified as single-stage (SINGLE) or multi-stage (MULTI). The primary endpoint was post-operative complications requiring further surgery, and the secondary endpoint was post-operative follow up. A total of 311 elective pediatric surgical procedures were performed on 239 patients. Surgical specialties included general surgery, orthopedics, otolaryngology, ophthalmology, neurosurgery and urology. 178 (57%) were SINGLE while 133 (43%) were MULTI. Fifteen patients required 32 procedures for post-operative complications. Approximately half of all procedures were performed as outpatient surgery. Median length of stay for inpatient was 2.2days, and all patients survived to discharge. The majority of patients returned for outpatient follow-up (207, 87%), and 4 patients (1.7%) died after discharge. Elective pediatric surgical care in a forward deployed setting is feasible; however, limitations in resources for perioperative care and rehabilitation mandate prudent patient selection particularly with respect to procedures that require prolonged post-operative care. Formal guidance on the process of patient selection for elective humanitarian surgery in these settings is needed. Published by Elsevier Inc.

  14. Mandatory palliative care education for surgical residents: initial focus on teaching pain management. (United States)

    Oya, Hisaharu; Matoba, Motohiro; Murakami, Satoshi; Ohshiro, Taihei; Kishino, Takayoshi; Satoh, Yuya; Tsukahara, Tetsuo; Hori, Syutarou; Maeda, Masahiro; Makino, Takashi; Maeda, Takashi


    Knowledge concerning palliative care and the associated skills, including effective pain control, is essential for surgeons who treat cancer patients in daily practice. This study focuses on a palliative care training course that has been mandatorily conducted for all surgical residents of our hospital since 2009. We evaluated the effectiveness of our mandatory palliative care training course by conducting a retrospective study of the patients' medical records and participants' questionnaire results and discussed the importance of palliative care education for surgical residents. All 12 surgical residents who participated in the course in 2009 had graduated 4-9 years back. They were assigned to look after a total of 92 cases (average, 7.66 cases per resident) during the course. The purpose of care in most cases (92.3%) was to mitigate pain. Introducing analgesic adjuvants such as gabapentin or amitriptyline accounted for the largest part of initial interventions (23.9%) aimed at controlling cancer pain, followed by changes in route of administration or doses of prior opioid analgesics (21.7%). Interventions with opioid analgesics were conducted most frequently (47.7%). The overall pain improvement rate was 89.1%. We used a questionnaire after the course to evaluate its effectiveness. The surgical residents stated that it was a meaningful course through which they gained practical knowledge on palliative care and that the experience would change their approach to home care.

  15. [Systematization of nursing assistance in critical care unit]. (United States)

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


    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.

  16. Reflection and Critical Thinking of Humanistic Care in Medical Education

    Directory of Open Access Journals (Sweden)

    Shu-Jen Shiau


    Full Text Available The purpose of this paper is to stress the importance and learning issues of humanistic care in medical education. This article will elaborate on the following issues: (1 introduction; (2 reflection and critical thinking; (3 humanistic care; (4 core values and teaching strategies in medical education; and (5 learning of life cultivation. Focusing on a specific approach used in humanistic care, it does so for the purpose of allowing the health professional to understand and apply the concepts of humanistic value in their services.

  17. Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

    Directory of Open Access Journals (Sweden)

    Deng-Wei Chou

    Full Text Available OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%. The most common computed tomographic findings included a feeding vessel sign (90%, peripheral nodules without cavities (80% or with cavities (65%, and peripheral wedge-shaped opacities (75%. The most common primary source of infection was liver abscess (40%, followed by pneumonia (25%. The two most frequent causative pathogens were Klebsiella pneumoniae (50% and Staphylococcus aureus (35%. Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

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

    Directory of Open Access Journals (Sweden)

    Yurdanur Dikmen


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

  19. Critical Incident Stress Debriefing for Health Care Workers. (United States)

    Lane, Pamela S.


    Describes Critical Incident Stress Debriefing process (CISD) as model designed to mitigate impact of life-threatening crises on health care workers, to facilitate their return to routine functioning, and to prevent pathological responses to trauma that is inherent aspect of their profession. Examines development of CISD and explores its…

  20. Critically reflective work behavior of health care professionals

    NARCIS (Netherlands)

    Groot, Esther de; Jaarsma, Debbie; Endedijk, Maaike; Mainhard, Tim; Lam, Ineke; Simons, Robert-Jan; Beukelen, Peter van


    INTRODUCTION: Better understanding of critically reflective work behavior (CRWB), an approach for work-related informal learning, is important in order to gain more profound insight in the continuing development of health care professionals. METHODS: A survey, developed to measure CRWB and its predi

  1. Staffing and training issues in critical care hyperbaric medicine. (United States)

    Kot, Jacek


    The integrated chain of treatment of the most severe clinical cases that require hyperbaric oxygen therapy (HBOT) assumes that intensive care is continued while inside the hyperbaric chamber. Such an approach needs to take into account all the risks associated with transportation of the critically ill patient from the ICU to the chamber and back, changing of ventilator circuits and intravascular lines, using different medical devices in a hyperbaric environment, advanced invasive physiological monitoring as well as medical procedures (infusions, drainage, etc) during long or frequently repeated HBOT sessions. Any medical staff who take care of critically ill patients during HBOT should be certified and trained according to both emergency/intensive care and hyperbaric requirements. For any HBOT session, the number of staff needed for any HBOT session depends on both the type of chamber and the patient's status--stable, demanding or critically ill. For a critically ill patient, the standard procedure is a one-to-one patient-staff ratio inside the chamber; however, the final decision whether this is enough is taken after careful risk assessment based on the patient's condition, clinical indication for HBOT, experience of the personnel involved in that treatment and the available equipment.

  2. Starting with Self: Teaching Autoethnography to Foster Critically Caring Literacies (United States)

    Camangian, Patrick


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

  3. Worldwide overview of critical care nursing organizations and their activities. (United States)

    Williams, G; Chaboyer, W; Thornsteindóttir, R; Fulbrook, P; Shelton, C; Wojner, A; Chan, D


    While critical care has been a specialty within nursing for almost 50 years, with many countries having professional organizations representing these nurses, it is only recently that the formation of an international society has been considered. A three-phased study was planned: the aim of the first phase was to identify critical care organizations worldwide; the aim of the second was to describe the characteristics of these organizations, including their issues and activities; and the aim of the third was to plan for an international society, if international support was evident. In the first phase, contacts in 44 countries were identified using a number of strategies. In the second phase, 24 (55%) countries responded to a survey about their organizations. Common issues for critical care nurses were identified, including concerns over staffing levels, working conditions, educational programme standards and wages. Critical care nursing organizations were generally favourable towards the notion of establishing a World Federation of their respective societies. Some of the important issues that will need to be addressed in the lead up to the formation of such a federation are now being considered.

  4. Crossing boundaries, re-defining care: the role of the critical care outreach team. (United States)

    Coombs, Maureen; Dillon, Ann


    There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient-focused service delivered by clinical teams working effectively together. Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services. Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients. Activity data and observations from the first 6-month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward-based teams. The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries. Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning.

  5. Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study. (United States)

    Mason, Virginia M; Leslie, Gail; Clark, Kathleen; Lyons, Pat; Walke, Erica; Butler, Christina; Griffin, Martha


    Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low

  6. Patient satisfaction with nursing care in a colorectal surgical population. (United States)

    Lumby, J; England, K


    This paper describes one arm of a much larger, multi-site study whose hypothesis was that evidence-based nursing practice is more effective than routine nursing care in improving patient outcomes and health gain. This arm of the study investigated patient satisfaction as an outcome measure for those patients undergoing colorectal surgery. The study's relevance for nurses is in the potential feedback for reviewing nursing practice and health care delivery. Patient satisfaction with nursing care was measured through a validated questionnaire, the SERVQUAL, followed by interviews with a percentage of the study population. The results of this arm of the study confirm the importance of measuring patient satisfaction through a triangulated method which investigates thoroughly, providing feedback for continuous quality improvement. The in-depth interviews provided greater insight into the results of the questionnaire, enabling clear feedback to nursing staff at the different sites of the study. Results of the questionnaire revealed age, sex and education levels of patients as major influences on individual perceptions of nursing care. Patients whose surgery resulted in stomas were also less satisfied with health-care delivery.

  7. Critical incidents connected to nurses’ leadership in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Elaine Cantarella Lima

    Full Text Available ABSTRACT Objective: The goal of this study is to analyze nurses’ leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Method: Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results: Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses’ behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses’ activities; people management; and the setting of high quality care targets. Final considerations: Researchers identified a mixed leadership model, leading them to the conclusion that nurses’ knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization’s results.

  8. Structural elements of critical thinking of nurses in emergency care

    Directory of Open Access Journals (Sweden)

    Maria da Graça Oliveira Crossetti

    Full Text Available The objective of this study was to analyze the structural elements of critical thinking (CT of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

  9. Diagnostic and prognostic biomarkers of sepsis in critical care. (United States)

    Kibe, Savitri; Adams, Kate; Barlow, Gavin


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

  10. Critical care nurses' information-seeking behaviour during an unfamiliar patient care task. (United States)

    Newman, Kristine M; Doran, Diane


    Critical care nurses complete tasks during patient care to promote the recovery or maintain the health of their patients. These tasks can be routine or non-routine to the nurse. Non-routine tasks are characterized by unfamiliarity, requiring nurses to seek additional information from a variety of sources to effectively complete the tasks. Critical care units are dynamic environments where decisions are often made by nurses under stress and time pressure because patient status changes rapidly. A non-routine task (e.g., administration of an unfamiliar medication) to the critical care nurse can impact patient care outcomes (e.g., increased time to complete task has consequences for the patient). In this article, the authors discuss literature reviewed on nurses' information-seeking and explore an information-seeking conceptual model that will be used as a guide to examine the main concepts found through the empirical evidence.

  11. Effects of technology on nursing care and caring attributes of a sample of Iranian critical care nurses. (United States)

    Bagherian, Behnaz; Sabzevari, Sakineh; Mirzaei, Tayebeh; Ravari, Ali


    To examine the association between attitudes of critical care nurses about influences of technology and their caring attributes. In a cross-sectional study, firstly the psychometric properties of caring attributes questionnaire, which was developed to examine caring attributes of a sample of international nurses, was refined in a sample of 200 critical care nurses working in educational hospitals of a city in the southwest of Iran. Results of factor analysis with Varimax rotation decreased 60 items of caring attributes to 47 items which loaded under five subscales of caring negation, caring compassionate, caring advocacy, caring essence and caring communication. Secondly, attitudes of these nurses toward influences of technology on nursing care were assessed using a 22-item questionnaire, developed by the study researchers. Finally, the association between scores of caring attributes and attitudes toward influences of technology of this sample was determined. There was a positive association between caring attributes and influences of technology among our study nurses. Caring attributes scores were higher in female single nurses. Although caring attributes' scores had decreased along with age and work experience, caring commitment was higher in older more experienced nurses. Furthermore, female nurses had a better attitude toward influences of technology on their care. In contrast, younger and less experienced nurses had negative views on the effects of technology on nursing care. Continuing education and life-long learning on application of new technological equipment in nursing care and harmonising their use with caring values are necessary for nursing students and registered nurses to ensure delivering a patient-centred care, in a technologically driven environment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Referral for a bariatric surgical consultation: it is time to set a standard of care. (United States)

    Dixon, John B


    Indications for bariatric surgery have been clear for some time and many would say that they are conservative. Unfortunately few eligible candidates seek or are referred for bariatric surgery, with less than 1% currently treated annually. In recent years, the evidence base supporting surgical therapy has strengthened with demonstrable improvements in both safety and efficacy. We now have evidence of remarkable improvements in health, quality of life, and increased life expectancy. There is continued frustration with the poor efficacy of non-surgical therapies and no indication that this is about to change. A caring physician should, as best care, refer the seriously ill morbidly obese patient for a surgical opinion. It is no different from their obligation to adequately manage type-2 diabetes, depression or unstable angina. Currently, even discussion of a surgical referral is optional. It is time we articulated and defined a group of patients where referral for a surgical opinion is no longer merely an option but a physician's responsibility as best care for the patient. It is time to provide leadership towards the delivery of better care for these patients.

  13. Pediatric Surgical Care in a Dutch Military Hospital in Afghanistan

    NARCIS (Netherlands)

    Idenburg, Floris J.; Van Dongen, Thijs T C F; Tan, Edward C T H; Hamming, Jaap H.; Leenen, Luke P H; Hoencamp, Rigo


    Background   From August 2006–August 2010, as part of the ISAF mission, the Armed Forces of the Netherlands deployed a role 2 enhanced Medical Treatment Facility (R2E-MTF) to Uruzgan province, Afghanistan. Although from the principle doctrine not considered a primary task, care was delivered to civi

  14. Acute surgical wound care. 4: The importance of documentation. (United States)

    Foster, L; Moore, P

    This article, the last in a series of four, discusses the importance of documenting wound care. Studies have shown that nurses do not document wound care as often, or as accurately, as they should in order to comply with the UKCC's (1998) Guidelines for Records and Record Keeping. Although some wound assessment charts have been published and are in use, there is still concern about the validity or reliability of some of these charts. Studies show that further research is necessary in order to validate the charts that are currently in use. An increase in litigation has placed more emphasis on accurate record keeping which shows, in detail, the wound care that is given to each patient. Patients also want to be more informed about their treatment, and this can be done through the use of clinical pathways or multidisciplinary documents. This article also discusses the factors that have to be considered when putting a wound care chart together and gives some examples of existing charts.

  15. Care of the breastfeeding mother in medical-surgical areas. (United States)

    Wenner, Lori


    Benefits and myths of breastfeeding may interfere with the breastfeeding relationship during maternal hospitalization. Guidelines for maintaining the breastfeeding relationship and/or protecting the milk supply during contact with the health care system outside of the maternal child area are presented.

  16. [Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units]. (United States)

    Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura


    Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.

  17. [Qualified and emergency specialized surgical care for those with wounds to the extremities]. (United States)

    Iurkevich, V V; Fidarov, E Z; Bauér, V A


    Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.

  18. Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses. (United States)

    Sacco, Tara L; Ciurzynski, Susan M; Harvey, Megan Elizabeth; Ingersoll, Gail L


    Although critical care nurses gain satisfaction from providing compassionate care to patients and patients' families, the nurses are also at risk for fatigue. The balance between satisfaction and fatigue is considered professional quality of life. To establish the prevalence of compassion satisfaction and compassion fatigue in adult, pediatric, and neonatal critical care nurses and to describe potential contributing demographic, unit, and organizational characteristics. In a cross-sectional design, nurses were surveyed by using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction. Nurses (n = 221) reported significant differences in compassion satisfaction and compassion fatigue on the basis of sex, age, educational level, unit, acuity, change in nursing management, and major systems change. Understanding the elements of professional quality of life can have a positive effect on work environment. The relationship between professional quality of life and the standards for a healthy work environment requires further investigation. Once this relationship is fully understood, interventions to improve this balance can be developed and tested. ©2015 American Association of Critical-Care Nurses.

  19. Ventilator withdrawal: procedures and outcomes. Report of a collaboration between a critical care division and a palliative care service. (United States)

    O'Mahony, Sean; McHugh, Marlene; Zallman, Leah; Selwyn, Peter


    To describe an institutional procedure for ventilator withdrawal and to analyze patient responses to terminal extubation, the medical records of 21 patients who underwent withdrawal of mechanical ventilation according to the process followed by an interdisciplinary palliative care team were retrospectively reviewed. The cohort was a convenience sample of sequentially treated patients in a 1048-bed urban university-affiliated medical center. Sixteen of the 21 patients were on medical or surgical floors and five patients were in critical care units. Patients were assessed for discomfort, such as dyspnea, agitation, or anxiety. Sedative and analgesic medications were administered based on clinical parameters. Palliative care clinician observations of patient reports, tachypnea,use of accessory muscles, and signs of discomfort such as agitation or anxiety were recorded for the first 4 hours after extubation. Medication use and length of survival were recorded. Fifty-seven percent were symptomatic during the extubation process and required administration of either a benzodiazepine or opioid medication. The median survival of the 18 patients who died post-extubation was 0.83 hours (interquartile range 0.5-43.8). Bolus doses of opioid or benzodiazepine medications were effective for management of symptoms in about two-thirds of patients. One-third of patients required continuous infusions. Eighteen patients died following extubation in the medical center, and three of these patients were transferred to an inpatient hospice unit. Three patients (14%) survived to discharge from the hospital. The procedure followed provides a foundation for collaboration between palliative care and critical care services to ensure continuity of care across clinical settings/units.

  20. Optimizing resources for the surgical care of children: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee consensus statement. (United States)

    Goldin, Adam B; Dasgupta, Roshni; Chen, Li Ern; Blakely, Martin L; Islam, Saleem; Downard, Cynthia D; Rangel, Shawn J; St Peter, Shawn D; Calkins, Casey M; Arca, Marjorie J; Barnhart, Douglas C; Saito, Jacqueline M; Oldham, Keith T; Abdullah, Fizan


    The United States' healthcare system is facing unprecedented pressures: the healthcare cost curve is not sustainable while the bar of standards and expectations for the quality of care continues to rise. Systems committed to the surgical treatment of children will likely require changes and reorganization. Regardless of these mounting pressures, hospitals must remain focused on providing the best possible care to each child at every encounter. Available clinical expertise and hospital resources should be optimized to match the complexity of the treated condition. Although precise criteria are lacking, there is a growing consensus that the optimal combination of clinical experience and hospital resources must be defined, and efforts toward this goal have been supported by the Regents of the American College of Surgeons, the members of the American Pediatric Surgical Association, and the Society for Pediatric Anesthesia (SPA) Board of Directors. The topic of optimizing outcomes and the discussion of the concepts involved have unfortunately become divisive. Our goals, therefore, are 1) to provide a review of the literature that can provide context for the discussion of regionalization, volume, and optimal resources and promote mutual understanding of these important terms, 2) to review the evidence that has been published to date in pediatric surgery associated with regionalization, volume, and resource, 3) to focus on a specific resource (anesthesia), and the association that this may have with outcomes, and 4) to provide a framework for future research and policy efforts.

  1. Conversations in end-of-life care: communication tools for critical care practitioners. (United States)

    Shannon, Sarah E; Long-Sutehall, Tracy; Coombs, Maureen


    Communication skills are the key for quality end-of-life care including in the critical care setting. While learning general, transferable communication skills, such as therapeutic listening, has been common in nursing education, learning specific communication tools, such as breaking bad news, has been the norm for medical education. Critical care nurses may also benefit from learning communication tools that are more specific to end-of-life care. We conducted a 90-min interactive workshop at a national conference for a group of 78 experienced critical care nurses where we presented three communication tools using short didactics. We utilized theatre style and paired role play simulation. The Ask-Tell-Ask, Tell Me More and Situation-Background-Assessment-Recommendation (SBAR) tools were demonstrated or practiced using a case of a family member who feels that treatment is being withdrawn prematurely for the patient. The audience actively participated in debriefing the role play to maximize learning. The final communication tool, SBAR, was practiced using an approach of pairing with another member of the audience. At the end of the session, a brief evaluation was completed by 59 nurses (80%) of the audience. These communication tools offer nurses new strategies for approaching potentially difficult and emotionally charged conversations. A case example illustrated strategies for applying these skills to clinical situations. The three tools assist critical care nurses to move beyond compassionate listening to knowing what to say. Ask-Tell-Ask reminds nurses to carefully assess concerns before imparting information. Tell Me More provides a tool for encouraging dialogue in challenging situations. Finally, SBAR can assist nurses to distill complex and often long conversations into concise and informative reports for colleagues. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care Nurses.

  2. Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: recommendations of the Working Group on Emergency Mass Critical Care. (United States)

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


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

  3. The chronic critical illness: a new disease in intensive care. (United States)

    Desarmenien, Marine; Blanchard-Courtois, Anne Laure; Ricou, Bara


    Advances in intensive care medicine have created a new disease called the chronic critical illness. While a significant proportion of severely ill patients who twenty years ago would have died survive the acute phase, they remain heavily dependent on intensive care for a prolonged period of time. These patients, who can be called "Patient Long Séjour" in French (PLS) or Prolonged Length of Stay patients in English, develop specific health issues that are still poorly recognised. They require special care, which differs from treatments that are given during the acute phase of their illness. A multidisciplinary team dedicated to ensuring their management and follow-up acquired a wide range of knowledge and expertise about these PLSs. Many new monitoring tools and diverse human approaches were implemented to ensure that care was targeted to these patients' needs. This multimodal care management aims to optimise the patients' and their families' quality of life during and following intensive care, whilst maintaining the motivation of the healthcare team of the unit. The purpose of this article is to present new management techniques to hospital and ambulatory caregivers, physicians and nurses, who may be taking care of such patients.

  4. Communication Needs of Critical Care Patients Who Are Voiceless. (United States)

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


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

  5. Clinical accompaniment: the critical care nursing students’ experiences in a private hospital

    Directory of Open Access Journals (Sweden)

    N. Tsele


    Full Text Available The quality of clinical accompaniment of the student enrolled for the post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General is an important dimension of the educational/learning programme. The clinical accompanist/mentor is responsible for ensuring the student’s compliance with the clinical outcomes of the programme in accordance with the requirements laid down by the Nursing Education Institution and the South African Nursing Council. The purpose of this study was to explore and describe the experiences of the students enrolled for a post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General, in relation to the clinical accompaniment in a private hospital in Gauteng. An exploratory, descriptive and phenomenological research design was utilised and individual interviews were conducted with the ten students in the research hospital. A content analysis was conducted and the results revealed both positive and negative experiences by the students in the internal and external worlds. The recommendations include the formulation of standards for clinical accompaniment of students. the evaluation of the quality of clinical accompaniment of students and empowerment of the organisation, clinical accompanists/mentors and clinicians.

  6. Managing variations from surgical care plans: challenges for coordination. (United States)

    Iversen, Tobias Buschmann; Melby, Line; Landmark, Andreas Dypvik; Toussaint, Pieter


    In surgical work there is a need for 'continuous planning' among staff to handle the frequently occurring variations from the planned patient treatment. In this paper, we present how three hospital information systems have support for three common patient trajectory variations. Highlight how deviations from a plan cause different information needs and implications for design of awareness supporting computer systems. Participant observations and semi-structured interviews with stakeholders involved in peri-operative work. When trajectories progress according to plan, information needs of staff seem to be minimal, as everything is "running to plan". However, when variations occur the information need increases. In order to provide better support for variations, awareness-support systems need to inform colleagues and other stakeholders about deviations from the plan. Plans and trajectories also need to be connected by projecting estimations of incidental time of ongoing relevant events. Additionally, end-users should have the option to switch between information-sparse and information-rich computer support. Published by Elsevier Ireland Ltd.

  7. Health care policy development: a critical analysis model. (United States)

    Logan, Jean E; Pauling, Carolyn D; Franzen, Debra B


    This article describes a phased approach for teaching baccalaureate nursing students critical analysis of health care policy, including refinement of existing policy or the foundation to create new policy. Central to this approach is the application of an innovative framework, the Grand View Critical Analysis Model, which was designed to provide a conceptual base for the authentic learning experience. Students come to know the interconnectedness and the importance of the model, which includes issue selection and four phases: policy focus, colleagueship analysis, evidence-based practice analysis, and policy analysis and development.

  8. Respiratory Acid-Base Disorders in the Critical Care Unit. (United States)

    Hopper, Kate


    The incidence of respiratory acid-base abnormalities in the critical care unit (CCU) is unknown, although respiratory alkalosis is suspected to be common in this population. Abnormal carbon dioxide tension can have many physiologic effects, and changes in Pco2 may have a significant impact on outcome. Monitoring Pco2 in CCU patients is an important aspect of critical patient assessment, and identification of respiratory acid-base abnormalities can be valuable as a diagnostic tool. Treatment of respiratory acid-base disorders is largely focused on resolution of the primary disease, although mechanical ventilation may be indicated in cases with severe respiratory acidosis. Published by Elsevier Inc.

  9. Peering: the essence of collaborative mentoring in critical care. (United States)

    Grossman, Sheila


    To provide and sustain high-quality patient care, nurses must collaborate and gain strength and vision for the future from their peers, young and old. It is known that mentoring assists all people, both mentors and mentees, to be better than what they would be by themselves. This underlying philosophy seems to improve recruitment and retention of staff by fostering a collegial and respectful unit culture. This project paired senior nursing students in critical care in their leadership/management rotation with a nurse and found that both new and experienced nurses had similar perceptions of mentoring and that it should include peer collaboration.

  10. [The perception of surgical nursing caregivers regarding care given to patients with mental disorder]. (United States)

    Lacchini, Annie Jeanninne Bisso; Noal, Helena Carolina; Padoin, Stela Maris de Mello; Terra, Marlene Gomes


    The following study aimed to understand the meanings on the discourse of a Nursing Surgical team regarding the care given to patients with mental disorders submitted to surgical procedures. For such comprehension, a theoretical-philosophical referential by Maurice Merleau-Ponty has been examined. Concerning a methodological approach Paul Ricouer's hermeneutics has been used. Eight nursing caregivers from a public hospital in southern Brazil were interviewed from August to September 2008. The results showed the necessity of stimulating nursing caregivers in the reflective process in acting, thinking, and observing care given to patients with mental disorder; as well as to offer emotional support for them. The caregivers displayed the necessity of understanding the human being receiving care in order to be able to give thorough care as a being-in-the-world.

  11. Provision of critical care services for the obstetric population. (United States)

    Sultan, P; Arulkumaran, N; Rhodes, A


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

  12. New initiatives in critical care: distinguishing hype from hope. (United States)

    Moran, John L; Solomon, Patricia J


    Recent viewpoints on critical care have expressed frustration at the slow development of new therapeutic agents and the failure of investigator-initiated trials. Several new directions have been proposed: personalised medicine and the embracing of "omic" technologies, resolving the heterogeneity of treatment effects, and adaptive trial designs. We examine these approaches in the context of analysis of randomised controlled trials (RCTs). The curse of treatment effect heterogeneity is found not only in critical care but also in cancer oncology. We find the uncritical appeal to personalised medicine to be misplaced because such treatments are not identified at the personal level, but at the group or stratified level. The analysis of RCTs has foundered over the problem of accounting for the centre effect and rejecting the random effects approach. Enthusiasm for adaptive trial designs has been articulated at the rhetorical, not the substantive, level.

  13. Waterborne Elizabethkingia meningoseptica in Adult Critical Care1 (United States)

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


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

  14. Year in review 2005: critical care--nephrology. (United States)

    Ricci, Zaccaria; Ronco, Claudio


    We summarize original research in the field of critical care nephrology accepted or published in 2005 in Critical Care and, when considered relevant or directly linked to this research, in other journals. The articles have been grouped into four categories to facilitate a rapid overview. First, physiopathology, epidemiology and prognosis of acute renal failure (ARF): an extensive review and some observational studies have been performed with the aim of describing aspects of ARF physiopathology, precise epidemiology and long-term outcomes. Second, several authors have performed clinical trials utilizing a potential nephro-protective drug, fenoldopam, with different results. Third, the issue of continuous renal replacement therapies dose has been addressed in a small prospective study and a large observational trial. And fourth, alternative indications to extracorporeal treatment of ARF and systemic inflammatory response syndrome have been explored by three original clinical studies.

  15. The role of melatonin in anaesthesia and critical care

    Directory of Open Access Journals (Sweden)

    Madhuri S Kurdi


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

  16. Global Surgery Fellowship: A model for surgical care and education in resource-poor countries. (United States)

    Aarabi, Shahram; Smithers, Charles; Fils, Marie-May Louis; Godson, Jean-Louis; Pierre, Jean-Hamilton; Mukherjee, Joia; Meara, John; Farmer, Paul


    Surgical diseases have recently been shown to be a major cause of global morbidity and mortality. Effective methods to decrease the burden of surgical disease and provide care in resource-poor settings are unknown. An opportunity to meet this need exists through collaborative efforts to train local surgeons in specialty care, such as pediatric general surgery. We present a novel model for the provision of surgical care and education in a resource-poor setting via a collaborative Global Surgery Fellowship program. Through Partners in Health in Haiti, this program placed a fully trained pediatric surgeon at an established rural hospital, both to temporarily serve that community and to teach local surgeons pediatric surgical care. The Global Surgery Fellow performed the cases presented here during his term, between July 2009 and June 2010. A total of 147 operative procedures were performed on 131 patients over the course of 12 weeks in Haiti. A total of 134 of the 147 total cases performed (91.2%) were educational cases, in which the Fellow operated with and trained one or more of the following: American medical students, American residents, Haitian residents, or Haitian staff surgeons. The Global Surgery Fellowship model overcomes many of the traditional challenges to providing adequate surgical care in resource-poor countries. Specifically, it meets the challenge of providing a broad educational experience for many levels of local and foreign physicians, while working within an established locally run health care system. We believe that this model is generalizable to many resource-poor hospitals with permanent local staff that are open to collaboration. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Delirium as a complication of the surgical intensive care

    Directory of Open Access Journals (Sweden)

    Horacek R


    Full Text Available Rostislav Horacek,1 Barbora Krnacova,2 Jan Prasko,2 Klara Latalova2 1Department of Central Intensive Care Unit for Surgery, 2Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Czech Republic Background: The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery.Patients and methods: Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation–agitation scale. Their blood pressure, heart rate, respiratory rate, and peripheral blood oxygen saturation were measured continually, and body temperature was monitored once in an hour. The laboratory blood tests including sodium, potassium, chlorides, phosphorus, urea and creatinine, hemoglobin, hematocrit, red and white blood cell count, and C-reactive protein, albumin levels and laboratory markers of renal and liver dysfunction were done every day. All measurements were made at least for ten consecutive days or longer until the delirium resolved.Results: The sample consisted of 140 consecutive delirious patients with a mean age of 68.21±12.07 years. Delirium was diagnosed in 140 of 5,642 patients (2.48% admitted in CICUS in the last 5 years. The median duration of delirium was 48 hours with a range of 12–240 hours. Statistical analysis showed that hyperactive subtype of delirium and treatment with antipsychotics were associated with prolonged delirium duration (hyperactive 76.15±40.53 hours, hypoactive 54.46±28.44 hours, mixed 61.22±37.86 hours; Kruskal–Wallis test: 8.022; P<0.05. The duration of delirium was significantly correlated also with blood potassium levels (Pearson’s r=0.2189, P<0.05, hypotension

  18. Let's Talk Critical. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows. (United States)

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


    Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows' self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi-square, 5.2; P = 0.02). More than 95% of our participants (n = 27

  19. Critical care management of severe traumatic brain injury in adults


    Haddad Samir H; Arabi Yaseen M


    Abstract Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death in children and young adults. The critical care management of severe TBI is largely derived from the "Guidelines for the Management of Severe Traumatic Brain Injury" that have been published by the Brain Trauma Foundation. The main objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion pressure (CPP...

  20. Noteworthy Literature Published in 2016 for Cardiothoracic Critical Care. (United States)

    Evans, Adam S; Mazzeffi, Michael; Ivascu, Natalia; Noguera, Edward; Gutsche, Jacob


    In 2016, demand for the presence of cardiothoracic anesthesiologists outside of the cardiac operating rooms continues to expand. This article is the second in this annual series to review relevant contributions in postoperative cardiac critical care that may impact the cardiac anesthesiologist. We explore the use of extracorporeal membrane oxygenation (ECMO), management of postoperative atrial fibrillation, coagulopathy, respiratory failure, and role of quality in cardiac surgery.

  1. Emergency obstetric care in a rural district of Burundi: What are the surgical needs? (United States)

    Zachariah, R.; Kumar, A. M. V.; Trelles, M.; Caluwaerts, S.; van den Boogaard, W.; Manirampa, J.; Tayler-Smith, K.; Manzi, M.; Nanan-N’zeth, K.; Duchenne, B.; Ndelema, B.; Etienne, W.; Alders, P.; Veerman, R.; Van den Bergh, R.


    Objectives In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes. Methods A retrospective analysis of EmOC data (2011 and 2012). Results A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%). A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died. Conclusion Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa. PMID:28170398

  2. Emergency obstetric care in a rural district of Burundi: What are the surgical needs? (United States)

    De Plecker, E; Zachariah, R; Kumar, A M V; Trelles, M; Caluwaerts, S; van den Boogaard, W; Manirampa, J; Tayler-Smith, K; Manzi, M; Nanan-N'zeth, K; Duchenne, B; Ndelema, B; Etienne, W; Alders, P; Veerman, R; Van den Bergh, R


    In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes. A retrospective analysis of EmOC data (2011 and 2012). A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%). A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by 'general practitioners with surgical skills' and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died. Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.

  3. Workplace violence: a primer for critical care nurses. (United States)

    Alexy, Eileen M; Hutchins, Joseph A


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

  4. The Critical Care Communication project: improving fellows' communication skills. (United States)

    Arnold, Robert M; Back, Anthony L; Barnato, Amber E; Prendergast, Thomas J; Emlet, Lillian L; Karpov, Irina; White, Patrick H; Nelson, Judith E


    The aim of this study was to develop an evidence-based communication skills training workshop to improve the communication skills of critical care fellows. Pulmonary and critical care fellows (N = 38) participated in a 3-day communication skills workshop between 2008 and 2010 involving brief didactic talks, faculty demonstration of skills, and faculty-supervised small group skills practice sessions with simulated families. Skills included the following: giving bad news, achieving consensus on goals of therapy, and discussing the limitations of life-sustaining treatment. Participants rated their skill levels in a pre-post survey in 11 core communication tasks using a 5-point Likert scale. Of 38 fellows, 36 (95%) completed all 3 days of the workshop. We compared pre and post scores using the Wilcoxon signed rank test. Overall, self-rated skills increased for all 11 tasks. In analyses by participant, 95% reported improvement in at least 1 skill; with improvement in a median of 10 of 11 skills. Ninety-two percent rated the course as either very good/excellent, and 80% recommended that it be mandatory for future fellows. This 3-day communication skills training program increased critical care fellows' self-reported family meeting communication skills. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Skin tumour surgery in primary care: do general practitioners need to improve their surgical skills?

    NARCIS (Netherlands)

    Rijsingen, M.C.J. van; Vossen, R.; Huystee, B.E.W.L. van; Gorgels, W.J.; Gerritsen, M.J.P.


    BACKGROUND: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care. OBJECTIVES: To assess surgical procedures used by GPs in skin tumour management. METHODS: We performed a retrospective study of 1,898

  6. Ileus development in the trauma/surgical intensive care unit: a process improvement evaluation. (United States)

    Phipps, Marcy; Bush, Jeffrey A; Buhrow, Dianne; Tittle, Mary B; Singh, Deepak; Harcombe, Julianne; Riddle, Evanthia


    Ileus development has been associated with a wide range of complications among hospitalized patients, ranging from increased patient pain and discomfort to malnutrition, aspiration, delayed rehabilitation, and sepsis. This article examines factors that appeared to correlate with an increase in ileus development among patients in a trauma/surgical intensive care unit, with the goal of preventing the condition through nursing practice changes.

  7. Evaluating disparities in inpatient surgical cancer care among American Indian/Alaska Native patients. (United States)

    Simianu, Vlad V; Morris, Arden M; Varghese, Thomas K; Porter, Michael P; Henderson, Jeffrey A; Buchwald, Dedra S; Flum, David R; Javid, Sara H


    American Indian/Alaska Native (AI/AN) patients with cancer have the lowest survival rates of all racial and ethnic groups, possibly because they are less likely to receive "best practice" surgical care than patients of other races. Prospective cohort study comparing adherence with generic and cancer-specific guidelines on processes of surgical care between AI/AN and non-Hispanic white (NHW) patients in Washington State (2010 to 2014) was conducted. A total of 156 AI/AN and 6,030 NHW patients underwent operations for 10 different cancers, and had similar mean adherence to generic surgical guidelines (91.5% vs 91.9%, P = .57). AI/AN patients with breast cancer less frequently received preoperative diagnostic core needle biopsy (81% vs 94%, P = .004). AI/AN patients also less frequently received care adherent to prostate cancer-specific guidelines (74% vs 92%, P = .001). Although AI/ANs undergoing cancer operations in Washington receive similar overall best practice surgical cancer care to NHW patients, there remain important, modifiable disparities that may contribute to their lower survival. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. (United States)

    Gentile, Lori F; Cuenca, Alex G; Efron, Philip A; Ang, Darwin; Bihorac, Azra; McKinley, Bruce A; Moldawer, Lyle L; Moore, Frederick A


    Surgical intensive care unit (ICU) stay of longer than 10 days is often described by the experienced intensivist as a "complicated clinical course" and is frequently attributed to persistent immune dysfunction. "Systemic inflammatory response syndrome" (SIRS) followed by "compensatory anti-inflammatory response syndrome" (CARS) is a conceptual framework to explain the immunologic trajectory that ICU patients with severe sepsis, trauma, or emergency surgery for abdominal infection often traverse, but the causes, mechanisms, and reasons for persistent immune dysfunction remain unexplained. Often involving multiple-organ failure (MOF) and death, improvements in surgical intensive care have altered its incidence, phenotype, and frequency and have increased the number of patients who survive initial sepsis or surgical events and progress to a persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Often observed, but rarely reversible, these patients may survive to transfer to a long-term care facility only to return to the ICU, but rarely to self-sufficiency. We propose that PICS is the dominant pathophysiology and phenotype that has replaced late MOF and prolongs surgical ICU stay, usually with poor outcome. This review details the evolving epidemiology of MOF, the clinical presentation of PICS, and our understanding of how persistent inflammation and immunosuppression define the pathobiology of prolonged intensive care. Therapy for PICS will involve innovative interventions for immune system rebalance and nutritional support to regain physical function and well-being. Copyright © 2012 by Lippincott Williams & Wilkins.

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

    Directory of Open Access Journals (Sweden)

    Jose Chacko


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

  10. Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review. (United States)

    Donaldson, L H; Gill, A J; Hibbert, M


    There are conflicting reports regarding the role of surgical lung biopsies in patients who present to the intensive care unit (ICU) with unexplained respiratory failure and diffuse pulmonary infiltrates on imaging. To describe the utility of surgical lung biopsies in patients presenting to the ICU with unexplained respiratory failure and diffuse pulmonary infiltrates. A retrospective cohort study was performed. All patients admitted to the ICU who underwent a surgical lung biopsy for the investigation of respiratory failure and unexplained pulmonary infiltrates between 1998 and 2012 were included. The primary outcome measures for this descriptive study were the biopsy histopathology, changes in patient management following biopsy and in-hospital mortality. A total of 30 patients was included in the review. Biopsies in 22 patients (73%) demonstrated diffuse alveolar damage (DAD), with 15 of these biopsies (50%) suggesting a specific underlying aetiology. In 73% of cases (n = 22), the biopsy finding was associated with a change in management, although this generally involved the escalation of an existing therapy rather than initiation of a new treatment. Biopsies were performed at a median 10 days after admission (interquartile range 5-17 days), with the majority of patients being treated empirically prior to the biopsy with systemic steroids and broad-spectrum antimicrobials. Mortality was 53%. In this series, DAD was the most frequent pathology. The biopsy result was associated with a change in management in a majority of the subjects, most frequently an escalation of prior empiric therapy. Mortality was high. © 2016 Royal Australasian College of Physicians.

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

    Directory of Open Access Journals (Sweden)

    Raschke RA


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

  12. [Critical issues in clinical practice guidelines for geriatric care]. (United States)

    Zanetti, Ermellina


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

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

    Directory of Open Access Journals (Sweden)

    Saurabh Saigal


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

  14. Laboratory testing during critical care transport: point-of-care testing in air ambulances. (United States)

    Di Serio, Francesca; Petronelli, Maria Antonia; Sammartino, Eugenio


    Air and ground transport are used for prehospital transport of patients in acute life-threatening situations, and increasingly, critically ill patients undergo interhospital transportation. Results from clinical studies suggest that critical tests performed during the transport of critically ill patients presents a potential opportunity to improve patient care. Our project was to identify, according to the recommendations published at this time, a model of point-of-care testing (POCT) (arterial blood gases analysis and glucose, sodium, potassium, ionized calcium, hematocrit/hemoglobin measurements) in air ambulances. In order to identify the key internal and external factors that are important to achieving our objective, an analysis of the Strengths, Weaknesses, Opportunities, and Threats (SWOT analysis) was incorporated into our planning model prior to starting the project. To allow the entire POCT process (pre-, intra-, and post-analytic steps) to be under the control of the reference laboratory, an experimental model of information technology was applied. Real-time results during transport of critically ill patients must be considered to be an integral part of the patient care process and excellent channels of communication are needed between the intensive care units, emergency medical services and laboratories. With technological and computer advances, POCT during critical care transport will certainly increase in the future: this will be a challenge from a laboratory and clinical context.

  15. Prevention of Critical Care Complications in the Coronary Intensive Care Unit: Protocols, Bundles, and Insights From Intensive Care Studies. (United States)

    van Diepen, Sean; Sligl, Wendy I; Washam, Jeffrey B; Gilchrist, Ian C; Arora, Rakesh C; Katz, Jason N


    Over the past half century, coronary care units have expanded from specialized ischemia arrhythmia monitoring units into intensive care units (ICUs) for acutely ill and medically complex patients with a primary cardiac diagnosis. Patients admitted to contemporary coronary intensive care units (CICUs) are at risk for common and preventable critical care complications, yet many CICUs have not adopted standard-of-care prevention protocols and practices from general ICUs. In this article, we (1) review evidence-based interventions and care bundles that reduce the incidence of ventilator-associated pneumonia, excess sedation during mechanical ventilation, central line infections, stress ulcers, malnutrition, delirium, and medication errors and (2) recommend pragmatic adaptations for common conditions in critically ill patients with cardiac disease, and (3) provide example order sets and practical CICU protocol implementation strategies.

  16. The effect of robotic telerounding in the surgical intensive care units impact on medical education. (United States)

    Marini, Corrado Paolo; Ritter, Garry; Sharma, Cordelia; McNelis, John; Goldberg, Michael; Barrera, Rafael


    Robotic telerounding is effective from the standpoint of patients' satisfaction and patients' care in teaching and community hospitals. However, the impact of robotic telerounding by the intensivist rounding remotely in the surgical intensive care unit (SICU), on patients' outcome and on the education of medical students physician assistants and surgical residents, as well as on nurses' satisfaction has not been studied. Prospective evaluation of robotic telerounding (RT) using a Likert Scale measuring tool to assess whether it can replace conventional rounding (CR) from the standpoint of patients' care and outcome, nursing satisfaction, and educational effectiveness. RT did not have a negative impact on patients' outcome during the study interval: mortality 5/42 (12 %) versus 6/37 (16 %), RT versus CR, respectively, p = 0.747. The intensivists rounding in the SICU were satisfied with their ability to deliver the same patients' care remotely (Likert score 4.4 ± 0.2). The educational experience of medical students, physicia assistants, and surgical residents was not affected by RT (average Likert score 4.5 ± 0.2, 3.9 ± 0.4, and 4.4 ± 0.4 for surgical residents, medical students and PAs, respectively, p > 0.05). However, as shown by a Likert score of 3.5 ± 1.0, RT did not meet nurses' expectations from several standpoints. Intensivists regard robotic telerounding as an effective alternative to conventional rounding from the standpoint of patients' care and teaching. Medical students, physician assistants (PA's), and surgical residents do not believe that RT compromises their education. Despite similar patients' outcome, nurses have a less favorable opinion of RT; they believe that the physical presence of the intensivist is favorable at all times.

  17. Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey. (United States)

    Ludin, Salizar Mohamed


    A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses' decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses' critical thinking and decision-making has not been examined closely in Malaysia. To understand whether critical care nurses' critical thinking disposition affects their clinical decision-making skills. This was a cross-sectional study in which Malay and English translations of the Short Form-Critical Thinking Disposition Inventory-Chinese Version (SF-CTDI-CV) and the Clinical Decision-making Nursing Scale (CDMNS) were used to collect data from 113 nurses working in seven critical care units of a tertiary hospital on the east coast of Malaysia. Participants were recruited through purposive sampling in October 2015. Critical care nurses perceived both their critical thinking disposition and decision-making skills to be high, with a total score of 71.5 and a mean of 48.55 for the SF-CTDI-CV, and a total score of 161 and a mean of 119.77 for the CDMNS. One-way ANOVA test results showed that while age, gender, ethnicity, education level and working experience factors significantly impacted critical thinking (pdecision-making (pdecision-making (r=0.637, p=0.001). While this small-scale study has shown a relationship exists between critical care nurses' critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses' perceived high level of critical thinking and decision-making also needs further investigation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. The Swan-Ganz Catheter Remains a Critically Important Component of Monitoring in Cardiovascular Critical Care. (United States)

    Lee, Matthew; Curley, Gerard F; Mustard, Mary; Mazer, C David


    Few inventions in modern medicine have generated as passionate and extended debate as the pulmonary artery catheter (PAC). Since its introduction in 1970, the PAC remains an indispensable monitor in cardiovascular critical care. Despite attempts to develop less invasive alternatives, the PAC remains unequaled as a single monitoring device capable of measuring physiological derangement in most components of the circulation, in the awake or sedated patient, with real-time feedback on the efficacy of an intervention. In reviewing the literature, we contend that the PAC remains the "gold standard" for hemodynamic monitoring of critically ill cardiac patients. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. Experience of developing rural surgical care in a remote mountainous region of Pakistan: Challenges and opportunities

    Directory of Open Access Journals (Sweden)

    R Alvi


    Full Text Available Background: Pakistan is one of the most populated countries with a population of 160 million; 67% are rural population but all the tertiary care facilities are concentrated in large cities. The Northern Areas is the most remote region with difficult terrain, harsh weather conditions and the tertiary care hospital at a distance of 600 km with traveling time of 16 h. The Aga Khan Medical Centre, Singul (AKMCS is a secondary healthcare facility in Ghizer district with a population of 132,000. AKMCS was established in 1992 to provide emergency and common elective surgical care. It has strengthened the primary health service through training, education and referral mechanism. It also provided an opportunity for family physicians to be trained in common surgical operations with special emphasis on emergency obstetric care. In addition it offers elective rotations for the residents and medical students to see the spectrum of diseases and to understand the concept of optimal care with limited resources. Methods and Results: The clinical data was collected prospectively using international classification of diseases ICD -9 coding and the database was developed on a desktop computer. Information about the operative procedures and outcome was separately collected on an Excel worksheet. The data from January 1998 to December 2001 were retrieved and descriptive analysis was done on epi info-6. Thirty-one thousand seven hundred and eighty-two patients were seen during this period, 53% were medical, 24% surgical, 16% obstetric and 7% with psychiatric illness. Out of 1990 surgical operations 32% were general surgery, 31% orthopedic, 21% pediatric, 12% obstetric and 4% urological cases; 42% of operations were done under general anesthesia, 22% spinal, 9% intravenous (IV ketamine, 6% IV sedation and 21% under local anesthesia. Six hundred and sixty-two were done in the main operation room including general surgery 337, obstetric 132, urological 67, pediatric 66

  20. Impact of Critical Care Nursing on 30-Day Mortality of Mechanically Ventilated Older Adults (United States)

    Kelly, Deena M.; Kutney-Lee, Ann; McHugh, Matthew D.; Sloane, Douglas M.; Aiken, Linda H.


    Objectives The mortality rate for mechanically ventilated older adults in ICUs is high. A robust research literature shows a significant association between nurse staffing, nurses’ education, and the quality of nurse work environments and mortality following common surgical procedures. A distinguishing feature of ICUs is greater investment in nursing care. The objective of this study is to determine the extent to which variation in ICU nursing characteristics—staffing, work environment, education, and experience—is associated with mortality, thus potentially illuminating strategies for improving patient outcomes. Design Multistate, cross-sectional study of hospitals linking nurse survey data from 2006 to 2008 with hospital administrative data and Medicare claims data from the same period. Logistic regression models with robust estimation procedures to account for clustering were used to assess the effect of critical care nursing on 30-day mortality before and after adjusting for patient, hospital, and physician characteristics. Setting Three hundred and three adult acute care hospitals in California, Florida, New Jersey, and Pennsylvania. Patients The patient sample included 55,159 older adults on mechanical ventilation admitted to a study hospital. Interventions None. Measurements and Main Results Patients in critical care units with better nurse work environments experienced 11% lower odds of 30-day mortality than those in worse nurse work environments. Additionally, each 10% point increase in the proportion of ICU nurses with a bachelor’s degree in nursing was associated with a 2% reduction in the odds of 30-day mortality, which implies that the odds on patient deaths in hospitals with 75% nurses with a bachelor’s degree in nursing would be 10% lower than in hospitals with 25% nurses with a bachelor’s degree in nursing. Critical care nurse staffing did not vary substantially across hospitals. Staffing and nurse experience were not associated with

  1. Delirium as a complication of the surgical intensive care (United States)

    Horacek, Rostislav; Krnacova, Barbora; Prasko, Jan; Latalova, Klara


    Background The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery. Patients and methods Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation–agitation scale. Their blood pressure, heart rate, respiratory rate, and peripheral blood oxygen saturation were measured continually, and body temperature was monitored once in an hour. The laboratory blood tests including sodium, potassium, chlorides, phosphorus, urea and creatinine, hemoglobin, hematocrit, red and white blood cell count, and C-reactive protein, albumin levels and laboratory markers of renal and liver dysfunction were done every day. All measurements were made at least for ten consecutive days or longer until the delirium resolved. Results The sample consisted of 140 consecutive delirious patients with a mean age of 68.21±12.07 years. Delirium was diagnosed in 140 of 5,642 patients (2.48%) admitted in CICUS in the last 5 years. The median duration of delirium was 48 hours with a range of 12–240 hours. Statistical analysis showed that hyperactive subtype of delirium and treatment with antipsychotics were associated with prolonged delirium duration (hyperactive 76.15±40.53 hours, hypoactive 54.46±28.44 hours, mixed 61.22±37.86 hours; Kruskal–Wallis test: 8.022; Ppiracetam 46.96±18.42 hours; Kruskal–Wallis test: 17.39, P<0.0005), and history of alcohol abuse (with a history of abuse 73.63±45.20 hours, without a history of abuse 59.54±30.61 hours; Mann–Whitney U=1,840; P<0.05). One patient had suffered from complicated postoperative hypostatic pneumonia and died due to respiratory failure (patient with hypoactive subtype). According to the backward stepwise multiple regression

  2. Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi. (United States)

    Tyson, Anna F; Msiska, Nelson; Kiser, Michelle; Samuel, Jonathan C; Mclean, Sean; Varela, Carlos; Charles, Anthony G


    Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services. We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control. A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively). Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Communication skills training curriculum for pulmonary and critical care fellows. (United States)

    McCallister, Jennifer W; Gustin, Jillian L; Wells-Di Gregorio, Sharla; Way, David P; Mastronarde, John G


    The Accreditation Council for Graduate Medical Education requires physicians training in pulmonary and critical care medicine to demonstrate competency in interpersonal communication. Studies have shown that residency training is often insufficient to prepare physicians to provide end-of-life care and facilitate patient and family decision-making. Poor communication in the intensive care unit (ICU) can adversely affect outcomes for critically ill patients and their family members. Despite this, communication training curricula in pulmonary and critical care medicine are largely absent in the published literature. We evaluated the effectiveness of a communication skills curriculum during the first year of a pulmonary and critical care medicine fellowship using a family meeting checklist to provide formative feedback to fellows during ICU rotations. We hypothesized that fellows would demonstrate increased competence and confidence in the behavioral skills necessary for facilitating family meetings. We evaluated a 12-month communication skills curriculum using a pre-post, quasiexperimental design. Subjects for this study included 11 first-year fellows who participated in the new curriculum (intervention group) and a historical control group of five fellows who had completed no formal communication curriculum. Performance of communication skills and self-confidence in family meetings were assessed for the intervention group before and after the curriculum. The control group was assessed once at the beginning of their second year of fellowship. Fellows in the intervention group demonstrated significantly improved communication skills as evaluated by two psychologists using the Family Meeting Behavioral Skills Checklist, with an increase in total observed skills from 51 to 65% (P ≤ 0.01; Cohen's D effect size [es], 1.13). Their performance was also rated significantly higher when compared with the historical control group, who demonstrated only 49% of observed skills

  4. Call 4 Concern: patient and relative activated critical care outreach. (United States)

    Odell, Mandy; Gerber, Karin; Gager, Melanie

    Patients can experience unexpected deterioration in their physiological condition that can lead to critical illness, cardiac arrest, admission to the intensive care unit and death. While ward staff can identify deterioration through monitoring physiological signs, these signs can be missed, interpreted incorrectly or mismanaged. Rapid response systems using early warning scores can fail if staff do not follow protocols or do not notice or manage deterioration adequately. Nurses often notice deterioration intuitively because of their knowledge of individual patients. Patients and their relatives have the greatest knowledge of patients, and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems. However, this ability has been largely overlooked. Call 4 Concern (C4C) is a scheme where patients and relatives can call critical care teams directly if they are concerned about a patient's condition- it is believed to be the first of its kind in the UK. A C4C feasibility project ran for six months, covering patients being transferred from the intensive care unit to general wards. C4C has the potential to prevent clinical deterioration and is valued by patients and relatives. Concerns of ward staff could be managed through project management. As it is relatively new, this field offers further opportunities for research.

  5. Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions. (United States)

    Haider, Adil H; Schneider, Eric B; Sriram, N; Dossick, Deborah S; Scott, Valerie K; Swoboda, Sandra M; Losonczy, Lia; Haut, Elliott R; Efron, David T; Pronovost, Peter J; Lipsett, Pamela A; Cornwell, Edward E; MacKenzie, Ellen J; Cooper, Lisa A; Freischlag, Julie A


    Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities. To determine whether clinicians' unconscious race and/or social class biases correlate with patient management decisions. We conducted a web-based survey among 230 physicians from surgery and related specialties at an academic, level I trauma center from December 1, 2011, through January 31, 2012. We administered clinical vignettes, each with 3 management questions. Eight vignettes assessed the relationship between unconscious bias and clinical decision making. We performed ordered logistic regression analysis on the Implicit Association Test (IAT) scores and used multivariable analysis to determine whether implicit bias was associated with the vignette responses. Differential response times (D scores) on the IAT as a surrogate for unconscious bias. Patient management vignettes varied by patient race or social class. Resulting D scores were calculated for each management decision. In total, 215 clinicians were included and consisted of 74 attending surgeons, 32 fellows, 86 residents, 19 interns, and 4 physicians with an undetermined level of education. Specialties included surgery (32.1%), anesthesia (18.1%), emergency medicine (18.1%), orthopedics (7.9%), otolaryngology (7.0%), neurosurgery (7.0%), critical care (6.0%), and urology (2.8%); 1.9% did not report a departmental affiliation. Implicit race and social class biases were present in most respondents. Among all clinicians, mean IAT D scores for race and social class were 0.42 (95% CI, 0.37-0.48) and 0.71 (95% CI, 0.65-0.78), respectively. Race and class scores were similar across departments (general surgery, orthopedics, urology, etc), race, or age. Women demonstrated less bias concerning race (mean IAT D score, 0.39 [95% CI, 0.29-0.49]) and social class (mean IAT D score

  6. A critical appraisal of point-of-care coagulation testing in critically ill patients. (United States)

    Levi, M; Hunt, B J


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

  7. Ethical persuasion: the rhetoric of communication in critical care. (United States)

    Dubov, Alex


    This article reviews the ethics of rhetoric in critical care. Rational appeals in critical care fail to move patients or surrogates to a better course of action. Appeals to their emotions are considered illegitimate because they may preclude autonomous choice. This article discusses whether it is always unethical to change someone's beliefs, whether persuasive communication is inherently harmful and whether it leaves no space for voluntariness. To answer these questions, the article engages with Aristotle's work, Rhetoric. In considering whether there is a place for emotionally charged messages in a patient-provider relationship, the article intends to delineate the nature of this relationship and describe the duties this relationship implies. The article presents examples of persuasive communication used in critical care and discusses whether providers may have a duty to persuade patients. This duty is supported by the fact that doctors often influence patients' and families' choices by framing presented options. Doctors should assume responsibility in recognizing these personal and contextual influences that may influence the medical choices of their patients. They should attempt to modify these contextual factors and biases in a way that would assist patients and families in reaching the desired outcomes. The opening sections surveyed a number of definitions found in relevant literature and outlined some of the concepts included in the proposed definition. This definition helps to distinguish instances of persuasion from cases of manipulation, coercion and deception. Considering the fact that patients and families often make irrational decisions and the fact that doctors inadvertently influence their choices, the article suggested that persuasion can be a positive tool in medical communication. When patients or families clearly do not understand the risks or make decisions that contradict their long-term goals, persuasion can be used as a positive influence.

  8. Failures in communication and information transfer across the surgical care pathway: interview study. (United States)

    Nagpal, Kamal; Arora, Sonal; Vats, Amit; Wong, Helen W; Sevdalis, Nick; Vincent, Charles; Moorthy, Krishna


    Effective communication is imperative to safe surgical practice. Previous studies have typically focused upon the operating theatre. This study aimed to explore the communication and information transfer failures across the entire surgical care pathway. Using a qualitative approach, semi-structured interviews were conducted with 18 members of the multidisciplinary team (seven surgeons, five anaesthetists and six nurses) in an acute National Health Service trust. Participants' views regarding information transfer and communication failures at each phase of care, their causes, effects and potential interventions were explored. Interviews were recorded, transcribed verbatim, and submitted to emergent theme analysis. Sampling ceased when categorical and theoretical saturation was achieved. Preoperatively, lack of communication between anaesthetists and surgeons was the most common problem (13/18 participants). Incomplete handover from the ward to theatre (12/18) and theatre to recovery (15/18) were other key problems. Work environment, lack of protocols and primitive forms of information transfer were reported as the most common cause of failures. Participants reported that these failures led to increased morbidity and mortality. Healthcare staff were strongly supportive of the view that standardisation and systematisation of communication processes was essential to improve patient safety. This study suggests communication failures occur across the entire continuum of care and the participants opined that it could have a potentially serious impact on patient safety. This data can be used to plan interventions targeted at the entire surgical pathway so as to improve the quality of care at all stages of the patient's journey.

  9. [Risk management in anesthesia and critical care medicine]. (United States)

    Eisold, C; Heller, A R


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

  10. [Multimodal neuromonitoring for the critical care management of acute coma]. (United States)

    Ltaief, Z; Ben-Hamouda, N; Suys, T; Daniel, R T; Rossetti, A O; Oddo, M


    Management of neurocritical care patients is focused on the prevention and treatment of secondary brain injury, i.e. the number of pathophysiological intracerebral (edema, ischemia, energy dysfunction, seizures) and systemic (hyperthermia, disorders of glucose homeostasis) events that occur following the initial insult (stroke, hemorrhage, head trauma, brain anoxia) that may aggravate patient outcome. The current therapeutic paradigm is based on multimodal neuromonitoring, including invasive (intracranial pressure, brain oxygen, cerebral microdialysis) and non-invasive (transcranial doppler, near-infrared spectroscopy, EEG) tools that allows targeted individualized management of acute coma in the early phase. The aim of this review is to describe the utility of multimodal neuromonitoring for the critical care management of acute coma.

  11. Extracorporeal Membrane Oxygenation Applications in Cardiac Critical Care. (United States)

    Raleigh, Lindsay; Ha, Rich; Hill, Charles


    The use of extracorporeal membrane oxygenation therapy (ECMO) in cardiac critical care has steadily increased over the past decade. Significant improvements in the technology associated with ECMO have propagated this recent resurgence and contributed to improved patient outcomes in the fields of cardiac and transplant (heart and lung) surgery. Specifically, ECMO is being increasingly utilized as a bridge to heart and lung transplantation, as well as to ventricular assist device placement. ECMO is also employed during the administration of cardiopulmonary resuscitation, known as extracorporeal life support. In this review, we examine the recent literature regarding the applications of ECMO and also describe emerging topics involving current ECMO management strategies.

  12. Dose Adjustment- An Important Issue in Critical Care

    Directory of Open Access Journals (Sweden)

    Dr. M. C. Joshi


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

  13. Medical simulation in respiratory and critical care medicine. (United States)

    Lam, Godfrey; Ayas, Najib T; Griesdale, Donald E; Peets, Adam D


    Simulation-based medical education has gained tremendous popularity over the past two decades. Driven by the patient safety movement, changes in the educational opportunities available to trainees and the rapidly evolving capabilities of computer technology, simulation-based medical education is now being used across the continuum of medical education. This review provides the reader with a perspective on simulation specific to respiratory and critical care medicine, including an overview of historical and modern simulation modalities and the current evidence supporting their use.

  14. Novel biomarkers in critical care: utility or futility? (United States)

    Ackland, Gareth L; Mythen, Michael G


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

  15. Reducing medication errors in critical care: a multimodal approach

    Directory of Open Access Journals (Sweden)

    Kruer RM


    Full Text Available Rachel M Kruer,1 Andrew S Jarrell,1 Asad Latif2,3 1Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA; 2Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 3Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA Abstract: The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days. The formulation of drugs is a potential contributor to medication errors. Challenges related to drug formulation are specific to the various routes of medication administration, though errors associated with medication appearance and labeling occur among all drug formulations and routes of administration. Addressing these multifaceted challenges requires a multimodal approach. Changes in technology, training, systems, and safety culture are all strategies to potentially reduce medication errors related to drug formulation in the intensive care unit. Keywords: medication safety, drug design, drug formulation, patient safety

  16. Rethinking critical reflection on care: late modern uncertainty and the implications for care ethics. (United States)

    Vosman, Frans; Niemeijer, Alistair


    Care ethics as initiated by Gilligan, Held, Tronto and others (in the nineteen eighties and nineties) has from its onset been critical towards ethical concepts established in modernity, like 'autonomy', alternatively proposing to think from within relationships and to pay attention to power. In this article the question is raised whether renewal in this same critical vein is necessary and possible as late modern circumstances require rethinking the care ethical inquiry. Two late modern realities that invite to rethink care ethics are complexity and precariousness. Late modern organizations, like the general hospital, codetermined by various (control-, information-, safety-, accountability-) systems are characterized by complexity and the need for complexity reduction, both permeating care practices. By means of a heuristic use of the concept of precariousness, taken as the installment of uncertainty, it is shown that relations and power in late modern care organizations have changed, precluding the use of a straightforward domination idea of power. In the final section a proposition is made how to rethink the care ethical inquiry in order to take late modern circumstances into account: inquiry should always be related to the concerns of people and practitioners from within care practices.

  17. The Surgical Care Improvement Project Antibiotic Guidelines: Should We Expect More Than Good Intentions? (United States)

    Schonberger, Robert B; Barash, Paul G; Lagasse, Robert S


    Since 2006, the Surgical Care Improvement Project (SCIP) has promoted 3 perioperative antibiotic recommendations designed to reduce the incidence of surgical site infections. Despite good evidence for the efficacy of these recommendations, the efforts of SCIP have not measurably improved the rates of surgical site infections. We offer 3 arguments as to why SCIP has fallen short of expectations. We then suggest a reorientation of quality improvement efforts to focus less on reporting, and incentivizing adherence to imperfect metrics, and more on creating local and regional quality collaboratives to educate clinicians about how to improve practice. Ultimately, successful quality improvement projects are behavioral interventions that will only succeed to the degree that they motivate individual clinicians, practicing within a particular context, to do the difficult work of identifying failures and iteratively working toward excellence.

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

    Directory of Open Access Journals (Sweden)

    S Moola


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

  19. Overview of point-of-care abdominal ultrasound in emergency and critical care. (United States)

    Kameda, Toru; Taniguchi, Nobuyuki


    Point-of-care abdominal ultrasound (US), which is performed by clinicians at bedside, is increasingly being used to evaluate clinical manifestations, to facilitate accurate diagnoses, and to assist procedures in emergency and critical care. Methods for the assessment of acute abdominal pain with point-of-care US must be developed according to accumulated evidence in each abdominal region. To detect hemoperitoneum, the methodology of a focused assessment with sonography for a trauma examination may also be an option in non-trauma patients. For the assessment of systemic hypoperfusion and renal dysfunction, point-of-care renal Doppler US may be an option. Utilization of point-of-care US is also considered in order to detect abdominal and pelvic lesions. It is particularly useful for the detection of gallstones and the diagnosis of acute cholecystitis. Point-of-case US is justified as the initial imaging modality for the diagnosis of ureterolithiasis and the assessment of pyelonephritis. It can be used with great accuracy to detect the presence of abdominal aortic aneurysm in symptomatic patients. It may also be useful for the diagnoses of digestive tract diseases such as appendicitis, small bowel obstruction, and gastrointestinal perforation. Additionally, point-of-care US can be a modality for assisting procedures. Paracentesis under US guidance has been shown to improve patient care. US appears to be a potential modality to verify the placement of the gastric tube. The estimation of the amount of urine with bladder US can lead to an increased success rate in small children. US-guided catheterization with transrectal pressure appears to be useful in some male patients in whom standard urethral catheterization is difficult. Although a greater accumulation of evidences is needed in some fields, point-of-care abdominal US is a promising modality to improve patient care in emergency and critical care settings.

  20. Systematic review of the use of computer simulation modeling of patient flow in surgical care. (United States)

    Sobolev, Boris G; Sanchez, Victor; Vasilakis, Christos


    Computer simulation has been employed to evaluate proposed changes in the delivery of health care. However, little is known about the utility of simulation approaches for analysis of changes in the delivery of surgical care. We searched eight bibliographic databases for this comprehensive review of the literature published over the past five decades, and found 34 publications that reported on simulation models for the flow of surgical patients. The majority of these publications presented a description of the simulation approach: 91% outlined the underlying assumptions for modeling, 88% presented the system requirements, and 91% described the input and output data. However, only half of the publications reported that models were constructed to address the needs of policy-makers, and only 26% reported some involvement of health system managers and policy-makers in the simulation study. In addition, we found a wide variation in the presentation of assumptions, system requirements, input and output data, and results of simulation-based policy analysis.

  1. Analysis of needs of the critically ill relatives and critical care professional's opinion. (United States)

    Sánchez-Vallejo, A; Fernández, D; Pérez-Gutiérrez, A; Fernández-Fernández, M


    To describe the needs of the families of patients admitted to the Intensive Care Unit (ICU) and the opinion of ICU professionals on aspects related to the presence of patient relatives in the unit. A prospective descriptive study was carried out between March and June 2015. Polyvalent ICU of León University Healthcare Complex (Spain). Two samples of volunteers were studied: one comprising the relatives emotionally closest to the primarily non-surgical patients admitted to the Unit for over 48hours, and the other composed of ICU professionals with over three months of experience in the ICU. One self-administered questionnaire was delivered to each relative and another to each professional. Sociodemographic data were collected. The variables in the questionnaire for relatives comprised the information received, closeness to the patient, safety of care, the support received, and comfort. In turn, the questionnaire for professionals addressed empathy and professional relationship with the family, visiting policy, and the effect of the family upon the patient. A total of 59% of the relatives (35/61) answered the questionnaire. Of these subjects, 91.4% understood the information received, though 49.6% received no information on nursing care. A total of 82.9% agreed with the visiting policy applied (95.2% were patient offspring; P<.05). Participation on the part of the professionals in turn reached 76.3% (61/80). A total of 59.3% would flexibilize the visiting policy, and 78.3% considered that the family afforded emotional support for the patient, with no destabilizing effect. On the other hand, 62.3% routinely informed the family, and 88% considered training in communication skills to be needed. Information was adequate, though insufficient in relation to nursing care. The professionals pointed to the need for training in communication skills. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  2. Poor cataract surgical output: eye care workers perspective in north central Nigeria. (United States)

    Adepoju, F G; Adekoya, B J; Ayanniyi, A A; Olatunji, V


    Cataract remains a disease of priority being the leading cause of blindness globally. Although surgically curable, cataract surgical output has remained low in Nigeria, Kwara state inclusive. A study was carried out to investigate the perception of eye care workers (ECW) on low surgical output and their adjudged reasons; this has hitherto not being evaluated. A cross-sectional quantitative survey with the aid of pretested structured questionnaire of all ECW and qualitative survey using in-depth interview on selected workers in Kwara State, Nigeria was done. A total of 142 out of the 157 ECWs (90.5%) working in the 14 surgical eye centers in the state were interviewed with a mean age of 40.37 years, SD ± 8.67. There were 94 (66.2%) females, with a female to male ratio of 2:1. 91 (64.1%) participants were of the opinion that the numbers of cataract surgeries in the state were inadequate. Hospital-based and human resource efficiency-related issues such as long clinic waiting time, multiple paying and procedural sites, poor staff mix, and gaps in available human resource were the major reasons given for low cataract output. Others reasons were high cost and fear of surgery, distance of eye clinics from patients. Regular operational researches, proper deployment, and efficient use of human and material resources in addition to subsidized cost and appropriate health education to allay fear of surgery are steps that could enhance cataract surgical output.

  3. Early Critical Care Course in Children after Liver Transplant (United States)

    Daoud, Hani; Bola, Sundeep S.; Singh, Ram N.; Atkison, Paul; Kornecki, Alik


    Objective. To review the critical care course of children receiving orthotopic liver transplantation (OLT). Methods. A retrospective chart review of patients admitted to the pediatric critical care following OLT performed in our center between 1988 and 2011. Results. A total of 149 transplants in 145 patients with a median age of 2.7 (IQR 0.9–7) years were analyzed. Mortality in the first 28 days was 8%. The median length of stay (LOS) was 7 (4.0–12.0) days. The median length of mechanical ventilation (MV) was 3 (1.0–6.2) days. Open abdomen, age, and oxygenation index on the 2nd day predicted LOS. Open abdomen, age, amount of blood transfused during surgery, and PRISM III predicted length of MV. 28% of patients had infection and 24% developed acute rejection. In recent group (2000–2011) OLT was performed in younger patients; the risk of infection and acute rejection was reduced and patients required longer LOS and MV compared with old group (1988–1999). Conclusion. The postoperative course of children after OLT is associated with multiple complications. In recent years OLT was performed in younger children; living donors were more common; the rate of postoperative infection and suspected rejection was reduced significantly; however patients required longer MV and LOS in the PCCU. PMID:25328695

  4. Critical care for paediatric patients with heart failure. (United States)

    Costello, John M; Mazwi, Mjaye L; McBride, Mary E; Gambetta, Katherine E; Eltayeb, Osama; Epting, Conrad L


    This review offers a critical-care perspective on the pathophysiology, monitoring, and management of acute heart failure syndromes in children. An in-depth understanding of the cardiovascular physiological disturbances in this population of patients is essential to correctly interpret clinical signs, symptoms and monitoring data, and to implement appropriate therapies. In this regard, the myocardial force-velocity relationship, the Frank-Starling mechanism, and pressure-volume loops are discussed. A variety of monitoring modalities are used to provide insight into the haemodynamic state, clinical trajectory, and response to treatment. Critical-care treatment of acute heart failure is based on the fundamental principles of optimising the delivery of oxygen and minimising metabolic demands. The former may be achieved by optimising systemic arterial oxygen content and the variables that determine cardiac output: heart rate and rhythm, preload, afterload, and contractility. Metabolic demands may be decreased by a number of ways including positive pressure ventilation, temperature control, and sedation. Mechanical circulatory support should be considered for refractory cases. In the near future, monitoring modalities may be improved by the capture and analysis of complex clinical data such as pressure waveforms and heart rate variability. Using predictive modelling and streaming analytics, these data may then be used to develop automated, real-time clinical decision support tools. Given the barriers to conducting multi-centre trials in this population of patients, the thoughtful analysis of data from multi-centre clinical registries and administrative databases will also likely have an impact on clinical practice.

  5. Improving the quality of care of the critically ill patients: Implementing ...

    African Journals Online (AJOL)

    Care bundles were originally developed in the USA as a health care ... The consistent implementation of evidence-based practice has been proven to improve ... included articles published in the medical and nursing critical care literature from ...

  6. Stress-related Psychological Disorders Among Surgical Care Nurses in Latvia


    Kristaps Circenis; Liana Deklava


    Background: The subject of stress related psychological disorders is considered to be one of the mostcritical problems in the 21st century. Latvia’s social-economic situation is stressful and a lot of nurses stillneed to work more than one shift. There are no complete studies about surgical care nurses and operatingroom nurses burnout, depression, anxiety and compassion fatigue situation in Latvia.Aim and Objectives: Research aim was to find out burnout, depression, compassion fatigue and anx...

  7. Body, stress and nursing: ethnography of an Intensive Care and Surgical Center


    Martins, Maria das Graças Teles [UNIFESP; Castro, Odilon; Pereira,Pedro Paulo Gomes


    This text seeks to reflect on the concepts of stress among nurses that work in the Surgical and Intensive Care Centers of a teaching hospital in the State of Paraíba. Qualitative ethnographic research allowed us to perceive that when talking about stress, these professionals mentioned their bodies and bodily manifestations. The research undertaken allowed us to understand the intimate relationships between the body, stress and nursing.

  8. Healthcare information technology and medical-surgical nurses: the emergence of a new care partnership. (United States)

    Moore, An'Nita; Fisher, Kathleen


    Healthcare information technology in US hospitals and ambulatory care centers continues to expand, and nurses are expected to effectively and efficiently utilize this technology. Researchers suggest that clinical information systems have expanded the realm of nursing to integrate technology as an element as important in nursing practice as the patient or population being served. This study sought to explore how medical surgical nurses make use of healthcare information technology in their current clinical practice and to examine the influence of healthcare information technology on nurses' clinical decision making. A total of eight medical surgical nurses participated in the study, four novice and four experienced. A conventional content analysis was utilized that allowed for a thematic interpretation of participant data. Five themes emerged: (1) healthcare information technology as a care coordination partner, (2) healthcare information technology as a change agent in the care delivery environment, (3) healthcare information technology-unable to meet all the needs, of all the people, all the time, (4) curiosity about healthcare information technology-what other bells and whistles exist, and (5) Big Brother is watching. The results of this study indicate that a new care partnership has emerged as the provision of nursing care is no longer supplied by a single practitioner but rather by a paired team, consisting of nurses and technology, working collaboratively in an interdependent relationship to achieve established goals.

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

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    L. Abed-Eddin


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

  10. Weaning readiness and fluid balance in older critically ill surgical patients. (United States)

    Epstein, Carol Diane; Peerless, Joel R


    Few studies address predictors for successful weaning of older adults from mechanical ventilation. To develop a clinical profile of older patients who are successfully weaned from long-term mechanical ventilation. Forty patients in the trauma and surgical intensive care unit who were at least 60 years old were enrolled in the study after 3 days of active weaning and were monitored daily until successfully weaned or until the end of the 14-day study. Hemodynamic and gas exchange variables, fluid balance, oxygen cost of breathing, and scores on the Burns Weaning Assessment Program were analyzed. Compared with patients who were not weaned, successfully weaned patients required mechanical ventilation for 5.3 days, started active weaning earlier (mean 10.7 vs 14.5 days, P = .04), had lower mean negative daily fluid balances in the beginning (-0.394 vs 1.107 L, P = .004), and had lower mean net cumulative fluid balances (6.856 vs 16.212 L) at the time of enrollment. They also maintained both a lower mean net cumulative fluid balance (10.753 vs 25.049 L, P= .02) and a negative daily fluid balance (-0.389 vs 1.904 L, P = .03) throughout. Their mean central venous pressure decreased over time and was significantly lower (Psurgical patients is associated with prolonged mechanical ventilation. Estimates of fluid balance might be useful in weaning older patients from long-term mechanical ventilation.

  11. Humanitarian Surgical Care Provided by a French Forward Surgical Team: Ten Years of Providing Medical Support to the Population of the Ivory Coast. (United States)

    Bonnet, Stéphane; Bertani, Antoine; Savoie, Pierre-Henri; Mathieu, Laurent; Boddaert, Guillaume; Gonzalez, Federico; Poichotte, Antoine; Durand, Xavier; Rongiéras, Frédéric; Balandraud, Paul; Pons, François; Rigal, Sylvain


    The aims of this study were as follows: first to quantify and review the types of surgical procedures performed by military surgeons assigned to a Forward Surgical Team (FST) providing medical support to the population (MSP) in the Ivory Coast (IC), and second to analyze how this MSP was achieved. Between 2002 and 2012, all of the local nationals operated on by the different FSTs deployed in the IC were included in the study. The surgical activity was analyzed and divided into surgical specialties, war wounds, nonwar emergency trauma, nontrauma emergencies, and elective surgery. Demographics, circumstances of health care management, wounded organs, and types of surgical procedures were described. Over this period, surgeons operated on 2,315 patients and performed 2,556 procedures. Elective surgery accounted for 78.7% of the surgical activity, nontrauma emergencies accounted for 12.7%, nonwar emergency trauma accounted for 8%, and war wounds accounted for 0.6%. The main surgical activities were visceral (43.8%) and orthopedic (including soft tissues) surgeries (38.5%). The FSTs contributed widely to MSP in the IC. This MSP required limited resources, standardization of the procedures and specific skills beyond the original surgical specialties of military surgeons to fulfill the needs of the local population. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  12. [Problems of organization of surgical care to the wounded in a modern armed conflict: surgical care to the walking wounded in armed conflicts (Report 2)]. (United States)

    Samokhvalov, I M; Kotenko, P K; Severin, V V


    There are two triage groups of the walking wounded in a medical company of a brigade/special-purpose medical team: those returning to fighting role and those who have to be evacuated to level 3 echelon of care. The main purposes of surgical care of the walking wounded in the 3rd echelon of care are the following: diagnosis of injury pattern ruling out severe damages and separation of the independent category of the walking wounded. There is medical evacuation of the walking wounded from the 3rd echelon to the 4th echelon deployed in a combat zone. The walking wounded who needs less than 30 days of staying in hospital are evacuated to the garrison military hospitals and medical treatment facilities subordinated to a district military hospital. The wounded with the prolonged period of hospitalization (more than 30 days) are evacuated toward the district military hospital. Treatment of the walking wounded should be accomplished in the military district where the armed conflict goes on.

  13. Creating healing intensive care unit environments: physical and psychological considerations in designing critical care areas. (United States)

    Bazuin, Doug; Cardon, Kerrie


    A number of elements contribute to a healing ICU environment. The layout of a critical care unit helps create an environment that supports caregiving, which helps alleviate a host of work-related stresses. A quieter environment, one that includes family and friends, dotted with windows and natural light, creates a space that makes people feel balanced and reassured. A healing environment responds to the needs of all the people within a critical care unit-those who receive or give care and those who support patients and staff. Critical care units should be designed to focus on healing the body, the mind, and the senses. The design and policies of that department can be created in such a way to provide a sense of calm and balance. The physical environment has an impact on patient outcomes; the psychological environment can, too. A healing ICU environment will balance both. The authors discuss the ways in which architecture, interior design, and behavior contribute to a healing ICU environment.

  14. Complicated deliveries, critical care and quality in emergency obstetric care in Northern Tanzania. (United States)

    Olsen, Ø E; Ndeki, S; Norheim, O F


    Our objective was to determine the availability and quality of obstetric care to improve resource allocation in northern Tanzania. We surveyed all facilities providing delivery services (n=129) in six districts in northern Tanzania using the UN Guidelines for monitoring emergency obstetric care (EmOC). The three last questions in this audit outline are examined: Are the right women (those with obstetric complications) using emergency obstetric care facilities (Met Need)? Are sufficient quantities of critical services being provided (cesarean section rate (CSR))? Is the quality of the services adequate (case fatality rate (CFR))? Complications are calculated using Plan 3 of the UN Guidelines to assess the value of routine data for EmOC indicator monitoring. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC qualified health facilities. 81.2% of the expected complicated deliveries are conducted in any facility (including facilities not qualifying as EmOC facilities). There is an inadequate level of critical services provided (CSR 4.6). Voluntary agencies provide most of these services in rural settings. All indicators show large variations with the setting (urban/rural location, level and ownership of facilities). Finally, there is large variation in the CFR with only one facility meeting the minimum accepted level. Utilization and quality of critical obstetric services at lower levels and in rural districts must be improved. The potential for improving the resource allocation within lower levels of the health care system is discussed. Given the small number of qualified facilities yet relatively high Met Need, we argue that it is neither the mothers' ignorance nor their lack of ability to get to a facility that is the main barrier to receiving quality care when needed, but rather the lack of quality care at the facility. Little can be concluded using the CFR to describe the quality of services provided.

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

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    Ilan Roy


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

  16. Critical care nurses' perceptions of their roles in family-team conflicts related to treatment plans. (United States)

    Edwards, Marie Patricia; Throndson, Karen; Dyck, Felicia


    Conflict over treatment plans is a cause of concern for those working in critical care environments. The purpose of this study was to explore and describe critical care nurses' perceptions of their roles in situations of conflict between family members and health-care providers in intensive care units. Using a qualitative descriptive design, 12 critical care nurses were interviewed individually and 4 experienced critical care nurses participated in focus group interviews. The roles described by the nurses were as follows: providing safe, competent, quality care to patients; building or restoring relationships of trust with families; and supporting other nurses. The nurses highlighted the level of stress when conflict arises, the need to be cautious in providing care and communicating with family members, and the need for support for nurses. More research related to working in situations of conflict is required, as is enhanced education for critical care nurses.

  17. Diabulimia: what it is and how to recognize it in critical care. (United States)

    Ruth-Sahd, Lisa A; Schneider, Melissa; Haagen, Brigitte


    Critical care nurses must be able to recognize the signs of symptoms of diabulimia-a potentially life-threatening disorder. Skipping insulin is used as a means of weight control in some persons with diabetes, particularly in young women. This article focuses on the assessment, pathophysiology, critical care nursing interventions, and psychosocial initiatives of interest to critical care nurses in the care of patients with diabulimia.

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


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


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

  19. The progression of holism into postgraduate curricula in critical care nursing: a discussion paper. (United States)

    Lane, Paula; O'Brien, Una; Gooney, Martina A; Reid, Tony


    Critical care education is an important part of the professional development of a competent critical care nurse. Interdependence between physiological and psychosocial theories and concepts is a key consideration in the development of critical care educational programs. This multidisciplinary educational framework fosters a deeper understanding of factors contributing to ill health. Establishing a strategic framework where research, education, clinical excellence, and quality assurance are interlinked is central to enhancing the efficacy of patient care outcomes.

  20. Situational Analysis of Essential Surgical Care Management in Iran Using the WHO Tool. (United States)

    Kalhor, Rohollah; Keshavarz Mohamadi, Nastaran; Khalesi, Nader; Jafari, Mehdi


    Surgery is an essential component of health care, yet it has usually been overlooked in public health across the world. This study aimed to perform a situational analysis of essential surgical care management at district hospitals in Iran. This research was a descriptive and cross-sectional study performed at 42 first-referral district hospitals of Iran in 2013. The World Health Organization (WHO) Tool for the situational analysis of emergency and essential care was used for data collection in four domains of facilities and equipment, human resources, surgical interventions, and infrastructure. Data analysis was conducted using simple descriptive statistical methods. In this study, 100% of the studied hospitals had oxygen cylinders, running water, electricity, anesthesia machines, emergency departments, archives of medical records, and X-ray machines. In 100% of the surveyed hospitals, specialists in surgery, anesthesia, and obstetrics and gynecology were available as full-time staff. Life-saving procedures were performed in the majority of the hospitals. Among urgent procedures, neonatal surgeries were conducted in 14.3% of the hospitals. Regarding non-urgent procedures, acute burn management was conducted in 38.1% of the hospitals. Also, a few other procedures such as cricothyrotomy and foreign body removal were performed in 85.7% of the hospitals. The results indicated that suitable facilities and equipment, human resources, and infrastructure were available in the district hospitals in Iran. These findings showed that there is potential for the district hospitals to provide care in a wider spectrum.

  1. Developing the PLA critical care medicine is critical for advancing the level of battle wound treatment in the new era

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    Wei-qin LI


    Full Text Available Critical care medicine is an emerging unique specialty developed from the later 20th century, since then, it has been enriched with theoretical and practical experiences and becomes the most active subject in the field of clinical medicine. Critical care medicine of the PLA has attained significant achievements in the treatment and research of severe trauma, sepsis, severe heat stroke, multiple organ failure and severe acute pancreatitis. Besides, it stands in the leading position in the organ function maintenance of critically ill patients, continuous hemofiltration and nutrition support in China. Furthermore, critical care medicine plays an important role in the rescue of critically ill patients, medical support and disaster relief. As the relationship between battle wound rescue system and critical care medicine has been increasingly close, transition in the form of war in the new period brings new tasks to battle wound treatment constantly. Combined with the characteristics of information-oriented war condition in the future, developing the PLA critical care medicine and advancing the level of battle wound treatment in the new period point out the direction for the future work of critical care medicine. DOI: 10.11855/j.issn.0577-7402.2017.02.01

  2. Mindful meditation: healing burnout in critical care nursing. (United States)

    Davies, William Richard


    The nursing profession is experiencing a crisis in both manpower and the ability to fend off the deleterious effects of burnout. Nursing professionals face extraordinary stress in our present medical environment, and studies have frequently found moderate-to-high levels of burnout among nurses. Nurses experience burnout for a variety of reasons, some inherent to the profession and others related to our 21st-century values that have necessitated multiple breadwinners within the household. Mindful meditation represents a complementary therapy that has shown promise in the reduction of negative stress and those extraneous factors that lead to burnout. A mindful, meditative practice can be another tool with which critical care nurses can regain the control of their careers and personal lives. The purpose of this article is to describe nurse burnout, identify those factors that contribute to burnout, and offer a solution to a continuing problem for nurses.

  3. Effect of caring behavior on disposition toward critical thinking of nursing students. (United States)

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


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

  4. A qualitative study exploring contextual challenges to surgical care provision in 21 LMICs. (United States)

    Raykar, Nakul P; Yorlets, Rachel R; Liu, Charles; Greenberg, Sarah L M; Kotagal, Meera; Goldman, Roberta; Roy, Nobhojit; Meara, John G; Gillies, Rowan D


    Billions of people worldwide are without access to safe, affordable, and timely surgical care. The Lancet Commission on Global Surgery (LCoGS) conducted a qualitative study to understand the contextual challenges to surgical care provision in low-income and middle-income countries (LMICs), and how providers overcome them. A semi-structured interview was administered to 143 care providers in 21 LMICs using stratified purposive sampling to include both urban and rural areas and reputational case selection to identify individual providers. Interviews were conducted in Argentina (n=5), Botswana (3), Brazil (10), Cape Verde (4), China (14), Colombia (4), Ecuador (6), Ethiopia (10), India (15), Indonesia (1), Mexico (9), Mongolia (4), Namibia (2), Pakistan (13), Peru (5), Philippines (1), Sierra Leone (11), Tanzania (5), Thailand (2), Uganda (9), and Zimbabwe (15). Local collaborators of LCoGS conducted interviews using a standardised implementation manual and interview guide. Questions revolved around challenges or barriers in the area of access to care for patients; challenges or barriers in the area of in-hospital care for patients; and challenges or barriers in the area of governance or health policy. De-identified interviews were coded and interpreted by an independent analyst. Providers across continent and context noted significant geographical, financial, and educational barriers to access. Surgical care provision in the rural hospital setting was hindered by a paucity of trained workforce, and inadequacies in basic infrastructure, equipment, supplies, and access to banked blood. In urban areas, providers face high patient volumes combined with staff shortages, minimal administrative support, and poor interhospital care coordination. At a policy level, providers identified regulations that were inconsistent with the realities of low-resource care provision (eg, a requirement to provide 'free' care to certain populations but without any guarantee for funding

  5. Promoting quality of care in disaster response: A survey of core surgical competencies. (United States)

    Wong, Evan G; Razek, Tarek; Elsharkawi, Hossam; Wren, Sherry M; Kushner, Adam L; Giannou, Christos; Khwaja, Kosar A; Beckett, Andrew; Deckelbaum, Dan L


    Recent humanitarian crises have led to a call for professionalization of the humanitarian field, but core competencies for the delivery of surgical care have yet to be established. The objective of this study was to survey surgeons with experience in disaster response to identify surgical competencies required to be effective in these settings. An online survey elucidating demographic information, scope of practice, and previous experience in global health and disaster response was transmitted to surgeons from a variety of surgical societies and nongovernmental organizations. Participants were provided with a list of 111 operative procedures and were asked to identify those deemed essential to the toolset of a frontline surgeon in disaster response via a Likert scale. Responses from personnel with experience in disaster response were contrasted with those from nonexperienced participants. A total of 147 surgeons completed the survey. Participants held citizenship in 22 countries, were licensed in 30 countries, and practiced in >20 countries. Most respondents (56%) had previous experience in humanitarian response. The majority agreed or strongly agreed that formal training (54%), past humanitarian response (94%), and past global health experiences (80%) provided adequate preparation. The most commonly deemed important procedures included control of intraabdominal hemorrhage (99%), abdominal packing for trauma (99%), and wound debridement (99%). Procedures deemed important by experienced personnel spanned multiple specialties. This study addressed specifically surgical competencies in disaster response. We provide a list of operative procedures that should set the stage for further structured education programs. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. The anxious production of beauty: Unruly bodies, surgical anxiety and invisible care. (United States)

    Leem, So Yeon


    This study is based on ethnographic fieldwork at a plastic surgery clinic in Seoul, South Korea. Examining the three phases of plastic--consultation, operation and recovery--I show how surgeons work to shape not only patients' bodies but also expectations and satisfaction. Surgeons do so in part to assuage their own anxieties, which arise from the possibility of misaligned beauty standards and unforeseen anatomies, as well as the possible dissatisfaction of the patient. I offer the concept of 'surgical anxiety', which occurs in relation to inherently unruly patient bodies in which worries, fear, frustration, self-pity, cynicism, anger and even loneliness are symptomatic. The unpredictability and uncontrollability of patients' bodies, which generates anxiety for both patients and surgeons, work to constrain the power of plastic surgery and making it inherently vulnerable. This study also pays attention to the invisible work of taking care of surgical anxiety, as practised by female staff members, and surgeons' dependence on these workers. My focus on anxiety is a kind of remedy for the predominant concern with 'ambivalence' in constructivist science and technology studies; rather than continue to highlight the power differentials between experts/practitioners and lay people/patients, this study illuminates surgical anxiety as their shared vulnerability. Thus, this study proposes a new politics of care in technoscience and medicine, which begins with anxiety.

  7. Logistic Regression Analysis and Nursing Interven-tions for High-risk Factors for Pressure Sores in Pa-tients in a Surgical Intensive Care Unit

    Institute of Scientific and Technical Information of China (English)

    Xin-Ran Wang∗; Bin-Ru Han


    Objective: To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods: A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam-ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results: According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were sta-tistically greater in the pressure sore group than in the control group ( P Conclusions: The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of de-compression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

  8. [Reducing patient pressure sore incidence in the surgical intensive care unit]. (United States)

    Chung, Hui-Ting; Shu, Ling-Hui; Pan, Chao-Chun; Yang, Shu-Yen; Chen, Wan-I


    Pressure ulcers were an increasingly significant problem among patients in the authors' ward. The eight patients diagnosed with pressure ulcers (0.42% of all inpatients) during the first half of 2009 represented a 140% increase over the first half of 2008 (0.28% of all inpatients). This project was designed to reduce pressure ulcer incidence in the surgical intensive care unit (ICU) to 0.05%. Intervention measures included: 1) holding professional training on preventing pressure ulcers; 2) specifying appropriate patient turnover tools; 3) creating and distributing to nurses a proper turnover technique and positioning manual; 4) creating and distributing to nurses a comprehensive patient skin inspection checklist; and 5) organizing a permanent pressure ulcer care quality and audit committee. Pressure ulcer incidence fell from 0.42% to 0.04% following implementation of the methods. Results demonstrate the effectiveness of using the proposed methods to reduce pressure ulcer incidence and enhance nursing care quality.

  9. Phenotyping Hypotensive Patients in Critical Care Using Hospital Discharge Summaries (United States)

    Dai, Yang; Lokhandwala, Sharukh; Long, William; Mark, Roger; Lehman, Li-wei H.


    Among critically-ill patients, hypotension represents a failure in compensatory mechanisms and may lead to organ hypoperfusion and failure. In this work, we adopt a data-driven approach for phenotype discovery and visualization of patient similarity and cohort structure in the intensive care unit (ICU). We used Hierarchical Dirichlet Process (HDP) as a nonparametric topic modeling technique to automatically learn a d-dimensional feature representation of patients that captures the latent “topic” structure of diseases, symptoms, medications, and findings documented in hospital discharge summaries. We then used the t-Distributed Stochastic Neighbor Embedding (t-SNE) algorithm to convert the d-dimensional latent structure learned from HDP into a matrix of pairwise similarities for visualizing patient similarity and cohort structure. Using discharge summaries of a large patient cohort from the MIMIC II database, we evaluated the clinical utility of the discovered topic structure in phenotyping critically-ill patients who experienced hypotensive episodes. Our results indicate that the approach is able to reveal clinically interpretable clustering structure within our cohort and may potentially provide valuable insights to better understand the association between disease phenotypes and outcomes. PMID:28630951

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

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    Rubenfeld Gordon D


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

  11. Survey among critical care nurses and physicians about delirium management. (United States)

    Nydahl, Peter; Dewes, Michael; Dubb, Rolf; Hermes, Carsten; Kaltwasser, Arnold; Krotsetis, Susanne; von Haken, Rebecca


    Association of Critical Care Nurses.

  12. Surgical care for the direct and indirect victims of violence in the eastern Democratic Republic of Congo

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    Ford Nathan


    Full Text Available Abstract Background The provision of surgical assistance in conflict is often associated with care for victims of violence. However, there is an increasing appreciation that surgical care is needed for non-traumatic morbidities. In this paper we report on surgical interventions carried out by Médecins sans Frontières in Masisi, North Kivu, Democratic Republic of Congo to contribute to the scarce evidence base on surgical needs in conflict. Methods We analysed data on all surgical interventions done at Masisi district hospital between September 2007 and December 2009. Types of interventions are described, and logistic regression used to model associations with violence-related injury. Results 2869 operations were performed on 2441 patients. Obstetric emergencies accounted for over half (675, 57% of all surgical pathology and infections for another quarter (160, 14%. Trauma-related injuries accounted for only one quarter (681, 24% of all interventions; among these, 363 (13% were violence-related. Male gender (adjusted odds ratio (AOR = 20.0, p Conclusions In this study, most surgical interventions were unrelated to violent trauma and rather reflected the general surgical needs of a low-income tropical country. Programs in conflict zones in low-income countries need to be prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the general population. Given the limited surgical workforce in these areas, training of local staff and task shifting is recommended to support broad availability of essential surgical care. Further studies into the surgical needs of the population are warranted, including population-based surveys, to improve program planning and resource allocation and the effectiveness of the humanitarian response.

  13. Acquired Muscle Weakness in the Surgical Intensive Care Unit: Nosology, Epidemiology, Diagnosis, and Prevention. (United States)

    Farhan, Hassan; Moreno-Duarte, Ingrid; Latronico, Nicola; Zafonte, Ross; Eikermann, Matthias


    Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.

  14. Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy. (United States)

    Godil, Saniya S; Parker, Scott L; Zuckerman, Scott L; Mendenhall, Stephen K; Devin, Clinton J; Asher, Anthony L; McGirt, Matthew J


    Given the unsustainable costs of the US health-care system, health-care purchasers, payers, and hospital systems are adopting the concept of value-based purchasing by shifting care away from low-quality providers or hospitals. Legislation now allows public reporting of these quality rankings. True measures of quality, such as surgical morbidity and validated questionnaires of effectiveness, are burdensome and costly to collect. Hence, patients' satisfaction with care has emerged as a commonly used metric as a proxy for quality because of its feasibility of collection. However, patient satisfaction metrics have yet to be validated as a measure of overall quality of surgical spine care. We set out to determine whether patient satisfaction is a valid measure of safety and effectiveness of care in a prospective longitudinal spine registry. Prospective longitudinal cohort study. All patients undergoing elective spine surgery for degenerative conditions over a 6-month period at a single medical center. Patient-reported outcome instruments (numeric rating scale [NRS], Oswestry disability index [ODI], neck disability index [NDI], short-form 12-item survey [SF-12], Euro-Qol-5D [EQ-5D], Zung depression scale, and Modified Somatic Perception Questionnaire [MSPQ] anxiety scale), return to work, patient satisfaction with outcome, and patient satisfaction with provider care. All patients undergoing elective spine surgery for degenerative conditions over a 6-month period at a single medical center were enrolled into a prospective longitudinal registry. Data collected on all patients included demographics, disease characteristics, treatment variables, readmissions/reoperations, and all 90-day surgical morbidity. Patient-reported outcome instruments (NRS, ODI, NDI, SF-12, EQ-5D, Zung depression scale, and MSPQ anxiety scale), return to work, patient satisfaction with outcome, and patient satisfaction with provider care were recorded at baseline and 3 months after treatment

  15. Practical strategies for increasing efficiency and effectiveness in critical care education. (United States)

    Joyce, Maurice F; Berg, Sheri; Bittner, Edward A


    Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

  16. Practical strategies for increasing efficiency and effectiveness in critical care education (United States)

    Joyce, Maurice F; Berg, Sheri; Bittner, Edward A


    Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs. PMID:28224102

  17. Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

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    Shochet Tara


    Full Text Available Abstract Background In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful. Methods A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation. Results Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%. Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92. Both tolerability of side effects and women’s satisfaction were similar in the two study arms. Conclusion Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability. Trial

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

    Kaddoura, Mahmoud A


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

  19. The perioperative surgical home: An innovative, patient-centred and cost-effective perioperative care model. (United States)

    Desebbe, Olivier; Lanz, Thomas; Kain, Zeev; Cannesson, Maxime


    Contrary to the intraoperative period, the current perioperative environment is known to be fragmented and expensive. One of the potential solutions to this problem is the newly proposed perioperative surgical home (PSH) model of care. The PSH is a patient-centred micro healthcare system, which begins at the time the decision for surgery is made, is continuous through the perioperative period and concludes 30 days after discharge from the hospital. The model is based on multidisciplinary involvement: coordination of care, consistent application of best evidence/best practice protocols, full transparency with continuous monitoring and reporting of safety, quality, and cost data to optimize and decrease variation in care practices. To reduce said variation in care, the entire continuum of the perioperative process must evolve into a unique care environment handled by one perioperative team and coordinated by a leader. Anaesthesiologists are ideally positioned to lead this new model and thus significantly contribute to the highest standards in transitional medicine. The unique characteristics that place Anaesthesiologists in this framework include their systematic role in hospitals (as coordinators between patients/medical staff and institutions), the culture of safety and health care metrics innate to the specialty, and a significant role in the preoperative evaluation and counselling process, making them ideal leaders in perioperative medicine.

  20. Mapping US pediatric hospitals and subspecialty critical care for public health preparedness and disaster response, 2008. (United States)

    Brantley, Mary D; Lu, Hua; Barfield, Wanda D; Holt, James B; Williams, Alcia


    The objective is to describe by geographic proximity the extent to which the US pediatric population (aged 0-17 years) has access to pediatric and other specialized critical care facilities, and to highlight regional differences in population and critical resource distribution for preparedness planning and utilization during a mass public health disaster. The analysis focused on pediatric hospitals and pediatric and general medical/surgical hospitals with specialized pediatric critical care capabilities, including pediatric intensive care units (PICU), pediatric cardiac ICUs (PCICU), level I and II trauma and pediatric trauma centers, and general and pediatric burn centers. The proximity analysis uses a geographic information system overlay function: spatial buffers or zones of a defined radius are superimposed on a dasymetric map of the pediatric population. By comparing the population living within the zones to the total population, the proportion of children with access to each type of specialized unit can be estimated. The project was conducted in three steps: preparation of the geospatial layer of the pediatric population using dasymetric mapping methods; preparation of the geospatial layer for each resource zone including the identification, verification, and location of hospital facilities with the target resources; and proximity analysis of the pediatric population within these zones. Nationally, 63.7% of the pediatric population lives within 50 miles of a pediatric hospital; 81.5% lives within 50 miles of a hospital with a PICU; 76.1% lives within 50 miles of a hospital with a PCICU; 80.2% lives within 50 miles of a level I or II trauma center; and 70.8% lives within 50 miles of a burn center. However, state-specific proportions vary from less than 10% to virtually 100%. Restricting the burn and trauma centers to pediatric units only decreases the national proportion to 26.3% for pediatric burn centers and 53.1% for pediatric trauma centers. This

  1. Diagnosis of a missed central line guidewire using critical care ultrasound

    Directory of Open Access Journals (Sweden)

    Ali Al Bshabshe


    Full Text Available Central venous catheterization, though an imperative tool in the management of critically ill patient, is associated with a variety of complications and some of which can be life-threatening. Here, we report an index case in the field of critical care of detecting a missed guidewire primarily using a bedside critical care ultrasound.

  2. Critical care nurses' perceptions of preparedness and ability to care for the dying and their professional quality of life. (United States)

    Todaro-Franceschi, Vidette


    A study was undertaken to explore whether critical care nurses perceive that they have been adequately prepared during basic nursing education to care for the dying and their loved ones and to identify if there is a relation between their perceptions of preparedness and ability to provide end of life care and professional quality of life (PQOL). Findings indicate that there is a relationship between critical care nurse perceptions of preparedness and ability to care for the dying and their PQOL, with higher compassion satisfaction scores, lower compassion fatigue scores, and lower burnout scores for those who perceive themselves more prepared and better able to provide end of life care (N = 473). Thus, pedagogic interventions to enhance perceptions of preparedness and ability to care for the dying can potentially improved PQOL for nurses working in critical care areas, possibly diminishing the incidence of compassion fatigue and burnout.

  3. Care interaction adding challenges to old patients’ well-being during surgical hospital treatment

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    Lisbeth Uhrenfeldt


    Full Text Available Today, hospitals offer surgical treatment within a short hospital admission. This brief interaction may challenge the well-being of old patients. The aim of this study was to explore how the well-being of old hospitalized patients was affected by the interaction with staff during a fast-track surgical treatment and hospital admission for colon cancer. We used an ethnographic methodology with field observations and unstructured interviews focusing on one patient at a time (n=9 during a full day; the hours ranging from 7:45 a.m. to 8 p.m. Participants were between 74 and 85 years of age and of both sexes. The study was reported to the Danish Data Protection Agency with reference number (2007-58-0010. The encounter between old patients and the staff was a main theme in our findings elucidating a number of care challenges. The identified care challenges illustrated “well-being as a matter of different perspectives,” “vulnerability in contrast to well-being,” and “staff mix influencing the care encounter.” The experience of well-being in old cancer patients during hospital admission was absent or challenged when staff did not acknowledge their individual vulnerability and needs.

  4. An Evaluation of Preparedness, Delivery and Impact of Surgical and Anesthesia Care in Madagascar: A Framework for a National Surgical Plan. (United States)

    Bruno, Emily; White, Michelle C; Baxter, Linden S; Ravelojaona, Vaonandianina Agnès; Rakotoarison, Hasiniaina Narindria; Andriamanjato, Hery Harimanitra; Close, Kristin L; Herbert, Alison; Raykar, Nakul; Saluja, Saurabh; Shrime, Mark G


    The Lancet Commission on Global Surgery (LCoGS) described the lack of access to safe, affordable, timely surgical, and anesthesia care. It proposed a series of 6 indicators to measure surgery, accompanied by time-bound targets and a template for national surgical planning. To date, no sub-Saharan African country has completed and published a nationwide evaluation of its surgical system within this framework. Mercy Ships, in partnership with Harvard Medical School and the Madagascar Ministry of Health, collected data on the 6 indicators from 22 referral hospitals in 16 out of 22 regions of Madagascar. Data collection was by semi-structured interviews with ministerial, medical, laboratory, pharmacy, and administrative representatives in each region. Microsimulation modeling was used to calculate values for financial indicators. In Madagascar, 29% of the population can access a surgical facility within 2 h. Surgical workforce density is 0.78 providers per 100,000 and annual surgical volume is 135-191 procedures per 100,000 with a perioperative mortality rate of 2.5-3.3%. Patients requiring surgery have a 77.4-86.3 and 78.8-95.1% risk of incurring impoverishing and catastrophic expenditure, respectively. Of the six LCoGS indicator targets, Madagascar meets one, the reporting of perioperative mortality rate. Compared to the LCoGS targets, Madagascar has deficits in surgical access, workforce, volume, and the ability to offer financial risk protection to surgical patients. Its perioperative mortality rate, however, appears better than in comparable countries. The government is committed to improvement, and key stakeholder meetings to create a national surgical plan have begun.

  5. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

    Directory of Open Access Journals (Sweden)

    Macleod Jana B


    Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.

  6. Perception of night-time sleep by surgical patients in an intensive care unit. (United States)

    Nicolás, Ana; Aizpitarte, Eva; Iruarrizaga, Angélica; Vázquez, Mónica; Margall, Angeles; Asiain, Carmen


    The night-time sleep of patients hospitalized in intensive care is a very important feature within the health or disease process, as it has a direct repercussion on their adequate recovery. (1) To describe how surgical patients perceive their sleep in the intensive care unit; (2) to compare the subjective perception of patients with the nursing records and analyse these for the degree of agreement. Descriptive research. One hundred and four surgical patients were recruited to the study. Patients completed the Richards-Campbell Sleep Questionnaire, a five-item visual analogue scale, to subjectively measure their perceived level of sleep (range 0-100 mm). The observation of patient sleep by nurses, demographic data, nursing care during the night and use of specific pharmacological treatments were also collected from the nursing records. The total mean score of sleep on the first post-operative night was 51.42 mm, 28% of patients had a good sleep, 46% a regular sleep and 26% a bad sleep. The sleep profile of these patients has been characterized by the patients having a light sleep, with frequent awakening and generally little difficulty to go back to sleep after the awakenings. The agreement between the nurses' perceptions of patients' sleep and the patients' perception of their sleep was tested by means of one-factor analysis of variance (p nurse-patient perception, we obtained 44% of total agreement and 56% of disagreement. When discrepancy was found, the nurse generally overestimated the patients' perception. Surgical patients' perceptions of their sleep in the ICU suggest that this is inadequate. Nurses' perceptions of patients' sleep partially coincides with the latter's perception, but we have also found that the former frequently overestimate patients' sleep.

  7. Increasing access to specialty surgical care: application of a new resource allocation model to bariatric surgery. (United States)

    Leroux, Eric J; Morton, John M; Rivas, Homero


    To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care. The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost. Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated. In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension. Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.

  8. Getting satisfaction: drivers of surgical Hospital Consumer Assessment of Health care Providers and Systems survey scores. (United States)

    Iannuzzi, James C; Kahn, Steven A; Zhang, Linlin; Gestring, Mark L; Noyes, Katia; Monson, John R T


    Hospital consumer assessment of health care providers and systems (HCAHPS) survey scores formally recognize that patients are central to health care, shifting quality metrics from the physician to patient perspective. This study describes clinical predictors of patient satisfaction in surgical patients. Analysis of a single institution's Surgical Department HCAHPS responses was performed from March 2011-October 2012. The end points were top box satisfaction on two global domains. Multivariable regression was used to determine satisfaction predictors including HCAHPS domains, demographics, and clinical variables such as comorbidities, intensive care unit stay, emergency case, discharge day, floor transfers, complications, and ancillary procedures. In total, 978 surveys were evaluated representing admissions to Acute care and/or Trauma (n = 177, 18.1%), Thoracic (n = 169, 17.3%), Colorectal (n = 107, 10.9%), Transplant (n = 95, 9.7%), Vascular (n = 92, 9.4%), Oncology (n = 88, 9.0%), Plastic (n = 49, 5.0%), and Cardiac (n = 201, 20.6%) divisions. Overall, 658 patients (67.3%) had high satisfaction and 733 (74.9%) gave definite hospital recommendations. Hospital satisfaction was positively associated with an intensive care unit admission (odds ratio [OR] = 1.64, confidence interval [CI]: 1.20-2.23, P = 0.002) and satisfaction with provider and pain domains. Factors associated with decreased satisfaction were race (non-black minority compared with whites; OR = 0.41, CI: 0.21-0.83, P = 0.012), self-reported poor health (OR = 0.43, CI: 0.27-0.68, P nurse-patient interactions. These results help inform future quality improvement and resource allocation. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. [A case report of successful surgical management of lower-limb critical ischaemia on the background of femoropopliteal atherosclerotic aneurysms]. (United States)

    Zotov, S P; Shcherbakov, A V; Zaĭtsev, S S; Khomiakova, E Iu; Abramovskaia, N V


    Presented herein is a case report of successful surgical management of a male patient presenting with lower-limb critical ischaemia on the background of thrombosis of femoropopliteal atherosclerotic aneurysms and the presence of a necrobiotic process on the stump of the foot. The reconstructive intervention performed resulted in salvation of the extremity, followed by uneventful wound healing on his left foot with complete medical and social rehabilitation of the patient.

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

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    Nagarajan Ramakrishnan


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

  11. Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program. (United States)

    Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya


    Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs. ©2016 American Association of Critical-Care Nurses.

  12. The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility. (United States)

    Everett, T C; Morgan, P J; Brydges, R; Kurrek, M; Tregunno, D; Cunningham, L; Chan, A; Forde, D; Tarshis, J


    Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole-team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. Medical management and teamwork were quantified via percentage adherence to key processes and the Team Emergency Assessment Measure, respectively. In the initial session, medical management was not improved by the presence of a checklist (56% without checklist vs. 62% with checklist; p = 0.50). In the retention session, teams performed significantly worse without the checklists (36% without checklist vs. 60% with checklist; p = 0.04). We did not observe a change in non-technical skills in the presence of a checklist in either the initial or retention sessions (68% without checklist vs. 69% with checklist (p = 0.94) and 69% without checklist vs. 65% with checklist (p = 0.36), respectively). Critical events checklists do not improve medical management or teamwork during simulated operating theatre crises in an ambulatory surgical daycare setting.

  13. Notes on critical care-review of seminal management and leadership papers in the United Kingdom. (United States)

    Coombs, Maureen


    Review of recent critical care provision reveals substantial changes in clinical unit operating, and policy drivers influencing international critical care delivery. Practitioners who have worked in healthcare environments over this time, will have witnessed substantial shifts in healthcare policy, changes in professional body guidance and greater service evaluation have impacted on critical care management and leadership. This paper offers a personal perspective on seminal management and leadership papers published in the critical care literature over the past decade. Presenting a range of national and international work that utilise diverse approaches, ten key papers are highlighted that have impacted in the United Kingdom setting. Through this, the influence of the modernisation agenda, the increasing significance of outcome studies, and the need for flexible, interdependent practice emerges. A key message to surface from this paper is the need for all in critical care to engage with, and understand the wider implications of management and leadership change for critical care delivery.

  14. The factors influencing burnout and job satisfaction among critical care nurses

    DEFF Research Database (Denmark)

    Alharbi, Jalal; Wilson, Rhonda; Woods, Cindy


    Aim: The aim of the study was to explore the prevalence of burnout and job satisfaction among Saudi national critical care nurses. Background: Burnout is caused by a number of factors, including personal, organisational and professional issues. Previous literature reports a strong relationship...... between burnout and job satisfaction among critical care nurses. Little is known about this phenomenon among Saudi national critical care nurses. Methods: A convenience sample of 150 Saudi national critical care nurses from three hospitals in Hail, Saudi Arabia were included in a cross-sectional survey....... Conclusions: Saudi national critical care nurses experience moderate to high levels of burnout and low levels of job satisfaction. Burnout is a predictor of job satisfaction for Saudi national critical care nurses. Implications for nursing and health policy: These results provide clear evidence of the need...

  15. Enhancing surgical performance outcomes through process-driven care: a systematic review. (United States)

    Pucher, Philip H; Aggarwal, Rajesh; Singh, Pritam; Darzi, Ara


    Recent evidence has demonstrated the variability in quality of postoperative care, as measured by rates of failure to rescue (FTR). The identification of structure- and process-related factors affecting the quality of postoperative care is the first step towards understanding and improving outcomes. The aim of this review is to review current evidence for structure and process factors affecting postoperative care. A systematic review was conducted. Studies were selected that examined structure or process variables affecting FTR rates and postoperative outcomes. Quality analysis with Jadad and Newcastle-Ottawa scales was conducted and poor-quality studies were excluded. Thirty-seven studies were included in final analysis. Of these, 23 were related to enhanced recovery protocols in seven surgical specialties. Twenty-one of these 23 studies reported decreases in length of stay. Six studies also reported decreases in morbidity. No studies reported increases in stay duration or morbidity. Of the 16 studies that examined other structural and process factors, the strongest evidence was for the association between nursing ratios and FTR rates. The effects of hospital size, resources, and subspecialist care processes were less clear. Process-led care represents a clear, evidence-based approach that can be integrated on a local scale, without necessitating major structural or organisational change, to improve outcomes and may also be cost effective. To foster success, process improvement must be driven on a local level and backed up by appropriate understanding, education, and multidisciplinary involvement.

  16. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone (United States)

    Dare, Anna J.; Lee, Katherine C.; Bleicher, Josh; Elobu, Alex E.; Kamara, Thaim B.; Liko, Osborne; Luboga, Samuel; Danlop, Akule; Kune, Gabriel; Hagander, Lars; Leather, Andrew J. M.; Yamey, Gavin


    Background Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs. Methods and Findings We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi-structured interviews with stakeholders involved in health agenda setting and surgical care in these countries. Interviews were triangulated with published academic literature, country reports, national health plans, and policies. Data were analyzed using a conceptual framework based on four components (actor power, ideas, political contexts, issue characteristics) to assess national factors influencing priority for surgery. Political priority for surgical care in the three countries varies. Priority was highest in Papua New Guinea, where surgical care is firmly embedded within national health plans and receives significant domestic and international resources, and much lower in Uganda and Sierra Leone. Factors influencing whether surgical care was prioritized were the degree of sustained and effective domestic advocacy by the local surgical community, the national political and economic environment in which health policy setting occurs, and the influence of international actors, particularly donors, on national agenda setting. The results from Papua New Guinea show that a strong surgical community can generate priority from the ground up, even where other factors are unfavorable. Conclusions National health agenda setting is a complex social and political process. To embed surgical care within national health policy, sustained advocacy efforts, effective framing of the problem and solutions, and country-specific data are required. Political

  17. Care of the gut in the surgical intensive care unit: fact or fashion? (United States)

    Steinmetz, O K; Meakins, J L


    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.

  18. Critical care management of major disasters: a practical guide to disaster preparation in the intensive care unit. (United States)

    Corcoran, Shawn P; Niven, Alexander S; Reese, Jason M


    Recent events and regulatory mandates have underlined the importance of medical planning and preparedness for catastrophic events. The purpose of this review is to provide a brief summary of current commonly identified threats, an overview of mass critical care management, and a discussion of resource allocation to provide the intensive care unit (ICU) director with a practical guide to help prepare and coordinate the activities of the multidisciplinary critical care team in the event of a disaster.

  19. Hearing loss in older critical care patients: participation in decision making

    National Research Council Canada - National Science Library

    Hardin, Sonya R


    Older adults with hearing loss who receive care in the noisy environment of a critical care unit can be disadvantaged in their ability to understand speech, thus limiting their participation in decision making...

  20. Incidence of surgical site infection in postoperative patients at a tertiary care centre in India. (United States)

    Akhter, M Siddique J; Verma, R; Madhukar, K Premjeet; Vaishampayan, A Rajiv; Unadkat, P C


    A prospective observational was carried out to calculate the incidence of surgical site infections (SSI) along with the main risk factors and causative organisms in postoperative patients at a tertiary care setting in Mumbai. A total number of 1196 patients between June 2011 to March 2013 admitted to the general surgical ward or surgical ICU of our hospital were included in the study. Post laproscopy patients and organ space SSIs were excluded. Patient data were collected using a preformed pro forma and a wound Southampton score tabulated and checked repeatedly until suture removal of patient. Regular follow-up was maintained until at least 30 days postoperatively. The study showed a SSI rate of 11%. Risk factors associated with a higher incidence of SSI were found to be age (>55 years), diabetes mellitus (especially uncontrolled sugar in the perioperative period), immunocompromised patients (mainly HIV and immunosuppressive therapy patients), surgeon skill (higher in senior professors compared with junior residents), nature of the cases, (emergency surgeries), placement of drains, wound class (highest in dirty wounds), type of closure (multilayer closure), prolonged duration of hospital stay, longer duration of surgery (>2 hours), type of surgery (highest in cholecystectomy). The highest rates of causative organisms for SSIs found were Staphylococcus aureus, Escherichia coli and Klebsiella ssp. Prevention of SSIs requires a multipronged approach with particular emphasis on optimising preoperative issues, adhering religiously to strict protocols during the intraoperative period and addressing and optimising metabolic and nutritional status in postoperative period.

  1. Innovations in technology--Novalung iLA: challenges for the field of critical care nursing. (United States)

    Gordon, Elizabeth


    The Novalung interventional lung assist (iLA) device is a new pumpless extracorporeal gas exchange device that imitates the native lung because it allows for protective mechanical ventilation by the reduction of tidal volumes and decreased end expiratory pressures. It is a rescue device for patients with refractory lung failure, as well as a bridge to lung transplantation. While used in Europe for some years, the Novalung iLA has been recently approved by both Health Canada and our facility, as a bridge to lung transplantation. In this article, the author discusses the introduction of this new advancement in extracorporeal gas exchange into an adult critical care setting. First, the author presents an overview of this new technology and how it differs from the traditional model of extracorporeal membrane oxygenation, and then shares the process in which the anticipated challenges of this device introduction were addressed in one institution. Particular attention is paid to the education of the nursing staff. A plan was developed to deliver information, education and training guidelines to prepare for patients requiring a bridge to lung transplantation with this device within the medical surgical intensive care unit in our hospital. Subsequently, these initiatives have expanded to include a workshop and a simulation experience.

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

    Directory of Open Access Journals (Sweden)

    Robbins RA


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

  3. Feasibility of Eyetracking in Critical Care Environments - A Systematic Review. (United States)

    Klausen, Andreas; Röhrig, Rainer; Lipprandt, Myriam


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

  4. Wills Eye Hospital and surgical network: successful pre-positioning strategies for payment reduction and managed care pressures. (United States)

    Kessler, D M


    Through strategic clinical diversification, political activism, and bold expansion, Wills Eye Hospital, a teaching specialty surgical hospital, survives ravages of sudden onslaughts of managed care payment reductions while maintaining autonomy. Slack inpatient resources were re-utilized to create unique programs attractive to regional managed care organizations. Advocacy and lobbying for short-term favorable treatment from Medicare bought the Hospital valuable time and positioning. Building out a regional network of ambulatory surgical centers assures the growth and access to market required for Wills to maintain its autonomy in a managed care contracting environment.

  5. 2016 CAPS ethics session/Ein debate: 1. Regionalization of pediatric surgical care 2. Ethical introduction of surgical innovation 3. Addressing stress in a surgical practice: resiliency, well-being, and burnout. (United States)

    Bagwell, Charles E; Chiu, Priscilla; Fecteau, Annie; Gow, Kenneth W; Mueller, Claudia M; Price, David; Zigman, Andrew F


    The following is the conference proceeding of the Second Ein Debate from the 48th Annual Meeting of the Canadian Association of Paediatric Surgeons held in Vancouver, BC, from September 22 to 24, 2016. The three main topics for debate, as prepared by the members of the CAPS Ethics Committee, are: 1. Regionalization of care: pros and cons, 2. Innovation in clinical care: ethical considerations, and 3. Surgeon well-being: caring for the caregiver. The authors of this paper, as participants in the debate, were assigned their positions at random. Therefore, the opinions they express within this summary might not reflect their own viewpoints. In the first discussion, arguments for and against the regionalization of pediatric surgical care are discussed, primarily in the context of a case of BA. In the pro argument, the evidence and lessons learned from different European countries are explored as well as different models to provide the best BA care outside of large teaching centers. In the counterargument, the author explains how regionalization of care could be detrimental for the patient, the family, the regional center, and for the health care system in general. In the debate on surgical innovation the authors define surgical innovation. They review the pertinent ethical principles, explore a model for its implementation, and the role of the institution at which the innovation is proposed. In the third section, surgeon well-being is examined, and recent literature on surgeon resiliency and burnout both at the attending and resident level is reviewed.

  6. Retrospective review of critical incidents in the post-anaesthesia care unit at a major tertiary hospital. (United States)

    Bruins, Suze Dominique; Leong, Pauline Meng Choo; Ng, Shin Yi


    We reviewed patients with critical incidents that occurred in the post-anaesthesia care unit (PACU) at a major tertiary hospital, and assessed the effect of these incidents on PACU length of stay and discharge disposition. A retrospective review was conducted of patients in the PACU over a two-year period from 24 June 2011 to 23 August 2013. Data on critical incidents was recorded in the administrative database using a standardised data form. There were 701 incidents involving 364 patients; 203 (55.8%) patients had American Society of Anesthesiologists (ASA) physical status I or II. The most common critical incidents were cardiovascular-related (n = 293, 41.8%), respiratory (n = 155, 22.1%), neurological (n = 52, 7.4%), surgical (n = 47, 6.7%) and airway-related (n = 34, 4.9%). There were two incidents of cardiac arrest and 25 incidents of unexpected reintubations. Many patients (n = 186, 51.2%) stayed for over four hours in the PACU due to critical incidents and 184 (50.5%) patients required a higher level of care postoperatively than initially planned. Some patients (n = 34, 9.3%) returned to the operation theatre for further management. A proportion of patients (n = 64, 17.6%) had unplanned intensive care unit admissions due to adverse events in the PACU. A wide spectrum of critical incidents occur in the PACU, many of which are related to the cardiovascular and respiratory systems. Critical incidents have a major impact on healthcare utilisation and result in prolonged PACU stays and higher levels of postoperative care than initially anticipated.

  7. [Early specialized surgical care for gunshot wounds of major vessels in Donbas]. (United States)

    Rozin, Yu A; Ivanenko, A A


    The authors share their experience gained in rendering early specialized surgical care during combat operations in Donbas, having operated on a total of 139 wounded with lesions of large vessels, of these, 21 (15.1%) presenting with concomitant lesions of vessels. Reconstructive operations were carried out in 122 (87.8%) wounded, ligating operations - in 12 (8.6%), and primary amputations - in 5 (3.6%). Two (1.4%) patients died. Blood flow was restored in 117 (84.2%) patients, with six amputations performed after primary operations. The limb was saved in 116 (83.4%) wounded. Peculiarities of a vascular injury in Donbas comprise a large proportion of severe concomitant vascular wounds and lack of intermediate stages of evacuation. The prognosis of life and limb salvage largely depends on correctly chosen method of temporary arrest of bleeding at first stages of medical evacuation and shortening the terms of rendering first specialized surgical care. The variant of operation (reconstruction, ligation or primary amputation) in severe concomitant vascular wounds should be determined proceeding from the degree of ischaemia and severity of the condition of the wounded person, assessed by means of the Military Surgery - Mangled Extremity Severity Score.

  8. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat

    Directory of Open Access Journals (Sweden)

    Lewis KM


    Full Text Available Kevin Michael Lewis,1 Carl Erik Kuntze,2 Heinz Gulle3 1Preclinical Safety and Efficacy, Baxter Healthcare Corporation, Deerfield, IL, USA; 2Medical Affairs, Baxter Healthcare SA, Zurich, Switzerland; 3Surgical Sciences and Engineering, Baxter Medical Products GmbH, Vienna, Austria Abstract: The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG. NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies. Keywords: HEMOPATCH, hemostasis, surgical hemostasis, sealing, surgical sealant

  9. Reduction of surgical site infections after implementation of a bundle of care.

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    Rogier M P H Crolla

    Full Text Available BACKGROUND: Surgical Site Infections (SSI are relatively frequent complications after colorectal surgery and are associated with substantial morbidity and mortality. OBJECTIVE: Implementing a bundle of care and measuring the effects on the SSI rate. DESIGN: Prospective quasi experimental cohort study. METHODS: A prospective surveillance for SSI after colorectal surgery was performed in the Amphia Hospital, Breda, from January 1, 2008 until January 1, 2012. As part of a National patient safety initiative, a bundle of care consisting of 4 elements covering the surgical process was introduced in 2009. The elements of the bundle were perioperative antibiotic prophylaxis, hair removal before surgery, perioperative normothermia and discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures. RESULTS: Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. 1537 colorectal procedures were performed during the study period and 300 SSI (19.5% occurred. SSI were associated with a prolonged length of stay (mean additional length of stay 18 days and a significantly higher 6 months mortality (Adjusted OR: 2.71, 95% confidence interval 1.76-4.18. Logistic regression showed a significant decrease of the SSI rate that paralleled the introduction of the bundle. The adjusted Odds ratio of the SSI rate was 36% lower in 2011 compared to 2008. CONCLUSION: The implementation of the bundle was associated with improved compliance over time and a 36% reduction of the SSI rate after adjustment for confounders. This makes the bundle an important tool to improve patient safety.

  10. Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study. (United States)

    Abdul Rahman, Hamzah; Jarrar, Mu'taman; Don, Mohammad Sobri


    Nursing knowledge and skills are required to sustain quality of care and patient safety. The numbers of nurses with Bachelor degrees in Malaysia are very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. A cross-sectional survey by questionnaire was conducted. A total 652 nurses working in the medical and surgical wards in 12 private hospitals were participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses' roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards' nurses is required for satisfying client expectations and sustaining the outcomes of patient care.

  11. [Perception of night-time sleep by the surgical patients in an intensive care unit]. (United States)

    Nicolás, A; Aizpitarte, E; Iruarrizaga, A; Vázquez, M; Margall, M A; Asiain, M C


    Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep.

  12. Patterns of antimicrobial resistance in a surgical intensive care unit of a university hospital in Turkey

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    Balci Iclal


    Full Text Available Abstract Background Several studies have reported higher rates of antimicrobial resistance among isolates from intensive care units than among isolates from general patient-care areas. The aims of this study were to review the pathogens associated with nosocomial infections in a surgical intensive care unit of a university hospital in Turkey and to summarize rates of antimicrobial resistance in the most common pathogens. The survey was conducted over a period of twelve months in a tertiary-care teaching hospital located in the south-eastern part of Turkey, Gaziantep. A total of 871 clinical specimens from 615 adult patients were collected. From 871 clinical specimens 771 bacterial and fungal isolates were identified. Results Most commonly isolated microorganisms were: Pseudomonas aeruginosa (20.3%, Candida species (15% and Staphylococcus aureus (12.9%. Among the Gram-negative microorganisms P. aeruginosa were mostly resistant to third-generation cephalosporins (71.3–98.1%, while Acinetobacter baumannii were resistant in all cases to piperacillin, ceftazidime and ceftriaxone. Isolates of S. aureus were mostly resistant to penicillin, ampicillin, and methicillin (82–95%, whereas coagulase-negative staphylococci were 98.6% resistant to methicillin and in all cases resistant to ampicillin and tetracycline. Conclusion In order to reduce the emergence and spread of antimicrobial-resistant pathogens in ICUs, monitoring and optimization of antimicrobial use in hospitals are strictly recommended. Therefore local resistance surveillance programs are of most value in developing appropriate therapeutic guidelines for specific infections and patient types.

  13. [Lung ultrasound in acute and critical care medicine]. (United States)

    Zechner, P M; Seibel, A; Aichinger, G; Steigerwald, M; Dorr, K; Scheiermann, P; Schellhaas, S; Cuca, C; Breitkreutz, R


    The development of modern critical care lung ultrasound is based on the classical representation of anatomical structures and the need for the assessment of specific sonography artefacts and phenomena. The air and fluid content of the lungs is interpreted using few typical artefacts and phenomena, with which the most important differential diagnoses can be made. According to a recent international consensus conference these include lung sliding, lung pulse, B-lines, lung point, reverberation artefacts, subpleural consolidations and intrapleural fluid collections. An increased number of B-lines is an unspecific sign for an increased quantity of fluid in the lungs resembling interstitial syndromes, for example in the case of cardiogenic pulmonary edema or lung contusion. In the diagnosis of interstitial syndromes lung ultrasound provides higher diagnostic accuracy (95%) than auscultation (55%) and chest radiography (72%). Diagnosis of pneumonia and pulmonary embolism can be achieved at the bedside by evaluating subpleural lung consolidations. Detection of lung sliding can help to detect asymmetrical ventilation and allows the exclusion of a pneumothorax. Ultrasound-based diagnosis of pneumothorax is superior to supine anterior chest radiography: for ultrasound the sensitivity is 92-100% and the specificity 91-100%. For the diagnosis of pneumothorax a simple algorithm was therefore designed: in the presence of lung sliding, lung pulse or B-lines, pneumothorax can be ruled out, in contrast a positive lung point is a highly specific sign of the presence of pneumothorax. Furthermore, lung ultrasound allows not only diagnosis of pleural effusion with significantly higher sensitivity than chest x-ray but also visual control in ultrasound-guided thoracocentesis.


    Directory of Open Access Journals (Sweden)

    Cotiu Madalina-Alexandra


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

  15. Surgical delay is a critical determinant of survival in perforated peptic ulcer

    DEFF Research Database (Denmark)

    Buck, Daniel; Vester-Andersen, M; Møller, M H


    Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. Surgical delay is a well established negative prognostic factor, but evidence derives from studies with a high risk of bias. The aim of the present nationwide cohort study was to evaluate the adjusted effect...

  16. Implementing Critical Health Services for Children in Foster Care. (United States)

    Klee, Linnea; And Others


    Recommendations concerning California's efforts to provide for the health needs of its children were developed at the California Conference on Health Care for Children in Foster Care. The conference was organized to discuss California's implementation of the Child Welfare League of America's Standards for Health Care Services for Children in…

  17. The World Health Organization program for emergency surgical, obstetric, and anesthetic care: from Mongolia to the future. (United States)

    Abdullah, Fizan; Troedsson, Hans; Cherian, Meena


    This special article provides an introduction to the World Health Organization (WHO) Emergency and Essential Surgical Care (EESC) program. The program was launched by the WHO in December of 2005 to address the lack of adequate surgical capacity as a global public health issue. The overall objective is to reduce death and disability from trauma, burns, pregnancy-related complications, domestic violence, disasters, and other surgically treatable conditions. The program and materials have spread to over 35 countries and focus on providing (1) basic education and training materials; (2) enhancement of surgical infrastructure at the governmental and health facility level; and (3) resources for monitoring and evaluating surgical, obstetrical, and anesthetic capacity. Additionally, a global forum for program members was established that collaborates with ministries of health, WHO country offices, nongovernmental organizations, and academia. The results of the third biennial meeting of global EESC members in Mongolia are outlined as well as future challenges.

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

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    Sangeeta Jain


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

  19. Quality and safety: reflection on the implications for critical care nursing education. (United States)

    Baid, Heather; Hargreaves, Jessica


    Safe and high quality health care is underpinned by health care professionals possessing the knowledge, skills and professional attributes which are necessary for their specific clinical speciality and area of practice. Education is crucial as it enables clinicians to learn and put into practice their specialist knowledge, skills and attributes. These elements will be based on clinical standards, which set the agenda for quality and safety in health care. The purpose of this paper is to reflect upon how a post-registration, degree-level critical care nursing course provided by an English university facilitates nurses to deliver high quality, safe nursing care for critically ill patients and their families. As a reflective analysis, the process of reflection will be guided and structured according to Rolfe's framework for reflective practice. The reflection is based upon the personal observations and teaching experiences of two university lecturers involved in the delivery of the critical care course. Critical care nursing education can incorporate informed practice, simulation and non-technical skills into post-registration critical-care nursing courses as a way of promoting high-quality, safe clinical practice in the critical care setting. This article provides examples from one course's experience with doing this and ends with specific recommendations for how critical care nursing courses can enhance further the promotion of quality and safety. Educators, mentors and students of post-registration critical care nursing courses are encouraged to explore the relevance of nursing education in promoting safe and high-quality clinical practice. © 2015 British Association of Critical Care Nurses.

  20. Evaluation Following Staggered Implementation of the "Rethinking Critical Care" ICU Care Bundle in a Multicenter Community Setting. (United States)

    Liu, Vincent; Herbert, David; Foss-Durant, Anne; Marelich, Gregory P; Patel, Anandray; Whippy, Alan; Turk, Benjamin J; Ragins, Arona I; Kipnis, Patricia; Escobar, Gabriel J


    To evaluate process metrics and outcomes after implementation of the "Rethinking Critical Care" ICU care bundle in a community setting. Retrospective interrupted time-series analysis. Three hospitals in the Kaiser Permanente Northern California integrated healthcare delivery system. ICU patients admitted between January 1, 2009, and August 30, 2013. Implementation of the Rethinking Critical Care ICU care bundle which is designed to reduce potentially preventable complications by focusing on the management of delirium, sedation, mechanical ventilation, mobility, ambulation, and coordinated care. Rethinking Critical Care implementation occurred in a staggered fashion between October 2011 and November 2012. We measured implementation metrics based on electronic medical record data and evaluated the impact of implementation on mortality with multivariable regression models for 24,886 first ICU episodes in 19,872 patients. After implementation, some process metrics (e.g., ventilation start and stop times) were achieved at high rates, whereas others (e.g., ambulation distance), available late in the study period, showed steep increases in compliance. Unadjusted mortality decreased from 12.3% to 10.9% (p Rethinking Critical Care implementation. The mean duration of mechanical ventilation and hospital stay also did not demonstrate incrementally greater declines after implementation. Rethinking Critical Care implementation was associated with changes in practice and a 12-15% reduction in the odds of short-term mortality. However, these findings may represent an evaluation of changes in practices and outcomes still in the midimplementation phase and cannot be directly attributed to the elements of bundle implementation.

  1. Quality Outcomes in the Surgical Intensive Care Unit after Electronic Health Record Implementation. (United States)

    Flatow, V H; Ibragimova, N; Divino, C M; Eshak, D S A; Twohig, B C; Bassily-Marcus, A M; Kohli-Seth, R


    The electronic health record (EHR) is increasingly viewed as a means to provide more coordinated, patient-centered care. Few studies consider the impact of EHRs on quality of care in the intensive care unit (ICU) setting. To evaluate key quality measures of a surgical intensive care unit (SICU) following implementation of the Epic EHR system in a tertiary hospital. A retrospective chart review was undertaken to record quality indicators for all patients admitted to the SICU two years before and two years after EHR implementation. Data from the twelve-month period of transition to EHR was excluded. We collected length of stay, mortality, central line associated blood stream infection (CLABSI) rates, Clostridium difficile (C. diff.) colitis rates, readmission rates, and number of coded diagnoses. To control for variation in the patient population over time, the case mix indexes (CMIs) and APACHE II scores were also analyzed. There was no significant difference in length of stay, C. diff. colitis, readmission rates, or case mix index before and after EHR. After EHR implementation, the rate of central line blood stream infection (CLABSI) per 1 000 catheter days was 85% lower (2.16 vs 0.39; RR, 0.18; 95% CI, 0.05 to 0.61, p < .005), and SICU mortality was 28% lower (12.2 vs 8.8; RR, 1.35; 95% CI, 1.06 to 1.71, p < .01). Moreover, after EHR there was a significant increase in the average number of coded diagnoses from 17.8 to 20.8 (p < .000). EHR implementation was statistically associated with reductions in CLABSI rates and SICU mortality. The EHR had an integral role in ongoing quality improvement endeavors which may explain the changes in CLABSI and mortality, and this invites further study of the impact of EHRs on quality of care in the ICU.

  2. The Genesis, Maturation, and Future of Critical Care Cardiology. (United States)

    Katz, Jason N; Minder, Michael; Olenchock, Benjamin; Price, Susanna; Goldfarb, Michael; Washam, Jeffrey B; Barnett, Christopher F; Newby, L Kristin; van Diepen, Sean


    The cardiac intensive care unit (CICU) has changed considerably over time and now serves a unique patient population with a high burden of cardiovascular and noncardiovascular critical illness. Patient complexity and technological evolutions in the CICU have catalyzed the development of critical care cardiology, a fledgling discipline that combines specialization in cardiovascular diseases with knowledge and experience in critical care medicine. Numerous uncertainties and challenges threaten to stymie the growth of this field. A multidisciplinary dialogue focused on the best care design for the CICU patient is needed as we consider alternative approaches to clinical training, staffing, and investigation in this rapidly evolving arena.

  3. Improving surgical care for children through multicenter registries and QI collaboratives. (United States)

    Hsiung, Grace E; Abdullah, Fizan


    The role of the healthcare organization is shifting and must overcome the challenges of fragmented, costly care, and lack of evidence in practice, to reduce cost, ensure quality, and deliver high-value care. Notable gaps exist within the expected quality and delivery of pediatric healthcare, necessitating a change in the role of the healthcare organization. To realize these goals, the use of collaborative networks that leverage massive datasets to provide information for the development of learning healthcare systems will become increasingly necessary as efforts are made to narrow the gap in healthcare quality for children. By building upon the lessons learned from early collaborative efforts and other industries, operationalizing new technologies, encouraging clinical-community partnerships, and improving performance through transparent pursuit of meaningful goals, pediatric surgery can increase the adoption of best practices by developing collaborative networks that provide evidence-based clinical decision support and accelerate progress toward a new culture of delivering high-quality, high-value, and evidenced-based pediatric surgical care.

  4. Successful implementation of a packed red blood cell and fresh frozen plasma transfusion protocol in the surgical intensive care unit.

    Directory of Open Access Journals (Sweden)

    Benjamin E Szpila

    Full Text Available Blood product transfusions are associated with increased morbidity and mortality. The purpose of this study was to determine if implementation of a restrictive protocol for packed red blood cell (PRBC and fresh frozen plasma (FFP transfusion safely reduces blood product utilization and costs in a surgical intensive care unit (SICU.We performed a retrospective, historical control analysis comparing before (PRE and after (POST implementation of a restrictive PRBC/FFP transfusion protocol for SICU patients. Univariate analysis was utilized to compare patient demographics and blood product transfusion totals between the PRE and POST cohorts. Multivariate logistic regression models were developed to determine if implementation of the restrictive transfusion protocol is an independent predictor of adverse outcomes after controlling for age, illness severity, and total blood products received.829 total patients were included in the analysis (PRE, n=372; POST, n=457. Despite higher mean age (56 vs. 52 years, p=0.01 and APACHE II scores (12.5 vs. 11.2, p=0.006, mean units transfused per patient were lower for both packed red blood cells (0.7 vs. 1.2, p=0.03 and fresh frozen plasma (0.3 vs. 1.2, p=0.007 in the POST compared to the PRE cohort, respectively. There was no difference in inpatient mortality between the PRE and POST cohorts (7.5% vs. 9.2%, p=0.39. There was a decreased risk of urinary tract infections (OR 0.47, 95%CI 0.28-0.80 in the POST cohort after controlling for age, illness severity and amount of blood products transfused.Implementation of a restrictive transfusion protocol can effectively reduce blood product utilization in critically ill surgical patients with no increase in morbidity or mortality.

  5. Out-of-office hours' elective surgical intensive care admissions and their associated complications. (United States)

    Morgan, David J R; Ho, Kwok Ming; Ong, Yang Jian; Kolybaba, Marlene L


    The 'weekend' effect is a controversial theory that links reduced staffing levels, staffing seniority and supportive services at hospitals during 'out-of-office hours' time periods with worsening patient outcomes. It is uncertain whether admitting elective surgery patients to intensive care units (ICU) during 'out-of-office hours' time periods mitigates this affect through higher staffing ratios and seniority. Over a 3-year period in Western Australia's largest private hospital, this retrospective nested-cohort study compared all elective surgical patients admitted to the ICU based on whether their admission occurred 'in-office hours' (Monday-Friday 08.00-18.00 hours) or 'out-of-office hours' (all other times). The main outcomes were surgical complications using the Dindo-Clavien classification and length-of-stay data. Of the total 4363 ICU admissions, 3584 ICU admissions were planned following elective surgery resulting in 2515 (70.2%) in-office hours and 1069 (29.8%) out-of-office hours elective ICU surgical admissions. Out-of-office hours ICU admissions following elective surgery were associated with an increased risk of infection (P = 0.029), blood transfusion (P = 0.020), total parental nutrition (P office hours ICU admissions were also associated with an increased hospital length-of-stay, with (1.74 days longer, P office hours ICU admissions following elective surgery is common and associated with serious post-operative complications culminating in significantly longer hospital length-of-stays and greater transfers with important patient and health economic implications. © 2017 Royal Australasian College of Surgeons.

  6. Obstetric patients in a surgical intensive care unit: prognostic factors and outcome. (United States)

    Mjahed, K; Hamoudi, D; Salmi, S; Barrou, L


    The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 - 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 - 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 - 0.99]). Median length of stay was longer in non- survivors (6.5 +/- 7.3 vs 5.5 +/- 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.

  7. Nursing Care after Surgical Treatment of Fungal Endoph-thalmitis in Children

    Institute of Scientific and Technical Information of China (English)

    Liqin Xu; Junlian Tan


    Purpose:To explore the nursing care following surgical treat-ment of fungal endophthalmitis in children. Methods:Thirty two children (32 eyes) with fungal endoph-thalmitis were enrolled in this study. After receiving antifungal medication,.the children underwent either intravitreal injec-tion,.intravitreal injection of medicine combined with vitrecto-my,.or intravitreal injection in combination with vitrectomy and intraocular C3F8 tamponade. Prior to surgery, psycholog-ical and quarantine nursing,.and medication use was properly prepared..After the surgery,.the changes in the severity of diseases were strictly observed..A suitable body posture was selected and the eyes were protected from infection. Results:.Among 32 patients with fungal endophthalmitis,.8 (25%).cases presented with alleviated inflammation and no changes in visual acuity. The visual acuity of 18 cases (56.25%). was improved to different extents postoperatively. The inflam-mation in 6 children (18.75%) was properly controlled and the visual acuity declined. No cross-infection was noted in any pa-tient. Conclusion: Prior to surgery, quarantine nursing and drug administration should be properly prepared. Postoperatively, the changes in the severity of diseases should be tightly moni-tored. The patients should be treated with effective therapies in a proper position,.aiming to enhance the surgical efficacy.

  8. Implementing Evidenced Based Oral Care for Critically Ill Patients (United States)


    Rundall, T. (2001). Evidence-based management : From theory to practice in health. The Milbank Quarterly, 79(3), 429-457. 7. Grap, M.J., Munro...determined if an evidence-based oral care program resulted in increased nurses’ knowledge and improved oral care practices compliance. Design: The project...process, and project specific oral care evidence-based practice instruction. Knowledge evaluations were conducted at three time points: before, immediately

  9. Surgical patients' and nurses' opinions and expectations about privacy in care. (United States)

    Akyüz, Elif; Erdemir, Firdevs


    The purpose of this study was to determine the opinions and expectations of patients and nurses about privacy during a hospital admission for surgery. The study explored what enables and maintains privacy from the perspective of Turkish surgical patients and nurses. The study included 102 adult patients having surgery and 47 nurses caring for them. Data were collected via semistructured questionnaire by face-to-face interviews. The results showed that patients were mostly satisfied by the respect shown to their privacy by the nurses but were less confident of the confidentiality of their personal data. It was found that patients have expectations regarding nursing approaches and attitudes about acknowledging and respecting patient autonomy and confidentiality. It is remarkable that while nurses focused on the physical dimension of privacy, patients focused on informational and psychosocial dimensions of privacy, as well as its physical dimension.

  10. Health Behavior Theory for Pressure Ulcer Prevention: Root-Cause Analysis Project in Critical Care Nursing. (United States)

    Choi, Kristen R; Ragnoni, Jennifer A; Bickmann, Jonathan D; Saarinen, Hannah A; Gosselin, Ann K


    The purpose of this project was to use a behavioral theory to examine pressure ulcer prevention by nurses in a critical care setting. A root-cause analysis approach was used, including an integrative literature review, operationalization of behavioral constructs into a survey, and root-cause analysis application in a cardiovascular intensive care unit. This article highlights an innovative approach to quality improvement in critical care.

  11. A statewide consortium of surgical care: a longitudinal investigation of vascular operative procedures at 16 hospitals. (United States)

    Henke, Peter K; Kubus, Jim; Englesbe, Michael J; Harbaugh, Calista; Campbell, Darrell A


    Regional surgical quality improvement consortiums are becoming more common. Herein we have reported the effectiveness of a statewide consortium focusing on open vascular operative procedures. The statewide Michigan Surgical Quality Consortium was established in 2005 with 16 hospitals that report cases of vascular open operative intervention, in a sampling manner consistent with the private sector National Surgical Quality Improvement Program. Data are abstracted by onsite trained nurses using defined and validated pre-, peri-, and postoperative variables with 30-day follow-up. Outpatient and emergent cases were excluded. We compared outcomes over the course of the consortium (era I, April 2005-March 2007; era II, April 2007-March 2008) via univariate and multivariate techniques. Era I (n = 2,453) and era II (n = 3,409) cases were similar in age (mean, 68 years), gender (61% male), relative value units (mean, 21), and distribution of Current Procedural Terminology codes. Duration of stay and operative time decreased by 15% and 11%, respectively, when comparing era I with era II (P cardiac or renal, complications. When evaluating both eras, modifiable variables (able to be altered by the surgeon) for morbidity included increased length of operation (odds ratio [OR], 1.004; 95% confidence interval [CI], 1.003-1.005; P < .0001), hypertension (OR, 1.46; 95% CI, 1.03-2.1; P = .03), and blood transfusion (OR, 2.8; 95% CI, 2.04-3.88; P < .0001). However, anemic patients (11%; hematocrit <30) who were transfused were less likely to suffer morbidity (OR, 56; 95% CI, 0.47-0.67; P < .0001) than those transfused who were not anemic. The absolute 2% reduction in complications led to a $172 cost savings for the payers per patient in era II compared with era I. A statewide quality-of-care consortium with timely feedback of data was associated with decreased morbidity over a relatively short follow-up period in vascular patients. Focusing on best processes in real-world practice

  12. En Route Critical Care: Evolving, Improving & Advancing Capabilities (United States)


    Conference Civilian Partnerships  ECMO Pediatric/Neonatology Consortium  58 y/o Male unresponsive to care  Needed Adult ECMO – USA ECMO MD – USAF...Neonatologist – Civilian Perfusionist – Civilian ECMO RN  Transported to Iowa 36 2011 MHS Conference International AE En Route Medical Care Conference

  13. Critically ill obstetric patients in the intensive care unit. (United States)

    Demirkiran, O; Dikmen, Y; Utku, T; Urkmez, S


    We aimed to determine the morbidity and mortality among obstetric patients admitted to the intensive care unit. In this study, we analyzed retrospectively all obstetric admissions to a multi-disciplinary intensive care unit over a five-year period. Obstetric patients were identified from 4733 consecutive intensive care unit admissions. Maternal age, gestation of newborns, mode of delivery, presence of coexisting medical problems, duration of stay, admission diagnosis, specific intensive care interventions (mechanical ventilation, continuous veno-venous hemofiltration, central venous catheterization, and arterial cannulation), outcome, maternal mortality, and acute physiology and chronic health evaluation (APACHE) II score were recorded. Obstetric patients (n=125) represented 2.64% of all intensive care unit admissions and 0.89% of all deliveries during the five-year period. The overall mortality of those admitted to the intensive care unit was 10.4%. Maternal age and gestation of newborns were similar in survivors and non-survivors. There were significant differences in length of stay and APACHE II score between survivors and non-survivors P intensive care unit admission was preeclampsia/eclampsia (73.6%) followed by post-partum hemorrhage (11.2%). Intensive care specialists should be familiar with these complications of pregnancy and should work closely with obstetricians.

  14. The development of an internet-based knowledge exchange platform for pediatric critical care clinicians worldwide*. (United States)

    Wolbrink, Traci A; Kissoon, Niranjan; Burns, Jeffrey P


    Advances in Internet technology now enable unprecedented global collaboration and collective knowledge exchange. Up to this time, there have been limited efforts to use these technologies to actively promote knowledge exchange across the global pediatric critical care community. To develop an open-access, peer-reviewed, not-for-profit Internet-based learning application, OPENPediatrics, a collaborative effort with the World Federation of Pediatric Intensive and Critical Care Societies, was designed to promote postgraduate educational knowledge exchange for physicians, nurses, and others caring for critically ill children worldwide. Description of program development. International multicenter tertiary pediatric critical care units across six continents. Multidisciplinary pediatric critical care providers. A software application, providing information on demand, curricular pathways, and videoconferencing, downloaded to a local computer. In 2010, a survey assessing postgraduate educational needs was distributed through World Federation of Pediatric Intensive and Critical Care Societies to constituent societies. Four hundred and twenty-nine critical care providers from 49 countries responded to the single e-mail survey request. Respondents included 68% physicians and 28% nurses who care for critically ill children. Fifty-two percent of respondents reported accessing the Internet at least weekly to obtain professional educational information. The five highest requests were for educational content on respiratory care [mechanical ventilation] (48% [38%]), sepsis (28%), neurology (25%), cardiology (14%), extracorporeal membrane oxygenation (10%), and ethics (8%). Based on these findings, and in collaboration with researchers in adult learning and online courseware, an application was developed and is currently being used by 770 registered users in 60 countries. We describe here the development and implementation of an Internet-based application which is among the first

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

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala


    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.

  16. Critical care nursing organizations and activities--a second worldwide review. (United States)

    Williams, G; Chaboyer, W; Alberto, L; Thorsteinsdottir, R; Schmollgruber, S; Fulbrook, P; Chan, D; Bost, N


    This study is the second world survey of critical care nursing organizations (CCNOs). The first survey was undertaken 6 years ago and data were collected from 23 countries over a 2-year period. The aim of the second survey was to profile the issues and activities of critical care nurses and their professional organizations, expanding on the previous survey to obtain both an update of the issues and a wider global perspective. A descriptive survey was emailed to 80 potential responding countries with recognized CCNOs or nursing leaders. Responses were analysed descriptively by geographical region. A total of 51 respondents completed the questionnaire over a 6-month period, achieving a return rate of 64%. The most common issues identified by critical care nurses were staffing levels and teamwork. Other important issues included wages, working conditions and access to quality educational programmes. The respondents perceived national conferences, professional representation, standards for educational courses, provision of a website, and educational workshops and forums as the five most important activities that should be provided for critical care nurses by national CCNOs. Workforce and education issues remain dominant themes among critical care nurses of the world. These issues have changed very little in the last 6 years. Using the World Federation of Critical Care Nurses network of regional CCNOs and critical care nursing leaders has proven to be a successful strategy for the collection of data on world issues and for international communication and support.

  17. Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt. (United States)

    Hasanin, Ahmed; Eladawy, Akram; Mohamed, Hossam; Salah, Yasmin; Lotfy, Ahmed; Mostafa, Hanan; Ghaith, Doaa; Mukhtar, Ahmed


    The prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to quantify the incidence, risk factors and outcome of patients harboring XDR-GNB. A one year prospective study was done by collecting all the bacteriological reports for cultures sent from the surgical intensive care unit, Cairo university teaching hospital. XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of antimicrobial agents. Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance. During one-year study period, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. XDR strains were significantly higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%), Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%). Relaparotomy was the only significant risk factor for acquisition of XDR infection. Extensively drug-resistant gram negative infections are frequent in our ICU. This is an alarming health care issue in Egypt which emphasizes the need to rigorously implement infection control practices.

  18. In-hospital fellow coverage reduces communication errors in the surgical intensive care unit. (United States)

    Williams, Mallory; Alban, Rodrigo F; Hardy, James P; Oxman, David A; Garcia, Edward R; Hevelone, Nathanael; Frendl, Gyorgy; Rogers, Selwyn O


    Staff coverage strategies of intensive care units (ICUs) impact clinical outcomes. High-intensity staff coverage strategies are associated with lower morbidity and mortality. Accessible clinical expertise, team work, and effective communication have all been attributed to the success of this coverage strategy. We evaluate the impact of in-hospital fellow coverage (IHFC) on improving communication of cardiorespiratory events. A prospective observational study performed in an academic tertiary care center with high-intensity staff coverage. The main outcome measure was resident to fellow communication of cardiorespiratory events during IHFC vs home coverage (HC) periods. Three hundred twelve cardiorespiratory events were collected in 114 surgical ICU patients in 134 study days. Complete data were available for 306 events. One hundred three communication errors occurred. IHFC was associated with significantly better communication of events compared to HC (Pcommunicated 89% of events during IHFC vs 51% of events during HC (PCommunication patterns of junior and midlevel residents were similar. Midlevel residents communicated 68% of all on-call events (87% IHFC vs 50% HC, Pcommunicated 66% of events (94% IHFC vs 52% HC, PCommunication errors were lower in all ICUs during IHFC (Pcommunication errors. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. [Reducing patient pressure sore incidence density in the pediatric surgical intensive care unit]. (United States)

    Huang, Wei-Chen; Chang, Shiow-Ru; Tang, Chi-Min


    Our unit recorded 21 cases of pressure sores from January 2011 to June 2011. The resulting pressure-sore incidence density of 0.74% exceeded the Taiwan Clinical Performance Indicator (TCPI) for medical centers (0.62%) as well as the mean incidence density for our unit (0.55%) during the same period in 2010. We developed this project to decrease the incidence density of pressure sores at our pediatric-surgical-intensive-care unit from 0.74% to 0.31%. Strategies implemented included: 1. providing on-the-job education; 2. providing bedside teaching; 3. developing a series of pictures to illustrate proper sitting, lying, and changing positions and the proper fixation of catheters; 4. implementing a reminder mechanism; 5. introducing pressure-preventing devices; 6. and establishing an audit team. Incidence density decreased from 0.74% (Jan. to Jun. 2011) to 0.18% (Mar. to Jul. 2012). We demonstrated that the developed improvement program effectively reduced the incidence density of pressure sores and increased the quality of nursing care.

  20. [Citomegalovirus reactivation in critical ill intensive care patients]. (United States)

    Carrillo Esper, Raúl


    Cytomegalovirus (CMV) is a β herpesvirus and a significant human pathogen. After primary infection establishes life long latency. In immunocompetent individuals cell-mediated host immune responses prevent the development of overt CMV disease. It has increasingly come to be recognized that critically ill patients are at risk for CMV reactivation from the latency. The risk factors associated to CMV reactivation in the critically ill are infection, sepsis, trauma, transfusions, major surgery, prolonged mechanical ventilation, steroids and vasopressors. In the pathogenesis are involved immunodysfunction and imbalance in immunomodulatory mediators principally tumor necrosis factor (TNF) and nuclear factor κB (NF-κB). Several studies have shown an association between CMV reactivation in immunocompetent critically ill patients and poor clinical outcomes. Further studies are warranted to identify subsets of patients who are at risk of developing CMV reactivation and to determine the role of antiviral agents on clinically outcomes in critically ill patients.

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

    Directory of Open Access Journals (Sweden)

    Pranati Gupte


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

  2. Three phases of disaster relief in Haiti--pediatric surgical care on board the United States Naval Ship Comfort. (United States)

    Walk, Ryan M; Donahue, Timothy F; Sharpe, Richard P; Safford, Shawn D


    On January 12, 2010, Haiti experienced the western hemisphere's worst-ever natural disaster. Within 24 hours, the United States Naval Ship Comfort received orders to respond, and a group of more than 500 physicians, nurses, and staff undertook the largest and most rapid triage and treatment since the inception of hospital ships. These data represent pediatric surgical patients treated aboard the United States Naval Ship Comfort between January 19 and February 27, 2010. Prospective databases managed by patient administration, radiology, blood bank, laboratory services, and surgical services were combined to create an overall patient care database that was retrospectively reviewed for this analysis. Two hundred thirty-seven pediatric surgical patients were treated, representing 27% of the total patient population. These patients underwent a total of 213 operations composed of 243 unique procedures. Orthopedic procedures represented 71% of the total caseload. Patients returned to the operating room up to 11 times and required up to 28 days for completion of surgical management. This represents the largest cohort of pediatric surgical patients in an earthquake response. Our analysis provides a model for anticipating surgical caseload, injury patterns, and duration of surgical course in preparing for future disaster response missions. Moreover, we propose a 3-phased response to disaster medicine that has not been previously described. Published by Elsevier Inc.

  3. The surgical stress response and the potential role of preoperative glucocorticoids on post-anesthesia care unit recovery

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin J; Kehlet, Henrik; Aasvang, Eske K


    The immediate postoperative course in the post-anaesthesia care unit (PACU) remains a challenge across surgical procedures. Postoperative pain, sedation/cognitive dysfunction, nausea and vomiting (PONV), circulatory and respiratory problems and orthostatic intolerance constitute the bulk of the d...

  4. Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule

    NARCIS (Netherlands)

    Houdenhoven, van Mark; Oostrum, van Jeroen M.; Wullink, Gerhard; Hans, Erwin; Hurink, Johann L.; Bakker, Jan; Kazemier, Geert


    Purpose: Mounting health care costs force hospital managers to maximize utilization of scarce resources and simultaneously improve access to hospital services. This article assesses the benefits of a cyclic case scheduling approach that exploits a master surgical schedule (MSS). An MSS maximizes ope

  5. Nasal Carriage of Staphylococcus Aureus and Cross-Contamination in a Surgical Intensive Care Unit: Efficacy of Mupirocin Ointment

    NARCIS (Netherlands)

    D. Talon; C. Rouget; V. Cailleaux; P. Bailly; M. Thouverez; F. Barale; Y. Michel-Briand


    textabstractA six month prospective study was carried out in a surgical intensive care unit (SICU) of a university hospital to assess the incidence and routes of exogenous colonization by Staphylococcus aureus. A total of 157 patients were included in the study. One thousand one hundred and eleven s

  6. Microvascular decompression as a surgical management for trigeminal neuralgia: A critical review of the literature

    Directory of Open Access Journals (Sweden)

    Kabatas Serdar


    Full Text Available Trigeminal neuralgia (TN is a common pain syndrome and is characterized by recurrent episodes of intense lancinating pain in one or more divisions of the trigeminal nerve. Neurovascular compression (NVC has been considered as the main cause of TN in the root entry zone (REZ of the trigeminal nerve in the cerebellopontine angle cistern. Microvascular decompression (MVD is the surgical procedure of choice for the treatment of medically refractory TN. MVD has also been shown to provide pain relief even in patients without visible neurovascular compression. Additionally, it has been accepted that MVD can provide the highest rate of long-term patient satisfaction with the lowest rate of pain recurrence. We did, systematic review of the subject and also our own experiences.

  7. Meeting the milestones. Strategies for including high-value care education in pulmonary and critical care fellowship training. (United States)

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


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

  8. Audit of co-management and critical care outreach for high risk postoperative patients (The POST audit). (United States)

    Story, D A; Shelton, A; Jones, D; Heland, M; Belomo, R


    Co-management and critical care outreach for high risk surgical patients have been proposed to decrease postoperative complications and mortality. We proposed that a clinical project with postoperative comanagement and critical care outreach, the Post Operative Surveillance Team: (POST), would be associated with decreased hospital length of stay. We conducted a retrospective before (control group) and after (POST group) audit of this hospital program. POST was staffed for four months in 2010 by two intensive care nurses and two senior registrars who conducted daily ward rounds for the first five postoperative days on high risk patients undergoing inpatient general or urological surgery. The primary endpoint was length of hospital stay and secondary endpoints were Medical Emergency Team (MET) calls, cardiac arrests and in-hospital mortality. There were 194 patients in the POST group and 1,185 in the control group. The length of stay in the POST group, median nine days (Inter-quartile range [IQR]: 5 to 17 days), was longer than the control group, median seven days (IQR: 4 to 13 days): difference two days longer (95.0% confidence interval [95.0% CI]: 1 to 3 days longer, P audit found that the POST service was not associated with reduced length of stay. Models of co-management, different to POST, or with different performance metrics, could be tested.

  9. 'In a dark place, we find ourselves': light intensity in critical care units. (United States)

    Durrington, Hannah J; Clark, Richard; Greer, Ruari; Martial, Franck P; Blaikley, John; Dark, Paul; Lucas, Robert J; Ray, David W


    Intensive care units provide specialised care for critically ill patients around the clock. However, intensive care unit patients have disrupted circadian rhythms. Furthermore, disrupted circadian rhythms are associated with worse outcome. As light is the most powerful 're-setter' of circadian rhythm, we measured light intensity on intensive care unit. Light intensity was low compared to daylight during the 'day'; frequent bright light interruptions occurred over 'night'. These findings are predicted to disrupt circadian rhythms and impair entrainment to external time. Bright lighting during daytime and black out masks at night might help maintain biological rhythms in critically ill patients and improve clinical outcomes.

  10. Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care. (United States)

    Bachoura, Abdo; Guitton, Thierry G; Smith, R Malcolm; Vrahas, Mark S; Zurakowski, David; Ring, David


    Orthopaedic surgical-site infections prolong hospital stays, double rehospitalization rates, and increase healthcare costs. Additionally, patients with orthopaedic surgical-site infections (SSI) have substantially greater physical limitations and reductions in their health-related quality of life. However, the risk factors for SSI after operative fracture care are unclear. We determined the incidence and quantified modifiable and nonmodifiable risk factors for SSIs in patients with orthopaedic trauma undergoing surgery. We retrospectively indentified, from our prospective trauma database and billing records, 1611 patients who underwent 1783 trauma-related procedures between 2006 and 2008. Medical records were reviewed and demographics, surgery-specific data, and whether the patients had an SSI were recorded. We determined which if any variables predicted SSI. Six factors independently predicted SSI: (1) the use of a drain, OR 2.3, 95% CI (1.3-3.8); (2) number of operations OR 3.4, 95% CI (2.0-6.0); (3) diabetes, OR 2.1, 95% CI (1.2-3.8); (4) congestive heart failure (CHF), OR 2.8, 95% CI (1.3-6.5); (5) site of injury tibial shaft/plateau, OR 2.3, 95% CI (1.3-4.2); and (6) site of injury, elbow, OR 2.2, 95% CI (1.1-4.7). The risk factors for SSIs after skeletal trauma are most strongly determined by nonmodifiable factors: patient infirmity (diabetes and heart failure) and injury complexity (site of injury, number of operations, use of a drain). Level II, prognostic study. See the Guideline for Authors for a complete description of levels of evidence.

  11. The "virtual" obstetrical intensive care unit: providing critical care for contemporary obstetrics in nontraditional locations. (United States)

    Leovic, Michael P; Robbins, Hailey N; Foley, Michael R; Starikov, Roman S


    Management of the critically ill pregnant patient presents a clinical dilemma in which there are sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness. The health care needs of the critically ill obstetric patient calls for clinicians to move beyond the traditional definition of the intensive care unit and develop a well-rounded, quickly responsive, and communicative interdisciplinary team that can provide high-quality, unique, and versatile care that best meets the needs of each particular patient. We propose a model in which a virtual intensive care unit team composed of preselected specialists from multiple disciplines (maternal-fetal medicine, neonatology, obstetric anesthesiology, cardiology, pulmonology, etc) participate in the provision of individualized, precontemplated care that is readily adapted to the specific patient's clinical needs, regardless of setting. With this team-based approach, an environment of trust and familiarity is fostered among team members and well thought-out patient care plans are developed through routine prebrief discussions regarding individual clinical care for parturients anticipated to required critical care services. Incorporating debriefings between team members following these intricate cases will allow for the continued evolution of care as the medical needs of this patient population change as well.

  12. Graduating nursing students' basic competence in intensive and critical care nursing. (United States)

    Lakanmaa, Riitta-Liisa; Suominen, Tarja; Perttilä, Juha; Ritmala-Castrèn, Marita; Vahlberg, Tero; Leino-Kilpi, Helena


    To describe and evaluate the basic competence of graduating nursing students in intensive and critical care nursing. Intensive and critical care nursing is focused on severely ill patients who benefit from the attention of skilled personnel. More intensive and critical care nurses are needed in Europe. Critical care nursing education is generally postqualification education that builds upon initial generalist nursing education. However, in Europe, new graduates practise in intensive care units. Empirical research on nursing students' competence in intensive and critical care nursing is scarce. A cross-sectional survey design. A basic competence scale (Intensive and Critical Care Nursing Competence Scale, version 1) and a knowledge test (Basic Knowledge Assessment Tool, version 7) were employed among graduating nursing students (n = 139). Sixty-nine per cent of the students self-rated their basic competence as good. No association between self-assessed Intensive and Critical Care Nursing-1 and the results of the Basic Knowledge Assessment Tool-7 was found. The strongest factor explaining the students' conception of their competence was their experience of autonomy in nursing after graduation. The students seem to trust their basic competence as they approach graduation. However, a knowledge test or other objective method of evaluation should be used together with a competence scale based on self-evaluation. In nursing education and in clinical practice, for example, during orientation programmes, it is important not only to teach broad basic skills and knowledge of intensive and critical care nursing, but also to develop self-evaluation skills through the use of special instruments constructed for this purpose. © 2013 John Wiley & Sons Ltd.

  13. Facilitators of an Interprofessional Approach to Care in Medical and Mixed Medical/Surgical ICUs: A Multicenter Qualitative Study (United States)

    Barg, Frances K.; Asch, David A.; Kahn, Jeremy M.


    The purpose of this study was to describe clinicians' perceptions of interprofessional collaboration in the intensive care unit and identify factors associated with interprofessional collaboration. We performed 64 semi-structured interviews in 7 hospitals with ICU nurses, physicians, respiratory therapists, nurse managers, clinical pharmacists and dieticians. ICU clinicians perceived two distinct types of facilitators to interprofessional collaboration in critical care: cultural and structural. In the critical care setting, cultural and structural facilitators worked independently as well as in concert to create effective interprofessional collaboration. Initiatives aimed at creating and facilitating interprofessional collaboration should focus attention on cultural and structural facilitators to improve patient care and team effectiveness. PMID:24995554

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

    Directory of Open Access Journals (Sweden)

    Amanda Towell


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

  15. Moral sensitivity and moral distress in Iranian critical care nurses. (United States)

    Borhani, Fariba; Abbaszadeh, Abbas; Mohamadi, Elham; Ghasemi, Erfan; Hoseinabad-Farahani, Mohammad Javad


    Moral sensitivity is the foremost prerequisite to ethical performance; a review of literature shows that nurses are sometimes not sensitive enough for a variety of reasons. Moral distress is a frequent phenomenon in nursing, which may result in paradoxes in care, dealing with patients and rendering high-quality care. This may, in turn, hinder the meeting of care objectives, thus affecting social healthcare standards. The present research was conducted to determine the relationship between moral sensitivity and moral distress of nurses in intensive care units. This study is a descriptive-correlation research. Lutzen's moral sensitivity questionnaire and Corley Moral Distress Questionnaire were used to gather data. Participants and research context: A total of 153 qualified nurses working in the hospitals affiliated to Shahid Beheshti University of Medical Sciences were selected for this study. Subjects were selected by census method. Ethical considerations: After explaining the objectives of the study, all the participants completed and signed the written consent form. To conduct the study, permission was obtained from the selected hospitals. Nurses' average moral sensitivity grade was 68.6 ± 7.8, which shows a moderate level of moral sensitivity. On the other hand, nurses also experienced a moderate level of moral distress (44.8 ± 16.6). Moreover, there was no meaningful statistical relationship between moral sensitivity and moral distress (p = 0.26). Although the nurses' moral sensitivity and moral distress were expected to be high in the intensive care units, it was moderate. This finding is consistent with the results of some studies and contradicts with others. As moral sensitivity is a crucial factor in care, it is suggested that necessary training be provided to develop moral sensitivity in nurses in education and practical environments. Furthermore, removing factors that contribute to moral distress may help decrease it in nurses.

  16. Pitfalls in ictal EEG interpretation: critical care and intracranial recordings. (United States)

    Gaspard, Nicolas; Hirsch, Lawrence J


    EEG is the cornerstone examination for seizure diagnosis, especially nonconvulsive seizures in the critically ill, but is still subject to many errors that can lead to a wrong diagnosis and unnecessary or inadequate treatment. Many of these pitfalls to EEG interpretation are avoidable. This article reviews common errors in EEG interpretation, focusing on ictal or potentially ictal recordings obtained in critically ill patients. Issues discussed include artifacts, nonepileptic events, equivocal EEG patterns seen in comatose patients, and quantitative EEG artifacts. This review also covers some difficulties encountered with intracranial EEG recordings in patients undergoing epilepsy surgery, including issues related to display resolution.

  17. Emergencies and Critical Care of Commonly Kept Fowl. (United States)

    Sabater González, Mikel; Calvo Carrasco, Daniel


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

  18. A Study to Determine the Best Method of Caring for Certain Short-Stay Surgical Patients at Reynolds Army Community Hospital (United States)


    tubal ligation , and myringotomy (Staff, 1984, July). Surgical Patients 25 This list was submitted to the Chiefs of the Department of Surgery and...capacity Surgical Patients 46 restricted to minimal care patients such as those with Acute Respiratory Disease Syndrome (ARDS). These wards were...the surgery and post -surgical healing is aided. And yet, in the military, lasers are seldom-used (there are none Surgical Patients 83 at RACR), and are

  19. Let’s Talk Critical. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows (United States)

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


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

  20. Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery.

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    Jasper van der Slegt

    Full Text Available BACKGROUND: Surgical site infections (SSI's are associated with severe morbidity, mortality and increased health care costs in vascular surgery. OBJECTIVE: To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. DESIGN: Prospective, quasi-experimental, cohort study. METHODS: A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP was introduced in 2009. The elements of the bundle were (1 perioperative normothermia, (2 hair removal before surgery, (3 the use of perioperative antibiotic prophylaxis and (4 discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback. RESULTS: Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4% SSI were observed. Deep SSI occurred in 25 (3.5% patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p<0.001 and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<0.001 had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32-6.63. Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009. CONCLUSION: The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI's in patients undergoing

  1. "In flight catering": feeding critical care patients during aeromedical evacuation. (United States)

    Turner, S; Ruth, M J; Bruce, D L


    The benefits of early enteral nutrition are well recognised but may be incompatible with CCAST evacuation due to the risk of micro-aspiration predisposing to pneumonia. A study has been approved by the Surgeon Generals Research Strategy Group designed to quantify the risks of microaspiration during CCAST flights in order to inform DMA policy with regard to feeding critically ill casualties during flight.

  2. Cognitive informatics in health and biomedicine case studies on critical care, complexity and errors

    CERN Document Server

    Patel, Vimla L; Cohen, Trevor


    This interdisciplinary book offers an introduction to cognitive informatics, focusing on key examples drawn from the application of methods and theories from cognitive informatics to challenges specific to the practice of critical-care medicine.

  3. Factors affecting mortality of critical care trauma patients

    African Journals Online (AJOL)



    Sep 3, 2013 ... Intensive Care Unit, Al-Ain Hospital, Al-Ain, United Arab Emirates. Abstract ... Univariate and multivariate analysis were used to compare patients who died and who did not. Gender, age ... AIS for the chest and head injuries and the ISS were studied. ... Trauma is a major health problem in the United Arab.

  4. The experience of distress in relation to surgical treatment and care for breast cancer: An interview study. (United States)

    Jørgensen, L; Garne, J P; Søgaard, M; Laursen, B S


    A diagnosis of breast cancer is a key turning point in a woman's life that may lead to her experiencing severe and persistent distress and potentially presaging a psychiatric disorder, such as major depression. In Denmark an increased standardization of care and a short hospital stay policy minimize the time of medical and nursing surveillance. Consequently, there is the potential risk that distress goes unnoticed, and therefore, untreated. Therefore, the purpose of this study was to explore the experience of distress in Danish women taking part in surgical continuity of care for breast cancer. A phenomenological-hermeneutic approach inspired by the French philosopher Paul Ricoeur was conducted to explore the experience of distress in relation to surgical treatment and care for breast cancer. Semi-structured interviews were conducted with 12 women who recently had surgery for breast cancer at six departments of breast surgery in Denmark from May 2013 to November 2013. The understanding of the experience of distress in the period of surgical continuity of care for breast cancer is augmented and improved through a discussion related to four identified themes: A time of anxiety, loss of identities, being treated as a person and being part of a system, drawing on theory and other research findings. Distress experienced by women in the period following diagnosis arises from multiple sources. Support and care must be based on the woman's individual experience of distress. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Anesthesia and critical-care delivery in weightlessness: A challenge for research in parabolic flight analogue space surgery studies (United States)

    Ball, Chad G.; Keaney, Marilyn A.; Chun, Rosaleen; Groleau, Michelle; Tyssen, Michelle; Keyte, Jennifer; Broderick, Timothy J.; Kirkpatrick, Andrew W.


    BackgroundMultiple nations are actively pursuing manned exploration of space beyond low-earth orbit. The responsibility to improve surgical care for spaceflight is substantial. Although the use of parabolic flight as a terrestrial analogue to study surgery in weightlessness (0 g) is well described, minimal data is available to guide the appropriate delivery of anesthesia. After studying anesthetized pigs in a 0 g parabolic flight environment, our group developed a comprehensive protocol describing prolonged anesthesia in a parabolic flight analogue space surgery study (PFASSS). Novel challenges included a physically remote vivarium, prolonged (>10 h) anesthetic requirements, and the provision of veterinary operating room/intensive care unit (ICU) equivalency on-board an aircraft with physical dimensions of ethical approval, multiple ground laboratory sessions were conducted with combinations of anesthetic, pre-medication, and induction protocols on Yorkshire-cross specific pathogen-free (SPF) pigs. Several constant rate infusion (CRI) intravenous anesthetic combinations were tested. In each regimen, opioids were administered to ensure analgesia. Ventilation was supported mechanically with blended gradients of oxygen. The best performing terrestrial 1 g regime was flight tested in parabolic flight for its effectiveness in sustaining optimal and prolonged anesthesia, analgesia, and maintaining hemodynamic stability. Each flight day, a fully anesthetized, ventilated, and surgically instrumented pig was transported to the Flight Research Laboratory (FRL) in a temperature-controlled animal ambulance. A modular on-board surgical/ICU suite with appropriate anesthesia/ICU and surgical support capabilities was employed. ResultsThe mean duration of anesthesia (per flight day) was 10.28 h over four consecutive days. A barbiturate and ketamine-based CRI anesthetic regimen supplemented with narcotic analgesia by bolus administration offered the greatest prolonged hemodynamic

  6. Queuing theory accurately models the need for critical care resources. (United States)

    McManus, Michael L; Long, Michael C; Cooper, Abbot; Litvak, Eugene


    Allocation of scarce resources presents an increasing challenge to hospital administrators and health policy makers. Intensive care units can present bottlenecks within busy hospitals, but their expansion is costly and difficult to gauge. Although mathematical tools have been suggested for determining the proper number of intensive care beds necessary to serve a given demand, the performance of such models has not been prospectively evaluated over significant periods. The authors prospectively collected 2 years' admission, discharge, and turn-away data in a busy, urban intensive care unit. Using queuing theory, they then constructed a mathematical model of patient flow, compared predictions from the model to observed performance of the unit, and explored the sensitivity of the model to changes in unit size. The queuing model proved to be very accurate, with predicted admission turn-away rates correlating highly with those actually observed (correlation coefficient = 0.89). The model was useful in predicting both monthly responsiveness to changing demand (mean monthly difference between observed and predicted values, 0.4+/-2.3%; range, 0-13%) and the overall 2-yr turn-away rate for the unit (21%vs. 22%). Both in practice and in simulation, turn-away rates increased exponentially when utilization exceeded 80-85%. Sensitivity analysis using the model revealed rapid and severe degradation of system performance with even the small changes in bed availability that might result from sudden staffing shortages or admission of patients with very long stays. The stochastic nature of patient flow may falsely lead health planners to underestimate resource needs in busy intensive care units. Although the nature of arrivals for intensive care deserves further study, when demand is random, queuing theory provides an accurate means of determining the appropriate supply of beds.

  7. Qualitative Research and Narrative Sources in the Context of Critical and Renal Cares


    Siles González, José; Solano Ruiz, María del Carmen


    The objective of this study is to clarify the relevance of qualitative research in the context of critical care and renal dialysis requires using narrative sources. Also specific objectives are to identify the phases or cultural moments that are distinguished in these processes. Research Question: How can the narrative materials contribute to the study of the processes of critical care and/or qualitative research in nephrology? Method and Sources: There have been studies focusing on the narra...

  8. 'Intensive care unit survivorship' - a constructivist grounded theory of surviving critical illness. (United States)

    Kean, Susanne; Salisbury, Lisa G; Rattray, Janice; Walsh, Timothy S; Huby, Guro; Ramsay, Pamela


    To theorise intensive care unit survivorship after a critical illness based on longitudinal qualitative data. Increasingly, patients survive episodes of critical illness. However, the short- and long-term impact of critical illness includes physical, psychological, social and economic challenges long after hospital discharge. An appreciation is emerging that care needs to extend beyond critical illness to enable patients to reclaim their lives postdischarge with the term 'survivorship' being increasingly used in this context. What constitutes critical illness survivorship has, to date, not been theoretically explored. Longitudinal qualitative and constructivist grounded theory. Interviews (n = 46) with 17 participants were conducted at four time points: (1) before discharge from hospital, (2) four to six weeks postdischarge, (3) six months and (4) 12 months postdischarge across two adult intensive care unit setting. Individual face-to-face interviews. Data analysis followed the principles of Charmaz's constructivist grounded theory. 'Intensive care unit survivorship' emerged as the core category and was theorised using concepts such as status passages, liminality and temporality to understand the various transitions participants made postcritical illness. Intensive care unit survivorship describes the unscheduled status passage of falling critically ill and being taken to the threshold of life and the journey to a life postcritical illness. Surviving critical illness goes beyond recovery; surviving means 'moving on' to life postcritical illness. 'Moving on' incorporates a redefinition of self that incorporates any lingering intensive care unit legacies and being in control of one's life again. For healthcare professionals and policymakers, it is important to realise that recovery and transitioning through to survivorship happen within an individual's time frame, not a schedule imposed by the healthcare system. Currently, there are no care pathways or policies in

  9. Does triage to critical care during a pandemic necessarily result in more survivors? (United States)

    Utley, Martin; Pagel, Christina; Peters, Mark J; Petros, Andy; Lister, Paula


    The 2009 H1N1 pandemic reinforced the need for a planned response to increased demand for critical care. Triage protocols have been proposed incorporating the exclusion of specified subgroups of patients from critical care. There have been no studies that explore the theoretical underpinning of triage at referral, and it is not clear under what circumstances triage would confer the intended benefits. We sought to explore the mechanisms whereby triage could lead to fewer deaths across a critical care population in the context of a pandemic. We constructed a mathematical model based on queuing theory to compare the estimated short-term survival achieved by using a critical care service with and without triage at referral. Illustrative scenarios concerning a hypothetical critical care population were constructed to explore the roles of length of stay and critical care survival in determining the impact of triage and to identify "tipping points" of demand at which triage would result in more survivors. Not applicable as this was a data-free mathematical modeling exercise. We identified circumstances in which triage would be expected to result in more survivors and circumstances in which it would not. In some scenarios, excluding patient groups solely on the basis of anticipated length of stay could be effective due to a more efficient use of critical care bed days. The impact of triage is dependent on the level of demand and on the scale of achievable differences between included and excluded groups in terms of anticipated length of stay and critical care survival. It cannot be assumed that triage can or will result in fewer deaths. It should be remembered that there are considerations other than population-level short-term survival when determining the objectives of triage and its ethical implementation.

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

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    Westcott Mia


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

  11. Optimal management of the critically ill: anaesthesia, monitoring, data capture, and point-of-care technological practices in ovine models of critical care. (United States)

    Chemonges, Saul; Shekar, Kiran; Tung, John-Paul; Dunster, Kimble R; Diab, Sara; Platts, David; Watts, Ryan P; Gregory, Shaun D; Foley, Samuel; Simonova, Gabriela; McDonald, Charles; Hayes, Rylan; Bellpart, Judith; Timms, Daniel; Chew, Michelle; Fung, Yoke L; Toon, Michael; Maybauer, Marc O; Fraser, John F


    Animal models of critical illness are vital in biomedical research. They provide possibilities for the investigation of pathophysiological processes that may not otherwise be possible in humans. In order to be clinically applicable, the model should simulate the critical care situation realistically, including anaesthesia, monitoring, sampling, utilising appropriate personnel skill mix, and therapeutic interventions. There are limited data documenting the constitution of ideal technologically advanced large animal critical care practices and all the processes of the animal model. In this paper, we describe the procedure of animal preparation, anaesthesia induction and maintenance, physiologic monitoring, data capture, point-of-care technology, and animal aftercare that has been successfully used to study several novel ovine models of critical illness. The relevant investigations are on respiratory failure due to smoke inhalation, transfusion related acute lung injury, endotoxin-induced proteogenomic alterations, haemorrhagic shock, septic shock, brain death, cerebral microcirculation, and artificial heart studies. We have demonstrated the functionality of monitoring practices during anaesthesia required to provide a platform for undertaking systematic investigations in complex ovine models of critical illness.

  12. Caring for critically injured children: An analysis of 56 pediatric damage control laparotomies. (United States)

    Villalobos, Miguel A; Hazelton, Joshua P; Choron, Rachel L; Capano-Wehrle, Lisa; Hunter, Krystal; Gaughan, John P; Ross, Steven E; Seamon, Mark J


    -8) days until closure (fascial, 90%; vicryl/split thickness skin grafting, 10%). DCL complications (surgical site infection, 18%; dehiscence, 2%; enterocutaneous fistula, 2%) were analyzed. When stratified by age ( 0.05). After controlling for DCL, age, and gender, multivariate analysis indicated only ISS (odds ratio, 1.10 [95% confidence interval, 1.01 - 1.19], p = 0.0218) and arrival systolic blood pressure (odds ratio, 0.96 [95% confidence interval, 0.93-0.99], p = 0.0254) predicted mortality after severe injury. DCL is a proven, lifesaving surgical technique in adults. This report is the first to analyze the use of DCL in children with critical abdominal injuries. With similar survival and morbidity rates as critically injured adults, DCL merits careful consideration in children with critical abdominal injuries. Therapeutic study, level IV.

  13. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. (United States)

    Diringer, Michael N; Bleck, Thomas P; Claude Hemphill, J; Menon, David; Shutter, Lori; Vespa, Paul; Bruder, Nicolas; Connolly, E Sander; Citerio, Giuseppe; Gress, Daryl; Hänggi, Daniel; Hoh, Brian L; Lanzino, Giuseppe; Le Roux, Peter; Rabinstein, Alejandro; Schmutzhard, Erich; Stocchetti, Nino; Suarez, Jose I; Treggiari, Miriam; Tseng, Ming-Yuan; Vergouwen, Mervyn D I; Wolf, Stefan; Zipfel, Gregory


    Subarachnoid hemorrhage (SAH) is an acute cerebrovascular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs. SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team. A lack of high quality data has led to numerous approaches to management and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of rebleeding, but provide limited discussion of the complex critical care issues involved in the care of SAH patients. The Neurocritical Care Society organized an international, multidisciplinary consensus conference on the critical care management of SAH to address this need. Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise. A jury of four experienced neurointensivists was selected for their experience in clinical investigations and development of practice guidelines. Recommendations were developed based on literature review using the GRADE system, discussion integrating the literature with the collective experience of the participants and critical review by an impartial jury. Recommendations were developed using the GRADE system. Emphasis was placed on the principle that recommendations should be based not only on the quality of the data but also tradeoffs and translation into practice. Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data.

  14. Academic Productivity of Accreditation Council for Graduate Medical Education-Accredited Critical Care Fellowship Program Directors. (United States)

    Fahy, Brenda G; Vasilopoulos, Terrie; White, Peggy; Culley, Deborah J


    Academic productivity is an expectation for program directors of Accreditation Council for Graduate Medical Education-accredited subspecialty programs in critical care medicine. Within the adult critical care Accreditation Council for Graduate Medical Education-accredited programs, we hypothesized that program director length of time from subspecialty critical care certification would correlate positively with academic productivity, and primary field would impact academic productivity. This study received Institutional Review Board exemption from the University of Florida. Data were obtained from public websites on program directors from all institutions that had surgery, anesthesiology, and pulmonary Accreditation Council for Graduate Medical Education-accredited subspecialty critical care training programs during calendar year 2012. Information gathered included year of board certification and appointment to program director, academic rank, National Institutes of Health funding history, and PubMed citations. Specialty area was significantly associated with total (all types of publications) (p = 0.0002), recent (p accounting for academic rank, years certified, and as a program director. These differences were most prominent in full professors, with surgery full professors having more total, recent, last author, and original research publications than full professors in the other critical care specialties. This study demonstrates that one's specialty area in critical care is an independent predictor of academic productivity, with surgery having the highest productivity. For some metrics, such as total and last author publications, surgery had more publications than both anesthesiology and pulmonary, whereas there was no difference between the latter groups. This suggests that observed differences in academic productivity vary by specialty.

  15. Effects of implementation of an urgent surgical care service on subspecialty general surgery training (United States)

    Wood, Leanne; Buczkowski, Andrzej; Panton, Ormond M.N.; Sidhu, Ravi S.; Hameed, S. Morad


    Background In July 2007, a large Canadian teaching hospital realigned its general surgery services into elective general surgery subspecialty-based services (SUBS) and a new urgent surgical care (USC) service (also know in the literature as an acute care surgery service). The residents on SUBS had their number of on-call days reduced to enable them to focus on activities related to SUBS. Our aim was to examine the effect of the creation of the USC service on the educational experiences of SUBS residents. Methods We enrolled residents who were on SUBS for the 6 months before and after the introduction of the USC service. We collected data by use of a survey, WEB eVAL and recorded attendance at academic half days. Our 2 primary outcomes were residents’ attendance at ambulatory clinics and compliance with the reduction in the number of on-call days. Our secondary outcomes included residents’ time for independent study, attendance at academic half days, operative experience, attendance at multidisciplinary rounds and overall satisfaction with SUBS. Results Residents on SUBS had a decrease in the mean number of on-call days per resident per month from 6.28 to 1.84 (p = 0.006), an increase in mean attendance at academic half days from 65% to 87% (p = 0.028), at multidisciplinary rounds (p = 0.002) and at ambulatory clinics and an increase in independent reading time (p = 0.015), and they reported an improvement in their work environment. There was no change in the amount of time residents spent in the operating room or in their overall satisfaction with SUBS. Conclusion Residents’ education in the SUBS structure was positively affected by the creation of a USC service. Compliance with the readjustment of on-call duties was high and was identified as the single most significant factor in enabling residents to take full advantage of the unique educational opportunities available only while on SUBS. PMID:20334744

  16. Translational Cognition for Decision Support in Critical Care Environments: A Review (United States)

    Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.


    The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731

  17. Mental health care delivery system in Greece: a critical overview. (United States)

    Stefanis, C N; Madianos, M G


    The organizational profile of the mental health care delivery system in Greece is mainly characterized by centralization which is reflected in various functional parts of the system (uneven distribution of psychiatric beds and manpower, absence of psychiatric units in general hospitals serving a certain catchment area, lack of community-based psychiatric services, etc.) As a result of this centralized structure there is a centrifugal flow of the mentally ill patients toward Athens and Thessaloniki and consequently the existing possibilities for community-based care as an alternative to inpatient treatment are rather limited. Future immediate objectives of the national social policy planning should be based on decentralization and reorganization of the psychiatric services in order for the mental health delivery system to respond more effectively to the mental health needs of the Greek population.

  18. Health-related quality of life of patients 12 months following surgical intensive care discharge

    Directory of Open Access Journals (Sweden)

    F. Karachi


    Full Text Available Health  related  quality  of  life  (HRQoL  and  the  effect  of  selected  socio-demographic  and  clinical  intensive  care  variables  on  HRQoL of  patients  12  months  following  adult  surgical  intensive  care  unit  discharge in  the  Western  Cape  was  evaluated.  A  prospective  observational  study  was conducted.  The  sample  comprised  46  patients  who  had  survived  12  months following discharge. Structured telephonic interviews were conducted using a self-developed  and  SF-36v2  HRQoL  questionnaire.  Data  was  analyzed  using Stastica 7 and values were accepted as significant at the 5% level. Low mean HRQoL  domain  scores  (43%  -  53%  were  found  implying  a  poor  HRQoL outcome. Physical functioning [43.5%], Role Play [44.5%] and Role Emotion [43.1%] scores were specifically lower than the other HRQoL domain scores. Age and severity of illness scores (APACHE II were significantly associated with the social functioning (p=0.01 and physical functioning (p=0.02 scores  respectively. APACHE  II  may  be  a  useful  contributor  in  predicting  long-term  physical  functioning  outcomes  in  patients  following  surgical  ICU  discharge.  The  HRQoL  outcomes  are  slightly  lower  than  that  found  for  inter-national ICU populations however responses in the domains affected are comparable. Low physical functioning, role play  and  role  emotion  scores  indicate  a  need  for  further  physical  and  emotional  rehabilitation  following  surgical  ICU discharge.

  19. The future of critical care: renal support in 2027


    Clark, William R.; Neri, Mauro; Garzotto, Francesco; Ricci, Zaccaria; Goldstein, Stuart L.; Ding, Xiaoqiang; Xu, Jiarui; Ronco, Claudio


    Since its inception four decades ago, both the clinical and technologic aspects of continuous renal replacement therapy (CRRT) have evolved substantially. Devices now specifically designed for critically ill patients with acute kidney injury are widely available and the clinical challenges associated with treating this complex patient population continue to be addressed. However, several important questions remain unanswered, leaving doubts in the minds of many clinicians about therapy prescr...

  20. Year in review 2013: critical care - respiratory infections


    Nair, Girish B; Niederman, Michael S


    Infectious complications, particularly in the respiratory tract of critically ill patients, are related to increased mortality. Severe infection is part of a multiple system illness and female patients with severe sepsis have a worse prognosis compared to males. Kallistatin is a protective hormokine released during monocyte activation and low levels in the setting of septic shock can predict adverse outcomes. Presepsin is another biomarker that was recently evaluated and is elevated in patien...

  1. Year in review 2013: Critical Care--respiratory infections. (United States)

    Nair, Girish B; Niederman, Michael S


    Infectious complications, particularly in the respiratory tract of critically ill patients, are related to increased mortality. Severe infection is part of a multiple system illness and female patients with severe sepsis have a worse prognosis compared to males. Kallistatin is a protective hormokine released during monocyte activation and low levels in the setting of septic shock can predict adverse outcomes. Presepsin is another biomarker that was recently evaluated and is elevated in patients with severe sepsis patients at risk of dying. The Centers for Disease Control and Prevention has introduced new definitions for identifying patients at risk of ventilator-associated complications (VACs), but several other conditions, such as pulmonary edema and acute respiratory distress syndrome, may cause VACs, and not all patients with VACs may have ventilator-associated pneumonia. New studies have suggested strategies to identify patients at risk for resistant pathogen infection and therapies that optimize efficacy, without the overuse of broad-spectrum therapy in patients with healthcare-associated pneumonia. Innovative strategies using optimized dosing of antimicrobials, maximizing the pharmacokinetic and pharmacodynamic properties of drugs in critically ill patients, and newer routes of drug delivery are being explored to combat drug-resistant pathogens. We summarize the major clinical studies on respiratory infections in critically ill patients published in 2013.

  2. 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


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

  3. Outcomes of surgical site infections in orthopedic trauma surgeries in a tertiary care centre in India

    Directory of Open Access Journals (Sweden)

    N Rajkumari


    Full Text Available Background: Surgical site infections (SSIs still cause significant morbidity and mortality despite advances in trauma care. We have studied in this paper the rate of SSIs, their outcomes in patients undergoing interventions for trauma and SSI trends in developing countries. Materials and Methods: A 16-month study (May, 2011- August, 2012 was carried out. Patients undergoing interventions for orthopedic trauma were followed and assessed for SSIs and their outcomes and antimicrobial sensitivity patterns of the micro-organisms isolated were noted and correlated. Results: A total of 40 (4.4% confirmed cases of SSIs were identified among 852 patients of orthopedic trauma. Based on the new CDC criteria, after ruling out cellulitis, only 24 (2.6% were found to have SSIs. A total of 12.5% of the SSIs were detected during follow-up. Acinetobacter baumannii was the predominant organism as also Staphylococcus aureus. Outcomes observed included changes in antibiotic regime, revision surgery, readmission to hospital and deaths. Conclusion: SSI is prevalent in orthopaedic trauma patients and an active surveillance program will help in early management and prevention.

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

    DEFF Research Database (Denmark)

    Jones, Christina; Bäckman, Carl; Capuzzo, Maurizia


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

  5. A Critical-Incident Stress Debriefing Program for Hospital-Based Health Care Personnel. (United States)

    Spitzer, William J.; Burke, Laurie


    Reviews individual and institutional effects of critical-incident stress on health care delivery and use of stress education, defusings, and debriefings as effective interventions with health care personnel. Presents successful efforts of social work department using these techniques in major university hospital system as model for replication in…

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

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


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

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

    Directory of Open Access Journals (Sweden)

    Rahul Amte


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

  8. Does Incremental Positioning (Weight Shifts) Reduce Pressure Injuries in Critical Care Patients? (United States)

    Krapfl, Lee Ann; Langin, Julia; Pike, Caitlin A; Pezzella, Patricia

    Incremental positioning or weight shifts are often suggested as an alternative to standard repositioning/turning in critical care patients deemed clinically unstable. This evidence-based report card reviews whether incremental positioning and/or weight shifts reduce hospital-acquired sacral/buttocks pressure injuries in critical care patients deemed too unstable to turn. A scoping review of the literature was conducted for studies related to repositioning and hospital-acquired pressure injuries in high-risk, critical care patients. The databases searched were CINAHL, EMBASE, and PubMed. Key words used in the search were "intensive care," "critical care," "pressure ulcer(s)," "pressure injury(ies)," "pressure sore(s)," "turn(s)," "turning," "shift(s)," "shifting," "position(s)," OR "positioning, cardiopulmonary support." The search yielded 183 articles. The search was then narrowed to those published within the past 10 years, yielding 35 citations. Following title and abstract review, 5 studies were identified that met inclusion criteria; an additional 13 articles were found by ancestry and hand-searching. No evidence was identified that incremental positioning and/or weight shifts reduce hospital-acquired sacral/buttocks pressure injuries in critical care patients deemed too unstable to turn. In addition, no evidence was found that incremental positioning and/or weight shifts affect interface pressure on the sacrum/buttocks. However, there was evidence that incremental positioning and/or weight shifts do impact gravitational equilibrium. Despite the paucity of evidence, incremental positioning and/or weight shifts are recommended as an intervention in critical care patients deemed too unstable to turn. Further research is needed to examine whether incremental positioning and/or weight shifts are effective in reducing pressure injuries in critical care patients.

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


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


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

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


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


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

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


    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


    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...

  12. Integration of Early Specialist Palliative Care in Cancer Care and Patient Related Outcomes: A Critical Review of Evidence (United States)

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


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

  13. Meta-analysis of colloids versus crystalloids in critically ill, trauma and surgical patients. (United States)

    Qureshi, S H; Rizvi, S I; Patel, N N; Murphy, G J


    There is uncertainty regarding the safety of different volume replacement solutions. The aim of this study was systematically to review evidence of crystalloid versus colloid solutions, and to determine whether these results are influenced by trial design or clinical setting. PubMed, Embase and the Cochrane Central Register of Controlled Trials were used to identify randomized clinical trials (RCTs) that compared crystalloids with colloids as volume replacement solutions in patients with traumatic injuries, those undergoing surgery and in critically ill patients. Adjusted odds ratios (ORs) for mortality and major morbidity including renal injury were pooled using fixed-effect and random-effects models. Some 59 RCTs involving 16 889 patients were included in the analysis. Forty-one studies (69 per cent) were found to have selection, detection or performance bias. Colloid administration did not lead to increased mortality (32 trials, 16 647 patients; OR 0·99, 95 per cent c.i. 0·92 to 1·06), but did increase the risk of developing acute kidney injury requiring renal replacement therapy (9 trials, 11 648 patients; OR 1·35, 1·17 to 1·57). Sensitivity analyses that excluded small and low-quality studies did not substantially alter these results. Subgroup analyses by type of colloid showed that increased mortality and renal replacement therapy were associated with use of pentastarch, and increased risk of renal injury and renal replacement therapy with use of tetrastarch. Subgroup analysis indicated that the risks of mortality and renal injury attributable to colloids were observed only in critically ill patients with sepsis. Current general restrictions on the use of colloid solutions are not supported by evidence. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    L. Salvador-Carulla


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

  15. An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine policy statement: the Choosing Wisely® Top 5 list in Critical Care Medicine. (United States)

    Halpern, Scott D; Becker, Deborah; Curtis, J Randall; Fowler, Robert; Hyzy, Robert; Kaplan, Lewis J; Rawat, Nishi; Sessler, Curtis N; Wunsch, Hannah; Kahn, Jeremy M


    The high costs of health care in the United States and other developed nations are attributable, in part, to overuse of tests, treatments, and procedures that provide little to no benefit for patients. To improve the quality of care while also combating this problem of cost, the American Board of Internal Medicine Foundation developed the Choosing Wisely Campaign, tasking professional societies to develop lists of the top five medical services that patients and physicians should question. To present the Critical Care Societies Collaborative's Top 5 list in Critical Care Medicine and describe its development. Each professional society in the Collaborative nominated members to the Choosing Wisely task force, which established explicit criteria for evaluating candidate items, generated lists of items, performed literature reviews on each, and sought external input from content experts. Task force members narrowed the list to the Top 5 items using a standardized scoring system based on each item's likely overall impact and merits on the five explicit criteria. From an initial list of 58 unique recommendations, the task force proposed a Top 5 list that was ultimately endorsed by each Society within the Collaborative. The five recommendations are: (1) do not order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions; (2) do not transfuse red blood cells in hemodynamically stable, nonbleeding ICU patients with an Hb concentration greater than 7 g/dl; (3) do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of an ICU stay; (4) do not deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation; and (5) do not continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort

  16. Improving critical care discharge summaries: a collaborative quality improvement project using PDSA. (United States)

    Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane


    Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called 'iMobile' is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work

  17. The evolution of nutrition in critical care: how much, how soon?


    Wischmeyer, Paul E


    Critical care is a very recent advance in the history of human evolution. Prior to the existence of ICU care, when the saber-tooth tiger attacked you had but a few critical hours to recover or you died. Mother Nature, and her survival of the fittest mentality, would never have favored the survival of the modern ICU patient. We now support ICU patients for weeks, or even months. During this period, patients appear to undergo phases of critical illness. A simplification of this concept would in...

  18. Critical care medicine for emerging Middle East respiratory syndrome: Which point to be considered? (United States)

    Wiwanitkit, Viroj


    The Middle East respiratory syndrome (MERS) is a new emerging respiratory tract infection. This coronavirus infection is firstly reported from the Middle East, and it becomes threat for the global public health at present due to its existence in a remote area such as USA and Korea. The concern on the management of the patients is very important. Since most of the patients can develop severe respiratory illness and critical care management is needed, the issue on critical care for MERS is the topic to be discussed in critical medicine.

  19. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Yeliz İrem Tunçel


    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.

  20. Professional stress and health among critical care nurses in Serbia. (United States)

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


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

  1. Prevention of Iatrogenic Anemia in Critical and Neonatal Care. (United States)

    Jakacka, Natalia; Snarski, Emilian; Mekuria, Selamawit


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

  2. Professional autonomy and job satisfaction: survey of critical care nurses in mainland Greece. (United States)

    Iliopoulou, Katerina K; While, Alison E


    This paper is a report of a study conducted to describe Greek critical care nurses' views on professional autonomy and its relationship with job satisfaction and other work-related variables. Professional autonomy is generally considered a highly desirable nursing attribute and a major factor in nurse job satisfaction. In the critical care environment, a high level of accountability, responsibility and autonomy are required to optimize outcomes of critically unstable patients. A questionnaire survey was conducted with a convenience sample of Greek critical care nurses (n = 431; response rate 70%) in 2007. Data were collected on professional autonomy, job satisfaction, role conflict and role ambiguity. Overall, nurses reported acting moderately autonomously. Younger nurses reported statistically significant lower levels of autonomy. Higher levels of autonomy were reported by female nurses. Multiple logistic regression revealed that appointment level, type of critical care unit and registration with a professional organization were independently associated with autonomy. A positive moderate association was found between reported autonomy, job satisfaction, role conflict and role ambiguity, but there was no relationship between job satisfaction and reported role conflict and role ambiguity. Further education, role enhancement and support are required for nurses working in critical care in Greece if they are to achieve the maximum potential of their professional role. Failure to address the perceptions of professional autonomy may have an impact on staff retention, because of job dissatisfaction. © 2010 Blackwell Publishing Ltd.

  3. Strategies of organization and service for the critical-care laboratory. (United States)

    Fleisher, M; Schwartz, M K


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

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

    Directory of Open Access Journals (Sweden)

    Vi Am Dinh


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

  5. A Critical Caring Theory of Protection for Migrants and Seasonal Farmworkers. (United States)

    Shearer, Jennifer E


    Pesticide exposures represent inequities among a vulnerable population of migrant and seasonal farmworkers. A social justice theory synthesized from an environmental health research framework, a middle range theory of critical caring, and literature on pesticide exposure is presented as a situation-specific public health practice theory. Concepts from the physiological, epistemological, vulnerability, and health protection domains are related to concepts of critical caring revealing protective strategies for vulnerable populations exposed to pesticides. The key concepts are risk exposure, community assessment, transpersonal health promotion, community competence, and controllability. Protection from exposure involves raising awareness, critically assessing communities, educating for empowerment, building capacity, and advocating to ensure social justice. Critical caring protection is provided in a mutually respectful relationship that promotes responsibility at the individual and population levels.

  6. Industry-sponsored economic studies in critical and intensive care versus studies sponsored by nonprofit organizations. (United States)

    Hartmann, Michael; Knoth, Holger; Schulz, Diane; Knoth, Sven; Meier-Hellmann, Andreas


    The purpose of this analysis of health economic studies in the field of intensive and critical care was to investigate whether any relationship could be established between type of sponsorship and (1) type of economic analysis, (2) health technology assessed, (3) sensitivity analysis performed, (4) publication status, and (5) qualitative cost assessment. Using the terms critical care or intensive care, all health economics publications in the field of critical and intensive care were identified in the Health Economic Evaluations Database (HEED, Version 1995-2001) on the basis of sponsorship and comparative studies. This search yielded a total of 42 eligible articles. Their evaluations were prepared independently by 2 investigators on the basis of specific criteria. When evaluators disagreed, a third investigator provided a deciding evaluation. There was no statistically demonstrable relationship between types of sponsorship and sensitivity analysis performed, publication status, types of economic analysis, or qualitative cost assessment.

  7. Evaluation of Critical Care Monitor Technology During the US Navy Strong Angel Exercise (United States)

    Johannesen, John; Rasbury, Jack


    The NASA critical path road map identifies "trauma and acute medical problems" as a clinical capability risk category ( Specific risks include major trauma, organ laceration or contusion, hemoperitoneum, pulmonary failure, pneumo- and hemothorax, burn, open bone fracture, blunt head trauma, and penetrating injury. Mitigation of these risks includes the capability for critical care monitoring. Currently, the International Space Station (ISS) Crew Health Care System (CHeCS) does not provide such a capability. The Clinical Space Medicine Strategic Planning Forum (4/8/97), sponsored by NASA Medical Operations, identified the development of trauma care capabilities as one of the top priorities for space medicine. The Clinical Care Capability Development Project (CCCDP) subsequently undertook the task to address this need.

  8. Stages of Adoption Concern and Technology Acceptance in a Critical Care Nursing Unit. (United States)

    Berg, Gina M; LoCurto, Jamie; Lippoldt, Diana


    The aim of this study is to examine the stages of concern (self, task, and impact) and usability (trust, perceived usefulness, and ease of use) shifts experienced by nurses adopting new technology. Patient care processes in critical care units can be disrupted with the incorporation of information technology. New users of technology typically transition through stages of concern and experience shifts in acceptance during assimilation. Critical care nurses (N = 41) were surveyed twice: (1) pre, immediately after training, and (2) post, 3 months after implementation of technology. From presurvey to postsurvey, self-concerns decreased 14%, whereas impact concerns increased 22%. Furthermore, there was a 30% increase in trust and a 17% increase in perceived usefulness, even with a 27% decrease in ease of use. Adoption of new technology requires critical care nurses to adapt current practices, which may improve trust and perceived usefulness yet decrease perceptions of ease of use.

  9. Using research to find the effects of process-oriented educational assessment in critical care nursing practice. (United States)

    Lemmer, B; O'Riordan, B


    This 1-year study was undertaken in the southeast of England to investigate whether a process-oriented educational assessment procedure was sustainable, following research in a sample of five critical care environments. Data were derived from clinical practice supervisors and students in each of two consecutive post-registration cohorts, selected from the following areas: intensive and coronary care units; neonatal nursing; medical-surgical units; operating theatres; and accident and emergency departments. The existing measure and then a modified assessment measure for resuscitation ability, were used to evaluate the effect of educational assessment in clinical settings. Data were collected using questionnaires with cohort 1 before and cohort 2 after introduction of an assessment grid developed by the course team based on data from focus group discussions during the clinical supervisors' workshops. The findings indicated that the descriptors of levels of attainment generated by the students and supervisors were in accord with Benner's descriptors (this had increased by phase 2 of the research). Students and supervisors considered that the assessment process increased their critical thinking abilities, but that finding time for supervision and assessment was difficult. Future work will focus on the development of a generic grid with criteria that can be used to guide assessment of any practice experience.

  10. The Untapped Potential of Patient and Family Engagement in the Organization of Critical Care. (United States)

    Haines, Kimberley J; Kelly, Phillipa; Fitzgerald, Peter; Skinner, Elizabeth H; Iwashyna, Theodore J


    There is growing interest in patient and family participation in critical care-not just as part of the bedside, but as part of educational and management organization and infrastructure. This offers tremendous opportunities for change but carries risk to patients, families, and the institution. The objective is to provide a concise definitive review of patient and family organizational participation in critical care as a high-risk population and other vulnerable groups. A pragmatic, codesigned model for critical care is offered as a suggested approach for clinicians, researchers, and policy-makers. To inform this review, a systematic search of Ovid Medline, PubMed, and Embase was undertaken in April 2016 using the MeSH terms: patient participation and critical care. A second search was undertaken in PubMed using the terms: patient participation and organizational models to search for other examples of engagement in vulnerable populations. We explicitly did not seek to include discussions of bedside patient-family engagement or shared decision-making. Two reviewers screened citations independently. Included studies either actively partnered with patients and families or described a model of engagement in critical care and other vulnerable populations. Data or description of how patient and family engagement occurred and/or description of model were extracted into a standardized form. There was limited evidence of patient and family engagement in critical care although key recommendations can be drawn from included studies. Patient and family engagement is occurring in other vulnerable populations although there are few described models and none which address issues of risk. A model of patient and family engagement in critical care does not exist, and we propose a pragmatic, codesigned model that takes into account issues of psychologic safety in this population. Significant opportunity exists to document processes of engagement that reflect a changing paradigm of

  11. The future of critical care: renal support in 2027. (United States)

    Clark, William R; Neri, Mauro; Garzotto, Francesco; Ricci, Zaccaria; Goldstein, Stuart L; Ding, Xiaoqiang; Xu, Jiarui; Ronco, Claudio


    Since its inception four decades ago, both the clinical and technologic aspects of continuous renal replacement therapy (CRRT) have evolved substantially. Devices now specifically designed for critically ill patients with acute kidney injury are widely available and the clinical challenges associated with treating this complex patient population continue to be addressed. However, several important questions remain unanswered, leaving doubts in the minds of many clinicians about therapy prescription/delivery and patient management. Specifically, questions surrounding therapy dosing, timing of initiation and termination, fluid management, anticoagulation, drug dosing, and data analytics may lead to inconsistent delivery of CRRT and even reluctance to prescribe it. In this review, we discuss current limitations of CRRT and potential solutions over the next decade from both a patient management and a technology perspective. We also address the issue of sustainability for CRRT and related therapies beyond 2027 and raise several points for consideration.

  12. Advances in the Critical Care Management of Ischemic Stroke

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    Vineeta Singh


    Full Text Available Given recent advances in diagnostic modalities and revascularization capabilities, clinicians are not only able to rapidly and accurately identify acute ischemic stroke, but may also be able to aggressively intervene to minimize the extent of infarction. In those cases where revascularization cannot occur and/or the extent of infarction is large, there are multiple strategies to prevent secondary decompensation as the stroke evolves, for instance, if malignant cerebral edema should develop. In this paper, we will review the indications for specialized ICU care for an ischemic stroke patient, the treatment principles, and strategies employed by neurointensivists to minimize secondary neuronal injury, the literature in support of such strategies (and the questions to be addressed by future studies, all with the ultimate goal of increasing the likelihood of favorable neurologic outcomes in our ischemic stroke population.

  13. Net4Care : Towards a Mission-Critical Software Ecosystem

    DEFF Research Database (Denmark)

    Christensen, Henrik Bærbak; Hansen, Klaus Marius


    (innovative) initiatives with little regards for national and global (standardization) initiatives. A reason for this discrepancy is that the software architecture for national (and global) systems and standards are hard to understand, hard to develop systems based on, and hard to deploy. To counter this, we...... propose a software ecosystem approach for telemedicine applications, providing a framework, Net4Care, encapsulating national/global design decisions with respect to standardization while allowing for local innovation. This paper presents an analysis of existing systems, of requirements for a software......, health centers are getting larger and more distributed, and the number of healthcare professionals does not follow the trend in chronic diseases. All of this leads to a need for telemedical and mobile health applications. In a Danish context, these applications are often developed through local...

  14. Pediatric asthma severity score is associated with critical care interventions (United States)

    Maue, Danielle K; Krupp, Nadia; Rowan, Courtney M


    AIM To determine if a standardized asthma severity scoring system (PASS) was associated with the time spent on continuous albuterol and length of stay in the pediatric intensive care unit (PICU). METHODS This is a single center, retrospective chart review study at a major children’s hospital in an urban location. To qualify for this study, participants must have been admitted to the PICU with a diagnosis of status asthmaticus. There were a total of 188 participants between the ages of two and nineteen, excluding patients receiving antibiotics for pneumonia. PASS was calculated upon PICU admission. Subjects were put into one of three categories based on PASS: ≤ 7 (mild), 8-11 (moderate), and ≥ 12 (severe). The groups were compared based on different variables, including length of continuous albuterol and PICU stay. RESULTS The age distribution across all groups was similar. The median length of continuous albuterol was longest in the severe group with a duration of 21.5 h (11.5-27.5), compared to 15 (7.75-23.75) and 10 (5-15) in the moderate and mild groups, respectively (P = 0.001). The length of stay was longest in the severe group, with a stay of 35.6 h (22-49) compared to 26.5 (17-30) and 17.6 (12-29) in the moderate and mild groups, respectively (P = 0.001). CONCLUSION A higher PASS is associated with a longer time on continuous albuterol, an increased likelihood to require noninvasive ventilation, and a longer stay in the ICU. This may help safely distribute asthmatics to lower and higher levels of care in the future.

  15. [Inappropriate use of blood components in critical care?]. (United States)

    Oddason, Karl Erlingur; Guđbjartsson, Tómas; Guđmundsson, Sveinn; Kárason, Sigurbergur; Hreinsson, Kári; Sigurđsson, Gisli H


    Due to potential risk of blood transfusions, clinical guidelines emphasize restrictive use of blood components. However, numerous studies indicate that adherence to guidelines is often less than optimal. Furthermore, information regarding use of blood transfusion in intensive care units (ICUs) and compliance to clinical guidelines is lacking. We studied the use of blood components in two adult ICUs in Iceland and the compliance to clinical guidelines. All adult patients that received blood components in both ICUs at Landspitali during 6 months in 2010 were studied. Hematology and coagulation parameters as well as indications for administration were compared with hospital guidelines. 202 patients (34%) received blood components, half of them after surgery. 30% received red-blood cells (RBCs), 18% fresh frozen plasma (FFP) and 9% platelets. The mean hemoglobin value before RBC transfusion was 87 g/L, but in one third of cases it exceeded 100 g/L. FFP was transfused at a normal prothrombin time in 9% of cases. No coagulation parameters were available before transfusion of 5% of FFP. Mean platelet count before transfusion of platelets was 82 x109/L and in 34% of cases it exceeded 100 x109/L. One third of patients received blood components during their ICU stay, most commonly RBCs. At least 6% of RBCs, 14% of FFPs and 33% of platelets were not transfused according to recent guidelines at Landspítali. Although our results are in line with findings of other studies it appears that the use of blood components in Icelandic ICUs can be improved. Key words: Blood transfusion, intensive care unit, red blood cells, fresh frozen plasma, platelets, transfusion clinical guidelines.

  16. Model of Caring Behavior Improvement to Achieve the Competence in Critical Care Nursing

    Directory of Open Access Journals (Sweden)

    Herdina Mariyanti


    Full Text Available Introduction: Nursing students need to build their capacity to understand and learn the form of caring of a professional nurse from a different point of view and apply the acquired knowledge into nursing practice. The purpose of the present study was to develop a model of caring behavior improvement in students of professional nursing education program in order to achieve students’ nursing care competence. Method: The present study used the explanatory survey and pre-experimental research design. Samples were students practicing in the ICU. Independent variables were attitude, personality, motivation and job design. Dependent variables were students’ caring behaviors and competence. Instruments used were a questionnaire for the independent variables and an observation sheet for the dependent variables. Data were analyzed using the Partial Least Square method. Result: Results showed that the loading factor of attitudes, personality, motivation, and job design against students’ caring behavior was > 1.96. The loading factor of students’ caring behaviors against the achievement of students’ competence was > 1.96. There were effects of attitude, personality, motivation and job design on students’ caring behaviors. Additionally, there was a signifi cant effect of caring behaviors on the achievement of student competence. Discussion: students’ attitudes, personality, motivation and job design would affect the shaping of students’ caring behaviors. Students’ caring behaviors would affect the achievement of student competence. Keywords: Caring behaviors, competence, ICU

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

    Directory of Open Access Journals (Sweden)

    Mª Cristina Pascual Fernández


    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.

  18. Evidence and its uses in health care and research: the role of critical thinking. (United States)

    Jenicek, Milos; Croskerry, Pat; Hitchcock, David L


    Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician's expertise, the patient's individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link. Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews. Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum.

  19. Expanding acute care nurse practitioner and clinical nurse specialist education: invasive procedure training and human simulation in critical care. (United States)

    Hravnak, Marilyn; Tuite, Patricia; Baldisseri, Marie


    Programs educating advanced practice nurses (APNs), including acute care nurse practitioners (ACNPs) and clinical nurse specialists (CNSs) may struggle with the degree to which technical and cognitive skills necessary and unique to the care of critically ill patients should be incorporated within training programs, and the best ways these skills can be synthesized and retained for clinical practice. This article describes the critical care technical skills training mechanisms and use of a High-Fidelity Human Simulation (HFHS) Laboratory in the ACNP and CNS programs at the University of Pittsburgh School of Nursing. The mechanisms for teaching invasive procedures are reviewed including an abbreviated course syllabus and documentation tools. The use of HFHS is discussed as a measure to provide students with technical and cognitive preparation to manage critical incidents. The HFHS Laboratory, scenario development and implementation, and the debriefing process are discussed. Critical care technical skills training and the use of simulation in the curriculum have had a favorable response from students and preceptors at the University of Pittsburgh School of Nursing, and have enhanced faculty's ability to prepare APNs.

  20. Surgical membranes as directional delivery devices to generate tissue: testing in an ovine critical sized defect model.

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    Melissa L Knothe Tate

    Full Text Available PURPOSE: Pluripotent cells residing in the periosteum, a bi-layered membrane enveloping all bones, exhibit a remarkable regenerative capacity to fill in critical sized defects of the ovine femur within two weeks of treatment. Harnessing the regenerative power of the periosteum appears to be limited only by the amount of healthy periosteum available. Here we use a substitute periosteum, a delivery device cum implant, to test the hypothesis that directional delivery of endogenous periosteal factors enhances bone defect healing. METHODS: Newly adapted surgical protocols were used to create critical sized, middiaphyseal femur defects in four groups of five skeletally mature Swiss alpine sheep. Each group was treated using a periosteum substitute for the controlled addition of periosteal factors including the presence of collagen in the periosteum (Group 1, periosteum derived cells (Group 2, and autogenic periosteal strips (Group 3. Control group animals were treated with an isotropic elastomer membrane alone. We hypothesized that periosteal substitute membranes incorporating the most periosteal factors would show superior defect infilling compared to substitute membranes integrating fewer factors (i.e. Group 3>Group 2>Group 1>Control. RESULTS: Based on micro-computed tomography data, bone defects enveloped by substitute periosteum enabling directional delivery of periosteal factors exhibit superior bony bridging compared to those sheathed with isotropic membrane controls (Group 3>Group 2>Group 1, Control. Quantitative histological analysis shows significantly increased de novo tissue generation with delivery of periosteal factors, compared to the substitute periosteum containing a collagen membrane alone (Group 1 as well as compared to the isotropic control membrane. Greatest tissue generation and maximal defect bridging was observed when autologous periosteal transplant strips were included in the periosteum substitute. CONCLUSION: Periosteum


    Directory of Open Access Journals (Sweden)

    Nishi Roshini


    Full Text Available AIM OF THE STUDY To identify infection rates and risk factors associated with Surgical Site Infection (SSI following Caesarean Section. DESIGN OF THE STUDY Case control study. PLACE OF STUDY Academic Tertiary Care Obstetrics and Gynaecology Centre with 60 Beds. PATIENTS All women who delivered by caesarean section in Govt. Medical College, Thrissur, during 1st June 2010 to 30th September 2011. METHODS Wound infections were identified during hospital stay using the criteria of the Centres for Disease Control and Prevention, National Nosocomial Infections Surveillance System. A case control study of 50 patients with wound infection after Lower Segment Caesarean Section (LSCS was undertaken between 1st June 2010 and 30th September 2011. The control group comprised of 50 patients selected randomly from among those who had LSCS during the study period with no wound infection. The CDC definition describes three levels of SSI (Superficial incisional, Deep incisional and Organ or Space infection. Comparisons for categorical variables were performed using the X2 or Fisher exact test. Continuous variables were compared using the 2-tailed Student ‘t’ test and p 0.05 was considered significant. RESULTS The overall wound infection rate in the study was 3.5%, (50 among 1410 Lower Transverse CS. Obesity, Hypertension and Poorly Controlled Diabetes are associated with significant risk for development of SSI. The commonest presentation of SSI in LSCS was fever 40 (80% followed by local pain and induration 25 (50%. SSI was detected on 6±3 days. Average duration of hospital stay among SSI was 22.78±10.2 days. Staphylococcus aureus was the commonest pathogen for SSI in our series. The increase in the presence of (Methicillin Resistant Staphylococcus Aureus MRSA (20.83% might alter the pattern of prophylactic antibiotic given preoperatively in the near future. CONCLUSIONS Increased incidence of drug resistant organisms needs proper attention and strategies for

  2. Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital (United States)

    Taufiq, Intikhab; Najjad, Muhammad Kazim Raheem; Khan, Naveed; Zia, Osama Bin


    Purpose Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital. Materials and Methods Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome. Results There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases. Conclusion Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome. PMID:28097111

  3. Intensive care survivors' experiences of ward-based care: Meleis' theory of nursing transitions and role development among critical care outreach services. (United States)

    Ramsay, Pam; Huby, Guro; Thompson, Andrew; Walsh, Tim


    To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.'s mid-range theory on experiencing transitions. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Meleis et al.'s work has resonance in terms of explicating intensive care patients' experiences of psychosocial distress throughout the transition to general ward-based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed

  4. Engineering waterborne Pseudomonas aeruginosa out of a critical care unit. (United States)

    Garvey, Mark I; Bradley, Craig W; Wilkinson, Martyn A C; Bradley, Christina; Holden, Elisabeth


    To describe engineering and holistic interventions on water outlets contaminated with Pseudomonas aeruginosa and the observed impact on clinical P. aeruginosa patient isolates in a large Intensive Care Unit (ICU). Descriptive study. Queen Elizabeth Hospital Birmingham (QEHB), part of University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, UK and provides clinical services to nearly 1 million patients every year. Breakpoint models were used to detect any significant changes in the cumulative yearly rates of clinical P. aeruginosa patient isolates from August 2013-December 2016 across QEHB. Water sampling undertaken on the ICU indicated 30% of the outlets were positive for P. aeruginosa at any one time. Molecular typing of patient and water isolates via Pulsed Field Gel Electrophoresis suggested there was a 30% transmission rate of P. aeruginosa from the water to patients on the ICU. From, February 2014, QEHB implemented engineering interventions, consisting of new tap outlets and PALL point-of-use filters; as well as holistic measures, from February 2016 including a revised tap cleaning method and appropriate disposal of patient waste water. Breakpoint models indicated the engineering and holistic interventions resulted in a significant (p<0.001) 50% reduction in the number of P. aeruginosa clinical patient isolates over a year. Here we demonstrate that the role of waterborne transmission of P. aeruginosa in an ICU cannot be overlooked. We suggest both holistic and environmental factors are important in reducing transmission. Copyright © 2017 Elsevier GmbH. All rights reserved.

  5. Management of Acute Pancreatitis in Critical Care Unit

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    Güniz Meyancı Köksal


    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