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Sample records for veterinary critical care

  1. Veterinary critical care.

    Science.gov (United States)

    Corley, Kevin T T; Mathews, Karol; Drobatz, Kenneth J; Bain, Fairfield T; Hughes, Dez

    2003-04-01

    Veterinary species experience similar perturbations of their health to those of human patients. When the long-term prognosis is good and providing suffering can be minimized, animals stand to benefit greatly from recent advances in the field of emergency and critical care. Outcomes in many conditions in small and large animals have improved markedly in the last 15 years, as management has improved, making the financial and emotional investment in critical care worthwhile for many owners.

  2. Epidural analgesia in veterinary critical care.

    Science.gov (United States)

    Wetmore, L A; Glowaski, M M

    2000-08-01

    Epidural analgesia has minimal systemic effects and is a useful technique for relieving pain in critical care patients. Before administration, patients must be thoroughly assessed to identify any preexisting conditions that preclude the safe use of this technique. Analgesia can be achieved by administration of local anesthetics, opioids, alpha 2 agonists, or a combination of these analgesic agents. Concurrent administration of more than one drug allows the synergistic interaction of these agents and generally improves the level of analgesia achieved, lengthens the duration of action, and lowers the dose of each drug required to achieve analgesia. Complications of epidural techniques are infrequent and include both iatrogenic and idiopathic problems, most of which have no permanent sequelae. This review provides a detailed description of the epidural analgesia technique and lists multiple sources of specialized supplies necessary for either single injection or epidural catheter placement. It also provides direction for monitoring the critical care patient with an epidural catheter.

  3. Magnesium physiology and clinical therapy in veterinary critical care.

    Science.gov (United States)

    Humphrey, Sarah; Kirby, Rebecca; Rudloff, Elke

    2015-01-01

    To review magnesium physiology including absorption, excretion, and function within the body, causes of magnesium abnormalities, and the current applications of magnesium monitoring and therapy in people and animals. Magnesium plays a pivotal role in energy production and specific functions in every cell in the body. Disorders of magnesium can be correlated with severity of disease, length of hospital stay, and recovery of the septic patient. Hypermagnesemia is seen infrequently in people and animals with significant consequences reported. Hypomagnesemia is more common in critically ill people and animals, and can be associated with platelet, immune system, neurological, and cardiovascular dysfunction as well as alterations in insulin responsiveness and electrolyte imbalance. Measurement of serum ionized magnesium in critically or chronically ill veterinary patients is practical and provides information necessary for stabilization and treatment. Tissue magnesium concentrations may be assessed using nuclear magnetic resonance spectroscopy as well as through the application of fluorescent dye techniques. Magnesium infusions may play a therapeutic role in reperfusion injury, myocardial ischemia, cerebral infarcts, systemic inflammatory response syndromes, tetanus, digitalis toxicity, bronchospasms, hypercoagulable states, and as an adjunct to specific anesthetic or analgesic protocols. Further veterinary studies are needed to establish the frequency and importance of magnesium disorders in animals and the potential benefit of magnesium infusions as a therapeutic adjunct to specific diseases. The prognosis for most patients with magnesium disorders is variable and largely dependent on the underlying cause of the disorder. © Veterinary Emergency and Critical Care Society 2014.

  4. A review of associated controversies surrounding glucocorticoid use in veterinary emergency and critical care.

    Science.gov (United States)

    Aharon, Maya A; Prittie, Jennifer E; Buriko, Kate

    2017-05-01

    To review the literature in human and veterinary medicine regarding the indications for, efficacy of, and controversies surrounding glucocorticoid (GC) administration in the emergency and critical care (ECC) setting, and to provide an overview of the most commonly used synthetic GC formulations. Synthetic GCs vary in GC and mineralocorticoid potency, hypothalamic pituitary axis suppression, duration of action, route of administration, and clinical indication for use. Some of the GC compounds commonly used in human and veterinary ECC include hydrocortisone, prednisone, methylprednisolone, and dexamethasone. GCs are used in human and veterinary ECC for a variety of disorders including anaphylaxis, acute lung injury/acute respiratory distress syndrome, septic shock, and spinal cord injury. Evidence for morbidity or mortality benefit with administration of GC within these populations exists; however, data are sparse and often conflicting. Routine use of GC in some conditions such as trauma, hemorrhagic shock, and traumatic brain injury is likely contraindicated. GC use has been associated with hyperglycemia, pneumonia, urinary tract infection, gastrointestinal ulceration, or increased mortality in some populations. © Veterinary Emergency and Critical Care Society 2017.

  5. Clinical features and management of equine post operative ileus (POI): Survey of Diplomates of the American Colleges of Veterinary Internal Medicine (ACVIM), Veterinary Surgeons (ACVS) and Veterinary Emergency and Critical Care (ACVECC).

    Science.gov (United States)

    Lefebvre, D; Hudson, N P H; Elce, Y A; Blikslager, A; Divers, T J; Handel, I G; Tremaine, W H; Pirie, R S

    2016-11-01

    A recent survey of European Colleges (European College of Equine Internal Medicine [ECEIM] and European College of Veterinary Surgeons [ECVS]) revealed the different strategies implemented by, and some of the challenges facing, European clinicians presented with cases of post operative ileus (POI). It was concluded that further comparative analysis of opinions, canvassed from additional colleges of equine veterinary specialism worldwide, would provide valuable additional insight into current POI knowledge on a more global scale. To report and compare the current strategies favoured by American veterinary specialists when managing POI in horses that underwent emergency colic surgery. Cross-sectional survey. Electronic invitations were sent to 814 Large Animal specialists, including 3 colleges: the American College of Veterinary Internal Medicine (ACVIM), American College of Veterinary Surgeons (ACVS) and the American College of Veterinary Emergency and Critical Care (ACVECC). The response rate was 14% (115/814). The majority of respondents (68%) reported an estimated prevalence range of POI of 0-20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. A lesion involving the small intestine was considered the main risk factor for POI. Anti-inflammatory drugs, intravenous (i.v.) fluids and antimicrobial drugs were the primary strategies used when managing POI. Flunixin meglumine and i.v. lidocaine were the drugs most commonly used in the treatment of horses with POI. Supplementary management strategies targeted mainly the prevention of post operative adhesions, infection and inflammation. There is a lack of consensus on the clinical definition of POI. Prospective and objective clinical assessment of the effectiveness of the different strategies contained within this and the European survey is necessary in order to identify a standardised approach to the management of equine POI. © 2015 EVJ Ltd.

  6. Influence of hang time and location on bacterial contamination of intravenous bags in a veterinary emergency and critical care setting.

    Science.gov (United States)

    Guillaumin, Julien; Olp, Nichole M; Magnusson, Karissa D; Butler, Amy L; Daniels, Joshua B

    2017-09-01

    To assess the rate of bacterial contamination of fluid and ports in intravenous bags in a veterinary emergency room (ER) and intensive care unit (ICU). Experimental model. Ninety intravenous fluid bags of lactated balanced-electrolytes solution (1 L) hung in a university hospital. Bags were hung in 2 different locations in the ER (sink and bins) and one location in the ICU (sink) for 11 days. Bags were punctured 3 times daily with a sterile needle to simulate clinical use. Injection ports were swabbed and 50 mL of fluid were collected in duplicates on days 0, 2, 4, 7, and 10. Aerobic bacterial cultures were performed on the fluid and injection port. Contamination was defined as bacterial growth of a similar phenotype across 2 consecutive times. Increase in the fluid contamination rate from day 0 was tested using an exact binomial test. Port contamination rate between locations was tested using Fisher's exact test. Combined bacterial growth on injection ports reached a mean (95% confidence interval) of 8.1 (0.005-16.2) cfu/port on day 10. The combined port contamination was 3.3%, 11.1%, 17.8%, and 31.1% on days 0, 2, 4, and 7, respectively. Port contamination was similar between ER and ICU. However, port contamination was higher in the sink versus the bins area (38.3% vs 16.7%, P = 0.032). No fluid bag was contaminated at days 0 and 2. The contamination rate of fluid bag was 1.1% and 4.4% on days 4 and 7, respectively. All bags with contaminated fluid were in the ER (6.7%, 95% exact binomial confidence interval 1.9-16.2%). Injection port contamination reached 31.1% on day 7. Contamination was more likely when the bags were hung next to a sink. In our model of bag puncture, fluid contamination occurred between days 2 and 4. © Veterinary Emergency and Critical Care Society 2017.

  7. Critical Care

    Science.gov (United States)

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

  8. 9 CFR 3.110 - Veterinary care.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Veterinary care. 3.110 Section 3.110... WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Marine Mammals Animal Health and Husbandry Standards § 3.110 Veterinary care. (a) Newly acquired marine mammals...

  9. Best practice recommendations for prehospital veterinary care of dogs and cats.

    Science.gov (United States)

    Hanel, Rita M; Palmer, Lee; Baker, Janice; Brenner, Jo-Anne; Crowe, Dennis T Tim; Dorman, David; Gicking, John C; Gilger, Brian; Otto, Cynthia M; Robertson, Sheilah A; Rozanski, Elizabeth; Trumpatori, Brian

    2016-01-01

    To examine available evidence on prehospital care in human and veterinary trauma and emergency medicine and develop best practice guidelines for use by both paramedical and nonparamedical personnel in the approach to the prehospital care of dogs and cats. Systematic evaluation of the literature gathered via medical databases searches of Medline, CAB abstracts, and Google Scholar. From a review and systematic evaluation of the available evidence, consensus guidelines on the approach to prehospital care of dogs and cats in 18 scenarios were developed. Due to the lack of current evidence in the veterinary prehospital arena, best practice guidelines were developed as an initial platform. Recommendations were based on a review of pertinent human and available veterinary literature as well as a consensus of the authors' professional opinions. It is anticipated that evidence-based additions will be made in the future. © Veterinary Emergency and Critical Care Society 2016.

  10. Surgical Critical Care Initiative

    Data.gov (United States)

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

  11. Focused critical care echocardiography.

    Science.gov (United States)

    Oren-Grinberg, Achikam; Talmor, Daniel; Brown, Samuel M

    2013-11-01

    Portable ultrasound is now used routinely in many ICUs for various clinical applications. Echocardiography performed by noncardiologists, both transesophageal and transthoracic, has evolved to broad applications in diagnosis, monitoring, and management of critically ill patients. This review provides a current update on focused critical care echocardiography for the management of critically ill patients. Source data were obtained from a PubMed search of the medical literature, including the PubMed "related articles" search methodology. Although studies demonstrating improved clinical outcomes for critically ill patients managed by focused critical care echocardiography are generally lacking, there is evidence to suggest that some intermediate outcomes are improved. Furthermore, noncardiologists can learn focused critical care echocardiography and adequately interpret the information obtained. Noncardiologists can also successfully incorporate focused critical care echocardiography into advanced cardiopulmonary life support. Formal training and proctoring are important for safe application of focused critical care echocardiography in clinical practice. Further outcomes-based research is urgently needed to evaluate the efficacy of focused critical care echocardiography.

  12. Characterisation of antimicrobial usage in cats and dogs attending UK primary care companion animal veterinary practices.

    Science.gov (United States)

    Buckland, E L; O'Neill, D; Summers, J; Mateus, A; Church, D; Redmond, L; Brodbelt, D

    2016-11-12

    There is scant evidence describing antimicrobial (AM) usage in companion animal primary care veterinary practices in the UK. The use of AMs in dogs and cats was quantified using data extracted from 374 veterinary practices participating in VetCompass. The frequency and quantity of systemic antibiotic usage was described.Overall, 25 per cent of 963,463 dogs and 21 per cent of 594,812 cats seen at veterinary practices received at least one AM over a two-year period (2012-2014) and 42 per cent of these animals were given repeated AMs. The main agents used were aminopenicillin types and cephalosporins. Of the AM events, 60 per cent in dogs and 81 per cent in cats were AMs classified as critically important (CIAs) to human health by the World Health Organisation. CIAs of highest importance (fluoroquinolones, macrolides, third-generation cephalosporins) accounted for just over 6 per cent and 34 per cent of AMs in dogs and cats, respectively. The total quantity of AMs used within the study population was estimated to be 1473 kg for dogs and 58 kg for cats.This study has identified a high frequency of AM usage in companion animal practice and for certain agents classified as of critical importance in human medicine. The study highlights the usefulness of veterinary practice electronic health records for studying AM usage. British Veterinary Association.

  13. Infection control in equine critical care settings.

    Science.gov (United States)

    Burgess, Brandy A; Morley, Paul S

    2014-08-01

    There is a recognizable standard of practice for infection control in veterinary medicine. Effort must be given to control and prevention of infectious disease transmission within a facility and among animal populations. In the critical care setting, patients typically have a high degree of systemic illness and immune compromise, are commonly subjected to invasive procedures and placement of indwelling devices, and frequently receive antimicrobials and gastric protectants. Every equine critical care unit is distinctive in its physical and operational features and the types of patients that are managed. Infection control programs must therefore be tailored to each facility's needs. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 6: Post-cardiac arrest care.

    Science.gov (United States)

    Smarick, Sean D; Haskins, Steve C; Boller, Manuel; Fletcher, Daniel J

    2012-06-01

    To systematically examine the evidence for interventions after the return of spontaneous circulation (ROSC) on outcomes from veterinary cardiopulmonary resuscitation and to determine important knowledge gaps. Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical post-cardiac arrest care. Academia, referral practice, and general practice. Fifteen standardized clinical questions important for post-cardiac arrest care were asked and research articles relevant to answering these questions were identified through structured, explicit literature database searches. The majority of these articles report research in species other than dogs or cats or consisted of experimental work in canine cardiac arrest models. Outcome metrics reported in these studies widely varied and ranged from quantification of mechanistic endpoints, such as elaboration of reactive oxygen species, to survival, and functional neurologic outcome. Despite the near complete absence of clinical veterinary studies, the process allowed the formulation of statements for several postcardiac arrest treatments that were either supportive, such as mild therapeutic hypothermia or controlled reoxygenation, or neutral, such as for mannitol administration or seizure prophylaxis. Evidence grading allowed transparency in regards to the strength of these recommendations. Moreover, numerous knowledge gaps emerged that will allow generation of a road map for progress in veterinary post-cardiac arrest care. © Veterinary Emergency and Critical Care Society 2012.

  15. Critical care monitoring.

    Science.gov (United States)

    Heard, D J

    1998-09-01

    Critical care monitoring in exotic practice is limited by the small size and the physiologic diversity of many patients. However, many of the principles applied to humans and other mammals can be extrapolated to monitoring in exotic animals. Advances in the monitoring of human patients offer the potential for more practical, low-cost monitoring in critical exotic patients in the future.

  16. Critical care toxicology.

    Science.gov (United States)

    Holstege, Christopher P; Dobmeier, Stephen G; Bechtel, Laura K

    2008-08-01

    Emergency physicians are regularly called on to care for critically poisoned patients. This article reviews the general approach and management of the critically poisoned patient. Specific clinical characteristics are identified that may clue the clinician into a specific toxin class as a diagnosis. Appropriate testing in the poisoned patient is reviewed. Complications of poisoning that may bring a rapid demise of the critically ill poisoned patient are highlighted and the management of those complications is discussed.

  17. Small mammal critical care.

    Science.gov (United States)

    Antinoff, N

    1998-09-01

    In emergency situations, veterinarians often are presented with critical patients of any species. The principles for critical care in traditional species such as the dog or cat can be applied to other small mammals. Although there are many unique aspects of the anatomy and physiology of different species, emergency care of small mammals can be instituted with the adaptation of products found in many general practices. Careful assessment of the patient, prioritization of the injuries, and rapid intervention can be life saving in any species.

  18. [Veterinary dental care: effective, efficient, and patient/client focused].

    Science.gov (United States)

    van Foreest, Andries

    2011-01-01

    The treatment of dental problems in animals and humans requires a different approach. While a basic knowledge of medicine is sufficient for dentists, a degree in veterinary medicine is a prerequisite for performing dental procedures in animals. Concepts such as oral-health veterinarian and dental care technician will be part of animal dental care in the future. When deciding on the plan of treatment, veterinarians should pay attention to the symptomatology, oral examination, and pain response. A number of treatments that are self-evident in human dentistry are often not recommended in veterinary medicine. Dental treatments for companion animals should be characterized by minimal interventions with maximum results: effective, efficient, and most of all patient/client focused.

  19. Medical Services: Medical, Dental, and Veterinary Care

    Science.gov (United States)

    2002-01-28

    Temporomandibular disorder patients in maintenance therapy. c. Class 3. Patients who have oral conditions that if not treated are expected to result in dental...oral infections, or provide timely follow-up care (for example, drain or suture removal) until resolved. (8) Temporomandibular disorders requiring...Standards. Cervical cytological smear (Papanicolaou smear) screening results should be available to the patient within 14 days of specimen collection

  20. Critical care nursing.

    Science.gov (United States)

    Dracup, K

    1987-01-01

    The research pertaining to the delivery of nursing care in the ICU was reviewed to describe: the impact of the unit structure and organization, including policies and procedures, on patients, nurses, and families; the process of critical care nursing; the outcomes of critical care nursing; some of the ethical issues germane to the care of the critically ill patient. Although these areas of inquiry are quite diverse, a number of similarities can be identified. The most obvious of the similarities was that, with few exceptions, the studies pertaining to delivery of nursing care were performed by researchers from a variety of disciplines other than nursing, including medicine, psychology, public health, and economics. In many instances, such as the studies of patients' stress experiences in ICUs, these efforts enhanced our knowledge of the phenomena and complemented or replicated the efforts of nurse researchers. Unfortunately, in some areas nurse researchers were quite absent, with the result that the studies lacked a nursing perspective. For example, the large body of knowledge related to the effects of critical care on patient outcome reflected medicine's orientation toward cure. While it is important to measure the effect of nursing care in the ICU on patient survival, the effect of nursing efforts on short- and long-term quality of life, functional status, and health maintenance is also critical and remains unknown. Nurse researchers need to build on the data base already acquired about critical care. Even more important, they need to fashion programs of research focused on the concepts central to the discipline of nursing. A second similarity relates to the increasing quality of the reported research over the past decade. In general, early descriptive studies were conducted in a single critical care unit with a small and often biased sample. These gave way to more carefully designed, multicenter studies, although lack of randomization procedures continued to be

  1. TQM in critical care.

    Science.gov (United States)

    Massarweh, L J

    1998-06-01

    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. The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs.

    Science.gov (United States)

    Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy

    2016-07-15

    As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.

  3. The clinical value of whole blood point-of-care biomarkers in large animal emergency and critical care medicine.

    Science.gov (United States)

    Radcliffe, Rolfe M; Buchanan, Ben R; Cook, Vanessa L; Divers, Thomas J

    2015-01-01

    To summarize the current medical literature and provide a clinical perspective of whole blood point-of-care (POC) biomarkers in large animal emergency and critical care practice. Original studies, reviews, and textbook chapters in the human and veterinary medical fields. POC biomarkers are tests used to monitor normal or disease processes at or near the patient. In both human and veterinary medicine these tools are playing an increasingly important role in the management of critical diseases. The most important whole blood POC biomarkers available for veterinary practitioners include l-lactate, cardiac troponin I, serum amyloid A, triglyceride, creatinine, and glucose, although many other tests are available or on the horizon. Whole blood POC biomarkers enable clinicians to provide improved management of critical diseases in large animals. These tools are especially useful for establishing a diagnosis, guiding therapy, and estimating disease risk and prognosis. © Veterinary Emergency and Critical Care Society 2015.

  4. Emergency and critical care of the avian patient

    OpenAIRE

    Silva, Andreia Luísa Reis da

    2012-01-01

    Dissertação de Mestrado Integrado em Medicina Veterinária Increasing numbers of exotic animals are being kept as pets and owners want to receive the same high quality veterinary medical care as given to other animals. The field of emergency and critical care is rapidly developing so this dissertation focus on clinically relevant information, some new advances and their application to therapy. In the first part of this work, the data gathered regarding all medical and surgical p...

  5. Training evidence-based veterinary medicine by collaborative development of critically appraised topics.

    Science.gov (United States)

    Arlt, Sebastian P; Haimerl, Peggy; Heuwieser, Wolfgang

    2012-01-01

    In current veterinary education, skills such as retrieving, critically appraising, interpreting, and applying the results of published scientific studies are rarely taught. In this study, the authors tested the concept of team-based development of critically appraised topics (CATs) in training students in evidence-based veterinary medicine (EBVM). The 116 participants were in their fifth year and attending the clinical rotation at the Clinic for Animal Reproduction. Students developed 18 CATs of varying quality on topics of their choice. Preparing the CATs in teams stimulated discussion on the topic and the quality of the retrieved papers. Evaluation of the project revealed that more than 90% of the students endorsed training in critical appraisal of information in veterinary education. In addition, more than 90% considered the development of CATs an effective exercise for assessing the quality of scientific literature. A provided literature evaluation form was perceived as a useful tool for systematically summarizing a publication's quality. In conclusion, team-based development of CATs during clinical rotations is highly valuable for training in EBVM. Learning and intrinsic motivation seem to be enhanced by creating a situation similar to veterinary practice because the task is embedded into an authentic clinical problem. This approach to clinical training helps to prepare students to integrate evidence from literature into practice.

  6. Critical care in difficult areas.

    Science.gov (United States)

    Prayag, Shirish

    2004-08-01

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

  7. Teacher development: a patchwork-text approach to enhancing critical reflection in veterinary and para-veterinary educators.

    Science.gov (United States)

    Silva-Fletcher, Ayona; May, Hilary; Magnier, Kirsty M; May, Stephen A

    2014-01-01

    Reflection is an essential component of teacher-development programs, and reliable, valid methods to teach, assess, and evaluate reflection are critical. However, it is important that appropriate methods are created for and evaluated across multiple disciplinary backgrounds, as the participants' backgrounds are a major factor in the development of critical reflection. The patchwork-text approach is a narrative process that is predominantly focused on the personal development of the individual. The current study used the patchwork-text approach for the development of reflection in participants with a science background who had not used a reflective approach for personal development before. Twenty summative essays and 103 formative essays from 21 participants who underwent a 1-year higher-education teacher-development program were analyzed to assess whether the quality and quantity of reflective writing was enhanced through a regular, iterative process of reflective writing with feedback. The analysis of the essays involved the use of a predefined set of criteria for identifying the different reflective levels from 1 to 4 and the calculation of a reflective score to evaluate the overall development. The results show a clear improvement of higher-level critical thinking as the participants progressed through their course. Higher levels of reflection were achieved particularly where a unit focused on a familiar area for the participant as opposed to one in which the participant had less experience. The analysis provides evidence that the patchwork text is a useful method for development and evaluation of reflection in participants with a veterinary/animal-science base.

  8. A Systematic Review of the Literature Addressing Veterinary Care for Underserved Communities.

    Science.gov (United States)

    LaVallee, Elizabeth; Mueller, Megan Kiely; McCobb, Emily

    2017-01-01

    Currently, there is a care gap in veterinary medicine affecting low-income and underserved communities, resulting in decreased nonhuman-animal health and welfare. The use of low-price and community veterinary clinics in underserved populations is a strategy to improve companion-animal health through preventative care, spay/neuter, and other low-price care programs and services. Little research has documented the structure and effectiveness of such initiatives. This systematic review aimed to assess current published research pertaining to accessible health care, community-based veterinary medicine, and the use of community medicine in teaching programs. The review was an in-depth literature search identifying 51 publications relevant to the importance, benefits, drawbacks, and use of low-price and community clinics in underserved communities. These articles identified commonly discussed barriers to care that may prevent underserved clientele from seeking veterinary care. Five barriers were identified including the cost of veterinary care, accessibility of care, problems with or lack of veterinarian-client communication, culture/language, and lack of client education. The review also identified a need for additional research regarding evidence of effectiveness and efficiency in community medicine initiatives.

  9. Understanding the primary care paradigm: an experiential learning focus of the early veterinary graduate.

    Science.gov (United States)

    Dixon, William H R; Kinnison, Tierney; May, Stephen A

    2017-11-01

    At a time where high levels of stress are reported in the veterinary profession, this study explores the challenges that veterinary graduates encounter when they enter general (first opinion) practice. Participants had written reflective accounts of their 'Most Puzzling Cases' for the postgraduate Professional Key Skills module of the Certificate in Advanced Veterinary Practice, offered by the Royal Veterinary College. Reasons that a case was puzzling, or became challenging, were thematically analysed. Fifteen summaries were analysed. Three core themes were identified: 'clinical reasoning', centred on the limitations of pattern recognition and the methods used to overcome this; the 'veterinary healthcare system', focusing on the need for continuity of care, time pressure and support in the transition to practice; and the 'owner', looking at the broader clinical skills needed to succeed in general practice. Clinical reasoning was raised as an issue; discussion of when pattern recognition is not appropriate and what to do in these cases was common. A lack of experience in general practice case types, and how to best operate in the resource-constrained environment in which they present, is the likely cause of this, suggesting that a greater focus on the primary care paradigm is needed within veterinary education. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. A review of the expanding field of exotic animal oral health care--veterinary dentistry.

    Science.gov (United States)

    Fagan, D A; Oosterhuis, J E; Kirkman, J E

    1998-09-01

    This article reviews the clinical literature of the field of Veterinary Dentistry from its conception in the late 1960's to its rapidly expanding role today as an emerging clinical specialty practice in veterinary medicine. It defines eight dental sub-disciplines in contemporary veterinary oral health care from a practical point of view and provides information concerning standardization of key words searches, definition of terms, and use of the expanded Medical Subject Headings (MeSH) necessary for a comprehensive review of the rapidly expanding literature stored in electronic databases.

  11. Critical Care of Pet Birds.

    Science.gov (United States)

    Jenkins, Jeffrey Rowe

    2016-05-01

    Successful care of the critical pet bird patient is dependent on preparation and planning and begins with the veterinarian and hospital staff. An understanding of avian physiology and pathophysiology is key. Physical preparation of the hospital or clinic includes proper equipment and understanding of the procedures necessary to provide therapeutic and supportive care to the avian patient. An overview of patient intake and assessment, intensive care environment, and fluid therapy is included. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Controversies in neurosciences critical care.

    Science.gov (United States)

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

    2012-06-01

    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. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. ASVCP guidelines: quality assurance for point-of-care testing in veterinary medicine.

    Science.gov (United States)

    Flatland, Bente; Freeman, Kathleen P; Vap, Linda M; Harr, Kendal E

    2013-12-01

    Point-of-care testing (POCT) refers to any laboratory testing performed outside the conventional reference laboratory and implies close proximity to patients. Instrumental POCT systems consist of small, handheld or benchtop analyzers. These have potential utility in many veterinary settings, including private clinics, academic veterinary medical centers, the community (eg, remote area veterinary medical teams), and for research applications in academia, government, and industry. Concern about the quality of veterinary in-clinic testing has been expressed in published veterinary literature; however, little guidance focusing on POCT is available. Recognizing this void, the ASVCP formed a subcommittee in 2009 charged with developing quality assurance (QA) guidelines for veterinary POCT. Guidelines were developed through literature review and a consensus process. Major recommendations include (1) taking a formalized approach to POCT within the facility, (2) use of written policies, standard operating procedures, forms, and logs, (3) operator training, including periodic assessment of skills, (4) assessment of instrument analytical performance and use of both statistical quality control and external quality assessment programs, (5) use of properly established or validated reference intervals, (6) and ensuring accurate patient results reporting. Where possible, given instrument analytical performance, use of a validated 13s control rule for interpretation of control data is recommended. These guidelines are aimed at veterinarians and veterinary technicians seeking to improve management of POCT in their clinical or research setting, and address QA of small chemistry and hematology instruments. These guidelines are not intended to be all-inclusive; rather, they provide a minimum standard for maintenance of POCT instruments in the veterinary setting. © 2013 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

  14. Connecting knowledge resources to the veterinary electronic health record: opportunities for learning at point of care.

    Science.gov (United States)

    Alpi, Kristine M; Burnett, Heidi A; Bryant, Sheila J; Anderson, Katherine M

    2011-01-01

    Electronic health records (EHRs) provide clinical learning opportunities through quick and contextual linkage of patient signalment, symptom, and diagnosis data with knowledge resources covering tests, drugs, conditions, procedures, and client instructions. This paper introduces the EHR standards for linkage and the partners-practitioners, content publishers, and software developers-necessary to leverage this possibility in veterinary medicine. The efforts of the American Animal Hospital Association (AAHA) Electronic Health Records Task Force to partner with veterinary practice management systems to improve the use of controlled vocabulary is a first step in the development of standards for sharing knowledge at the point of care. The Veterinary Medical Libraries Section (VMLS) of the Medical Library Association's Task Force on Connecting the Veterinary Health Record to Information Resources compiled a list of resources of potential use at point of care. Resource details were drawn from product Web sites and organized by a metric used to evaluate medical point-of-care resources. Additional information was gathered from questions sent by e-mail and follow-up interviews with two practitioners, a hospital network, two software developers, and three publishers. Veterinarians with electronic records use a variety of information resources that are not linked to their software. Systems lack the infrastructure to use the Infobutton standard that has been gaining popularity in human EHRs. While some veterinary knowledge resources are digital, publisher sites and responses do not indicate a Web-based linkage of veterinary resources with EHRs. In order to facilitate lifelong learning and evidence-based practice, veterinarians and educators of future practitioners must demonstrate to veterinary practice software developers and publishers a clinically-based need to connect knowledge resources to veterinary EHRs.

  15. Primary care veterinary usage of systemic glucocorticoids in cats and dogs in three UK practices.

    Science.gov (United States)

    O'Neill, D; Hendricks, A; Summers, J; Brodbelt, D

    2012-04-01

    To describe systemic glucocorticoid usage in cats and dogs by three primary care -veterinary practices in England and to ascertain risk factors for clinical use. To evaluate consistency of prescribing patterns across clinics. To validate a merged database of primary veterinary clinical data as a functional tool for clinical epidemiological research. A merged database was established from clinical data on 31,273 cat and dog consultations with pharmacotherapy from three veterinary practices in England. Descriptive statistics described systemic glucocorticoid drug use in cats and dogs while mixed-effects logistic regression modelling evaluated risk factors. Individual clinic usage was compared. Overall, 1877 (16·68%) cat consultations and 2913 (14·55%) dog consultations resulted in systemic glucocorticoid therapy. Cats received higher parenteral (Pveterinary clinical database was effective for epidemiological research. © 2012 British Small Animal Veterinary Association.

  16. Practice of Critical Care Pharmacy

    National Research Council Canada - National Science Library

    Weil, Max Harry

    1985-01-01

    ... departments and trauma units. This multiauthored book serves to orient pharmacists to the evolving programs in critical care pharmacy. There is a focus on organizational and administrative options. Paucity of scientific content or authoritative historical commentary are likely to limit the usefulness of this volume to clinical pharmacists who seek ...

  17. Delirium in Pediatric Critical Care.

    Science.gov (United States)

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

    2017-10-01

    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.

  18. [Recommendations for the veterinary care and assessment of bird of prey collections].

    Science.gov (United States)

    Lierz, M; Hafez, M H; Korbel, R; Krautwald-Junghanns, M; Kummerfeld, N; Hartmann, S; Richter, Th

    2010-01-01

    Legislation from a new regulation of the Federal Nature Conservation Act that became effective on March 1, 2010 requires a written program for veterinary prophylaxis, treatment and nutrition for zoo and animal collections. As a result of this act, veterinary care is now obligatory for all captive birds of prey kept within either private or commercial collections, independent on the number of birds involved. The legal requirements of the Act will shortly be introduced and recommendations for the veterinary care of bird of prey collections are provided. Firstly, risk assessment of different husbandry systems (falconry birds, show birds, breeding stock, rehabilitation) is performed and veterinary care programs are provided based upon these assessments. Additionally, instructions for anamnestic ascertainments, work flow, feeding, quarantine, cleaning and disinfection procedures as well as prophylactic measures such as vaccination are provided. As husbandry, in particular the size and equipment of cages is important for the health and welfare of the birds, species specific housing, care and protection measures are also discussed. Veterinarians will be able to refer to these guidelines and can use them in the future for collection management.

  19. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Science.gov (United States)

    2010-01-01

    ... on problems of animal health, behavior, and well-being is conveyed to the attending veterinarian; (4... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT...

  20. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Science.gov (United States)

    2010-01-01

    ... animal health, behavior, and well-being is conveyed to the attending veterinarian; (4) Guidance to... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE...

  1. Archives: Southern African Journal of Critical Care

    African Journals Online (AJOL)

    Items 1 - 24 of 24 ... Archives: Southern African Journal of Critical Care. Journal Home > Archives: Southern African Journal of Critical Care. Log in or Register to get access to full text downloads.

  2. Involving relatives in ICU patient care: critical care nursing challenges.

    Science.gov (United States)

    McConnell, Bridget; Moroney, Tracey

    2015-04-01

    To identify the barriers critical care nurses experience to relative involvement in intensive care unit patient care. Previous studies have discussed the experiences of relatives visiting an intensive care unit, the needs of relatives in the intensive care environment, critical care nurse and relative interaction, intensive care unit visiting policies and the benefits of including relatives in patient care. The barriers that critical care nurses experience to relative involvement in patient care have received minimal exploration. Critical care nurses were recruited for a mixed methods study. An explanatory mixed method design was used, with two phases. Phase 1 was Quantitative and Phase 2 was Qualitative. Data collection occurred over five months in 2012-2013. Phase 1 used an online questionnaire (n = 70), and semi-structured interviews (n = 6) were conducted in Phase 2. Phase 1 participants were 70 critical care nurses working in Australian intensive care units and six critical care nurses were recruited from a single Sydney intensive care unit for Phase 2. Through sequential data collection, Phase 1 results formed the development of Phase 2 interview questions. Participants reported various barriers to relative involvement in critically ill patient care. Factors related to the intensive care unit patient, the intensive care unit relative, the critical care nurse and the intensive care environment contributed to difficulties encompassing relative involvement. This study has identified that when considering relative involvement in patient care, critical care nurses take on a paternalistic role. The barriers experienced to relative involvement result in the individual critical care nurse deciding to include or exclude relatives from patient care. Knowledge of the barriers to relative involvement in critically ill patient care may provide a basis for improving discussion on this topic and may assist intensive care units to implement strategies to reduce barriers.

  3. A Novel Model for Teaching Primary Care in a Community Practice Setting: Tufts at Tech Community Veterinary Clinic.

    Science.gov (United States)

    McCobb, Emily; Rozanski, Elizabeth A; Malcolm, Elizabeth A; Wolfus, Gregory; Rush, John E

    2017-09-01

    Providing veterinary students with opportunities to develop clinical skills in a realistic, hands-on environment remains a challenge for veterinary education. We have developed a novel approach to teaching clinical medicine to fourth-year veterinary students and technical high school students via development of a primary care clinic embedded within a technical high school. The primary care clinic targets an underserved area of the community, which includes many of the participating high school students. Support from the veterinary community for the project has been strong as a result of communication, the opportunity for veterinarians to volunteer in the clinic, and the careful targeting of services. Benefits to veterinary students include the opportunity to build clinical competencies and confidence, as well as the exposure to a diverse client population. The financial model of the clinic is described and initial data on outcomes for case load, clinic income, veterinary student evaluations, and high school students' success in passing the veterinary assisting examination are reported. This clinical model, involving a partnership between a veterinary school and a technical high school, may be adoptable to other clinical teaching situations.

  4. Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care.

    Science.gov (United States)

    Adamik, Katja N; Yozova, Ivayla D; Regenscheit, Nadine

    2015-01-01

    To (1) review the development and medical applications of hydroxyethyl starch (HES) solutions with particular emphasis on its physiochemical properties; (2) critically appraise the available evidence in human and veterinary medicine, and (3) evaluate the potential risks and benefits associated with their use in critically ill small animals. Human and veterinary original research articles, scientific reviews, and textbook sources from 1950 to the present. HES solutions have been used extensively in people for over 30 years and ever since its introduction there has been a great deal of debate over its safety and efficacy. Recently, results of seminal trials and meta-analyses showing increased risks related to kidney dysfunction and mortality in septic and critically ill patients, have led to the restriction of HES use in these patient populations by European regulatory authorities. Although the initial ban on the use of HES in Europe has been eased, proof regarding the benefits and safety profile of HES in trauma and surgical patient populations has been requested by these same European regulatory authorities. The veterinary literature is limited mostly to experimental studies and clinical investigations with small populations of patients with short-term end points and there is insufficient evidence to generate recommendations. Currently, there are no consensus recommendations regarding the use of HES in veterinary medicine. Veterinarians and institutions affected by the HES restrictions have had to critically reassess the risks and benefits related to HES usage based on the available information and sometimes adapt their procedures and policies based on their reassessment. Meanwhile, large, prospective, randomized veterinary studies evaluating HES use are needed to achieve relevant levels of evidence to enable formulation of specific veterinary guidelines. © Veterinary Emergency and Critical Care Society 2015.

  5. Perceptions of the Veterinary Profession among Human Health Care Students before an Inter-Professional Education Course at Midwestern University.

    Science.gov (United States)

    Englar, Ryane E; Show-Ridgway, Alyssa; Noah, Donald L; Appelt, Erin; Kosinski, Ross

    2017-11-03

    Conflicts among health care professionals often stem from misperceptions about each profession's role in the health care industry. These divisive tendencies impede progress in multidisciplinary collaborations to improve human, animal, and environmental health. Inter-professional education (IPE) may repair rifts between health care professions by encouraging students to share their professional identities with colleagues in unrelated health care disciplines. An online survey was conducted at Midwestern University (MWU) to identify baseline perceptions about veterinary medicine among entry-level human health care students before their enrollment in an inter-professional course. Participation was anonymous and voluntary. The survey included Likert-type scales and free-text questions. Survey participants expressed their interest in and respect for the discipline of veterinary medicine, but indicated that their unfamiliarity with the profession hindered their ability to collaborate. Twenty percent of human health care students did not know the length of a Doctor of Veterinary Medicine (DVM) program and 27.6% were unaware that veterinarians could specialize. Although 83.2% of participants agreed that maintaining the human-animal bond is a central role of the veterinary profession, veterinary contributions to stem cell research, food and water safety, public health, environmental conservation, and the military were infrequently recognized. If IPE is to successfully pave the way for multidisciplinary collaboration, it needs to address these gaps in knowledge and broaden the definition of veterinary practice for future human health care providers.

  6. Encouraging Critical Clinical Thinking (CCT) Skills in First-Year Veterinary Students.

    Science.gov (United States)

    Ferguson, Duncan C; McNeil, Leslie Klis; Schaeffe, David J; Mills, Eric M

    First-year didactic course instructors at the University of Illinois College of Veterinary Medicine leverage earlier clinical rotation experiences with weekly "Clinical Correlations" exercises to provide early exposure to critical clinical thinking (CCT). This study evaluated the efficacy of individual and paired group exercises on CCT development. Before and after instruction, the Cornell Critical Thinking Test (Level Z) (CCTTZ) was administered. Based on the hypothesis that students with higher scores would coach lower-scoring colleagues during group exercises, heterogeneous groups with similar mean scores were established for the year. Students completed 14 individual and paired group exercises over 6 months. Exercises were designed to increase in complexity and decline in scaffolding. Seven of the exercises were cases using the Applied Learning Platform (ALP) at http://www.whenknowingmatters.com . Student analyses were scored according to a six-category critical-thinking rubric using a 5-point scale. Consistent with our hypothesis, individual and group rubric scores increased significantly, plateauing near the end of the year. Contrary to our hypothesis, mean overall CCTTZ scores did not change, but there was a small statistically significant increase in the ability to assess the validity of an argument. Student attitudes were mixed. Positive comments focused on reinforcement of prior didactic instruction, while negative comments focused on preparation time needed to conduct research on clinical concepts, and on a lack of explicit evaluation by summative examinations. Nonetheless, end-of-year GPAs correlated linearly with cumulative individual rubric scores. In summary, the value of early curriculum CCT training was confirmed when discipline-specific criteria were applied.

  7. Focused assessment with sonography in nontraumatized dogs and cats in the emergency and critical care setting.

    Science.gov (United States)

    McMurray, Jantina; Boysen, Søren; Chalhoub, Serge

    2016-01-01

    To evaluate the use of abdominal- and thoracic-focused assessment with sonography for trauma (AFAST and TFAST) in nontraumatized dogs and cats in the emergency and critical care setting and to compare prevalence of free fluid identified via these techniques between stable and unstable patients. Prospective observational study. University Distributed Veterinary Learning Community. One hundred client-owned dogs and cats presenting to an emergency service with no evidence of trauma. AFAST and TFAST performed within 12 hours of presentation. Free fluid was identified on AFAST or TFAST in 33% of dogs and cats in this study. Free fluid was identified in 27 of 36 (75%) cardiovascularly unstable or dyspneic patients, compared to 6 of 64 (9%) stable patients. A significantly greater proportion of unstable patients had free fluid compared to stable patients (P dogs and cats in the emergency and critical care setting, particularly patients that are unstable on presentation. © Veterinary Emergency and Critical Care Society 2015.

  8. Psychological implications of admission to critical care.

    Science.gov (United States)

    Pattison, Natalie

    Admission to critical care can have far-reaching psychological effects because of the distinct environment. Critical care services are being re-shaped to address long-term sequelae, including post-traumatic stress disorder, anxiety and depression. The long-term consequences of critical illness not only cost the individual, but also have implications for society, such as diminished areas of health-related quality-of-life in sleep, reduced ability to return to work and enjoy recreational activities (Audit Commission, 1999; Hayes et al, 2000). The debate around the phenomenon of intensive care unit (ICU) syndrome is discussed with reference to current thinking. After critical care, patients may experience amnesia, continued hallucinations or flashbacks, anxiety, depression, and dreams and nightmares. Nursing care for patients while in the critical care environment can have a positive effect on psychological well-being. Facilitating communication, explaining care and rationalizing interventions, ensuring patients are oriented as to time and place, reassuring patients about transfer, providing patients,where possible, with information about critical care before admission and considering anxiolytic use, are all practices that have a beneficial effect on patient care. Follow-up services can help patients come to terms with their experiences of critical illness and provide the opportunity for them to access further intervention if desired. Working towards providing optimal psychological care will have a positive effect on patients' psychological recovery and may also help physical recuperation after critical care.

  9. Occupational stress and the importance of self-care and resilience: focus on veterinary nursing.

    Science.gov (United States)

    Lloyd, Ciaran; Campion, Deirdre P

    2017-01-01

    Burnout and compassion fatigue are frequently mentioned in relation to veterinary work. Veterinary nursing is a caring profession and those who seek a career within this field do so because of a natural empathetic desire to care for animals. However it is the individuals who are the most caring and empathetic towards others that will be most at risk of experiencing occupational stress when they are confronted with psychologically demanding workplace roles and working environments. Burnout is considered an 'unintentional end point' for certain individuals who are exposed to chronic stress within their working environment. When suffering burnout, a person may experience emotional exhaustion, may become more cynical or they may have a reduced sense of personal accomplishment in regards to their own work. Signs of burnout can include increased levels of absenteeism at work, or the working standards of that staff member may decline below that of what would normally be expected of them. This could directly impact on patient care in the veterinary practice. Working in a role that places emotional demands on staff, such as a need to show compassion and empathy towards clients who are emotionally distressed, puts staff at risk from experiencing compassion fatigue. Workplace supports may include appropriate debriefing sessions among willing participants, particularly after an emotionally stressful encounter with a client. Taking personal responsibility for care of one's own mental and physical health is just as important as taking care of the patient's health. Personal strategies may include lifestyle changes, adopting a healthier lifestyle, reduction of working hours, and ensuring adequate sleep. Adopting healthy self-care strategies can promote characteristics of "resilience" - personal qualities or traits such as optimism, self-confidence, level headedness, hardiness, and having the ability to be resourceful during times of adversity. All veterinary staff may be better

  10. The experiences of qualified critical care nurses regarding students working in critical care units

    OpenAIRE

    2015-01-01

    M.Cur. (Nursing Science (Critical Care)) Qualified critical care nurses are under internal and external stresses in the workplace, relating to role conflict, role ambiguity, increased workloads, the need for rapid decision making and the speedy delivery of care. However, having inexperienced students in critical care units put responsibility and additional stress on the qualified critical care nurses within the units. This may result in some of these qualified nurses not being willing to h...

  11. What Is a Pediatric Critical Care Specialist?

    Science.gov (United States)

    ... this site from a secured browser on the server. Please enable scripts and reload this page. Turn ... pediatrician. Children who are critically ill require careful monitoring in a pediatric intensive care unit (PICU). Pediatric ...

  12. Intensive Care in Critical Access Hospitals

    Science.gov (United States)

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

    2007-01-01

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

  13. Alcohol withdrawal in the critical care unit.

    Science.gov (United States)

    Corfee, Flora A

    2011-05-01

    Managing acute alcohol withdrawal in critical care presents a unique challenge to the critical care nurse. The prominence of alcohol use within the Australian community means that many critical care admissions involve acute alcohol withdrawal, an alcohol induced illness, or indeed an unrelated admission with underlying heavy alcohol intake. Current statistics suggest 1 in 5 Australians drink to 'risky' levels each month. This suggests that most critical care nurses will encounter a patient who is experiencing active withdrawal from alcohol, often without clear physiological symptomatology. Acute alcohol withdrawal delirium can be difficult to distinguish from other forms of delirium and in the absence of a comprehensive history, alcohol withdrawal and its sequelae may go untreated. Contemporary management guidelines for alcohol withdrawal suggest a common framework of first line benzodiazepine usage, with emerging research focusing on adjunctive therapy aimed at reducing benzodiazepine doses, and therefore reducing length of stay in the critical care unit. The controversial therapy of ethanol infusion and common assessment and withdrawal scales are examined in relation to their usefulness in critical care. Alcohol withdrawal management in critical care necessitates careful nursing assessment, including alcohol usage history, delirium management, withdrawal assessment and symptomatic relief using an evidence-based protocol. Copyright © 2010 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Critical Care Organizations: Business of Critical Care and Value/Performance Building.

    Science.gov (United States)

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

    2018-01-01

    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

  15. Southern African Journal of Critical Care

    African Journals Online (AJOL)

    This Journal publishes scientific articles related to multidisciplinary critical and intensive medical care and the emergency care of critically ill humans. Other websites related to this journal: http://www.sajcc.org.za/index.php/SAJCC. Vol 33, No 2 (2017). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT ...

  16. Demographics, lifestyle and veterinary care of cats in Australia and New Zealand.

    Science.gov (United States)

    Johnston, Laura; Szczepanski, Julia; McDonagh, Phillip

    2017-12-01

    Objectives The aim of this survey was to provide up-to-date information on the demographics, lifestyle and veterinary care of cats in Australia and New Zealand. Methods An online survey consisting of 19 questions was created using SurveyMonkey. Cat owners were invited to participate through advertisements in veterinary clinics and social media. Results The average number of cats in a household was two. The majority of cats lived in free-standing houses (78%) in the suburbs (66%). The majority of cats were desexed (94% [49% female neutered; 45% male neutered]). A total of 57% of cats had been strays or came from an animal shelter. A total of 40% of owners had intended not to let the cats outside when they first acquired them. A total of 63% of cats were described as indoor-outdoor cats. Although owners described 34% of cats as 'indoor only', 58% of those cats had access to the outdoors. The majority of respondents' cats were vaccinated annually (63%) and visited a vet at least annually (79%). The most common reasons to take a cat to the vet were vaccinations or the cat being unwell. The most common reasons not to regularly take the cat to the vet were that the cat was never unwell, cost or stress for the cat. Conclusions and relevance Consideration of the lifestyle of cats is important to optimise veterinary care. Cats across Australia and New Zealand have a variety of different and changing lifestyles. Therefore, careful owner questioning is required at each visit to maximise healthcare outcomes for cats.

  17. Sleep and Mechanical Ventilation in Critical Care.

    Science.gov (United States)

    Blissitt, Patricia A

    2016-06-01

    Sleep disturbances in critically ill mechanically ventilated patients are common. Although many factors may potentially contribute to sleep loss in critical care, issues around mechanical ventilation are among the more complex. Sleep deprivation has systemic effects that may prolong the need for mechanical ventilation and length of stay in critical care and result in worse outcomes. This article provides a brief review of the physiology of sleep, physiologic changes in breathing associated with sleep, and the impact of mechanical ventilation on sleep. A summary of the issues regarding research studies to date is also included. Recommendations for the critical care nurse are provided. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Thirty years of critical care medicine

    OpenAIRE

    Vincent, Jean-Louis; Singer, Mervyn; Marini, John J.; Moreno, Rui; Levy, Mitchell; Matthay, Michael A.; Pinsky, Michael; Rhodes, Andrew; Ferguson, Niall D.; Evans, Timothy; Annane, Djillali; Jesse B Hall

    2010-01-01

    Critical care medicine is a relatively young but rapidly evolving specialty. On the occasion of the 30th International Symposium on Intensive Care and Emergency Medicine, we put together some thoughts from a few of the leaders in critical care who have been actively involved in this field over the years. Looking back over the last 30 years, we reflect on areas in which, despite large amounts of research and technological and scientific advances, no major therapeutic breakthroughs have been ma...

  19. Undergraduate medical education in critical care.

    Science.gov (United States)

    Fessler, Henry E

    2012-11-01

    To review the current status of critical care education of medical students, focusing on how early, vigorous undergraduate training may address the needs of the learners and society. Literature review of focused PubMed searches, online databases, and reference lists of recent publications. Although management of unstable and critically ill patients is required of most interns, undergraduate education in these skills remains largely elective, scattered, and highly variable. Critical care competencies for medical school graduates have not been established in the United States, and many students feel unprepared for these responsibilities that they assume as interns. Several successful approaches to medical student education in critical care have been demonstrated, and the availability of simulation technology provides new educational opportunities. Early exposure to other medical disciplines has influenced medical student career choice, although this has not been studied in regards to critical care fields. Undergraduate medical education in critical care would be advanced by consolidation and organization into formal curricula. These would teach biomedical and humanistic skills essential to critical care but valuable in all medical settings. Early, well-planned exposure to critical care as a distinct discipline might increase student interest in careers in the field. The effects of educational interventions on the acquisition of knowledge, attitudes, and skills as well as long-term career choice should be subjected to rigorous study.

  20. Quality of equine veterinary care. Part 2: Client satisfaction in equine top sports medicine in The Netherlands

    NARCIS (Netherlands)

    Loomans, J.B.A.; Waaijer, P.G.; Maree, J.T.M.; Weeren, van P.R.; Barneveld, A.

    2009-01-01

    The aim of this study was to evaluate systematically the quality of equine veterinary top sports medicine in The Netherlands and the degree to which the expectations in the field are met. Focus was on structure, process and outcome of care. The structure of care is generally satisfactory but there

  1. Empowerment in critical care - a concept analysis.

    Science.gov (United States)

    Wåhlin, Ingrid

    2017-03-01

    The purpose of this paper was to analyse how the concept of empowerment is defined in the scientific literature in relation to critical care. As empowerment is a mutual process affecting all individuals involved, the perspectives of not only patients and next of kin but also staff were sought. A literature review and a concept analysis based on Walker and Avant's analysis procedure were used to identify the basic elements of empowerment in critical care. Twenty-two articles with a focus on critical care were discovered and included in the investigation. A mutual and supportive relationship, knowledge, skills, power within oneself and self-determination were found to be the common attributes of empowerment in critical care. The results could be adapted and used for all parties involved in critical care - whether patients, next of kin or staff - as these defining attributes are assumed to be universal to all three groups, even if the more specific content of each attribute varies between groups and individuals. Even if empowerment is only sparsely used in relation to critical care, it appears to be a very useful concept in this context. The benefits of improving empowerment are extensive: decreased levels of distress and strain, increased sense of coherence and control over situation, and personal and/or professional development and growth, together with increased comfort and inner satisfaction. © 2016 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College.

  2. Veterinary practice marketeer.

    Science.gov (United States)

    Phillips, Justin

    2015-01-24

    Justin Phillips is marketing manager at White Cross Vets and the Veterinary Marketing Association's (VMA's) Young Veterinary Marketeer of the Year. Here, he describes what he does and why he believes other practices should embrace marketing to improve their quality and client care. British Veterinary Association.

  3. Predictors of pulmonary critical care recidivism

    Directory of Open Access Journals (Sweden)

    Mohsen Elshafey

    2014-10-01

    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.

  4. American Association of Critical-Care Nurses

    Science.gov (United States)

    ... in the ICU Explore Explore New Nurses Experienced Nurses Educators/Managers Advanced Practice Membership As a new member of AACN who is also new to critical care, you belong to a group of committed professionals ...

  5. Thirty years of critical care medicine.

    Science.gov (United States)

    Vincent, Jean-Louis; Singer, Mervyn; Marini, John J; Moreno, Rui; Levy, Mitchell; Matthay, Michael A; Pinsky, Michael; Rhodes, Andrew; Ferguson, Niall D; Evans, Timothy; Annane, Djillali; Hall, Jesse B

    2010-01-01

    Critical care medicine is a relatively young but rapidly evolving specialty. On the occasion of the 30th International Symposium on Intensive Care and Emergency Medicine, we put together some thoughts from a few of the leaders in critical care who have been actively involved in this field over the years. Looking back over the last 30 years, we reflect on areas in which, despite large amounts of research and technological and scientific advances, no major therapeutic breakthroughs have been made. We then look at the process of care and realize that, here, huge progress has been made. Lastly, we suggest how critical care medicine will continue to evolve for the better over the next 30 years.

  6. 13 Animal Emergencies That Should Receive Immediate Veterinary Consultation and/or Care

    Science.gov (United States)

    ... selected Animal Welfare Veterinary Careers Public Health 13 Animal Emergencies that Require Immediate Veterinary Consultation and/or ... SITES Externs on the Hill National Pet Week Animal Health SmartBrief WebMD® Pet Health Community Contact | AVMA ...

  7. On-site veterinary medical evaluation and care of working dogs and horses at the 2012 Republican National Convention.

    Science.gov (United States)

    Chatfield, Jenifer A; Dewell, Reneé; Miranda, Astrid J; Wilcox, Stefania; Vannieuwenhoven, Ty J

    2015-09-01

    To describe on-site veterinary medical care for working dogs and horses deployed for the 2012 Republican National Convention (RNC) in Tampa, Fla, August 24 to 30, 2012. Retrospective case series. 130 dogs and 45 horses. Data collected included breed, age, history, task assignment, reason for evaluation, and physical examination findings. A patient encounter report was recorded each time an animal was seen by veterinary staff for a physical evaluation. 46 of the 130 (35%) dogs and all 45 (100%) horses underwent at least 1 on-site veterinary evaluation, for a total of 478 patient encounters. The most common reason for an on-site veterinary evaluation was a wellness check (446 patient encounters). On the basis of veterinary recommendations, 1 dog and 4 horses were removed from continued service for the duration of the event. In addition, 1 dog and 1 horse were removed from active service for 12 to 24 hours but allowed to return to service for the duration of the event following a veterinary reevaluation. Results suggested that working dogs and horses deployed for large planned events face different health concerns, compared with concerns previously reported for animals deployed following disasters. Pre-event planning and training of handlers and riders may have helped reduce the number of health concerns, particularly health concerns related to high heat.

  8. Critical thinking in patient centered care.

    Science.gov (United States)

    Mitchell, Shannon H; Overman, Pamela; Forrest, Jane L

    2014-06-01

    Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques. The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes. Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date. The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Incorporating Educational Theory into Critical Care Orientation.

    Science.gov (United States)

    Rashotte, Judy; Thomas, Margot

    2002-01-01

    Describes a critical care nursing program based on Benner's novice-to-expert model, Schon's theory of reflective practice, and Cranton's transformative learning theory. Core components are orientation and continuing education that facilitate acquisition of knowledge, practice skills, attitudes, and critical thinking. (Contains 22 references.) (SK)

  10. Obstetric critical care services in South Africa

    African Journals Online (AJOL)

    OPINION. More than half of all global maternal deaths occur in Africa. A large percentage of these deaths are preventable, and lack of access to adequate critical care facilities is a contributing factor. There are limited published data on the clinical and management challenges presented by the critically ill obstetric patient ...

  11. Lipids in critical care medicine.

    Science.gov (United States)

    Ott, Juliane; Hiesgen, Christopher; Mayer, Konstantin

    2011-11-01

    While enteral nutrition is the basis for the critically ill, parenteral nutrition is often used when a sufficient enteral nutrition is not or not fully achievable. Lipids are a mainstay of caloric supply in both cases as they combine the provision of building blocks for the membranes and are precursors for function molecules including lipid mediators bearing the ability to influence immunity. Pro-inflammatory lipid mediators as prostaglandins and leukotrienes are generated from arachidonic acid (AA), a key member of the n-6 polyunsaturated fatty acids (PUFA). In contrast, lipid mediators derived from the n-3 fatty acids eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) may exhibit less inflammatory properties compared to their AA-derived counterparts. Furthermore, intercellular mediators as resolvins and protectins are generated from n-3 fatty acids. They induce the resolution of inflammation, hence the name resolution phase interaction product-resolvin. Modulating the amount of PUFA and the n-6/n-3 ratio were investigated as means to change the inflammatory response and improve the outcome of patients. Experimental data showed that n-3 fatty acids may improve acute lung injury and sepsis in animal models. Studies in patients undergoing major surgery with application of n-3 fatty acids demonstrated beneficial effects in terms of reduction of length of stay and infectious complications. Clinical data hints that this concept may also improve outcome in critically ill patients. Additionally, experimental and clinical data suggest that a reduction in n-6 PUFA may change the immune response. In conclusion, modulating the amount of PUFA, the n-6/n-3 ratio and the composition of lipid emulsions may prove to be a useful means to improve the outcome of critically ill patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Intensive and critical care medicine

    Energy Technology Data Exchange (ETDEWEB)

    Aochi, Osamu (Nagoya City Univ. (Japan). Faculty of Medicine); Amaha, Keisuke (Tokyo Medical and Dental Univ. (Japan). School of Medicine); Takeshita, Hiroshi (Yamaguchi Univ., Ube (Japan). School of Medicine) (eds.)

    1990-01-01

    Eight papers in this volume are in INIS scope, respectively dealing with the scientific use of the chest radiograph in intensive care unit, xenon computed tomography cerebral blood flow in diagnosis and management of symptomatic vasospasm and severe head injury, therapeutic relevance of MRI in acute head trauma, computerized tomography in the diagnosis of cerebral air embolism, thallium 201 myocardial perfusion during weaning from mechanical ventilation, thoracic computed tomography for ICU patients, and the effect of xenon inhalation upon internal carotid artery blood flow in awake monkeys. (H.W.). refs.; figs.; tabs.

  13. Critical Care Nurses' Knowledge of Confidentiality Legislation.

    Science.gov (United States)

    Newman, Angela B; Kjervik, Diane K

    2016-05-01

    Health care legislation can be difficult to understand and apply in critical situations where patients may not be physically capable of autonomous control of confidential health information. Nurses are often the first to encounter confidential information about patients. To explore critical care nurses' knowledge of federal and North Carolina state legislation regarding confidentiality. This descriptive, qualitative study included 12 critical care nurses who were asked to describe their knowledge of federal confidentiality legislation and specific knowledge of North Carolina's confidentiality legislation. Critical care nurses were knowledgeable about federal confidentiality laws but demonstrated a need for further education about state-specific legislation. Nurses' application of confidentiality legislation demonstrates their knowledge of confidentiality legislation. To continue the trusting relationship that nurses have traditionally held with patients and patients' families, it is imperative for nurses to remain current about confidentiality legislation. Through education both before and after licensure, correct application of legislation can be achieved. Further research can aid in exploring the intersection between health care legislation and ethics. ©2016 American Association of Critical-Care Nurses.

  14. The Professionalism of Critical Care Nurse Fellows After Completion of the Critical Care Nurse Fellowship Program.

    Science.gov (United States)

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

    2016-01-01

    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.

  15. Veterinary Services Program

    Data.gov (United States)

    Federal Laboratory Consortium — Mission:To provide quality veterinary medical care and environmental enrichment programs for all animals, representing nine different species.To provide guidance for...

  16. One world of veterinary medicine.

    Science.gov (United States)

    King, L J

    2009-08-01

    The veterinary profession finds itself in the midst of a new world order. Today veterinarians are part of a world that is exquisitely interconnected culturally, economically, socially, and professionally. As a consequence, societal needs and expectations of the profession are more demanding, critical and far-reaching. Veterinarians must play important roles in five intersecting domains of work: public health, bio-medical research, global food safety and security, ecosystem health and the more traditional role of caring for animals. To be successful in this broad and complex range of services and activities, veterinarians must possess an expanded knowledge base, acquire new skills, and develop a new mindset that will ensure their success and excellence in all these domains. The veterinary profession is becoming more fragmented and specialised, and it needs to be brought back together by a single sphere of knowledge or discipline that can serve as an intellectual foundation. The concept of One World of Veterinary Medicine can do just that. With this mindset veterinarians will become better connected to the world around and gain new public recognition and esteem. To achieve this, a special commitment by academic veterinary medicine is, of course, essential. Veterinary schools must lead an educational transformation that reaffirms the social contract of veterinarians and works to align diverse sectors, build a global community, find a common purpose and expand the 21st Century veterinary portfolio of services, activities, and new possibilities.

  17. Urinary incontinence in bitches under primary veterinary care in England: prevalence and risk factors.

    Science.gov (United States)

    O'Neill, D G; Riddell, A; Church, D B; Owen, L; Brodbelt, D C; Hall, J L

    2017-12-01

    To estimate prevalence and demographic risk factors for urinary incontinence in bitches under primary veterinary care in England. The study population included all bitches within the VetCompass database from September 1, 2009 to July 7, 2013. Electronic patient records were searched for urinary incontinence cases and additional demographic and clinical information was extracted. Of 100,397 bitches attending 119 clinics in England, an estimated 3108 were diagnosed with urinary incontinence. The prevalence of urinary incontinence was 3·14% (95% confidence intervals: 2·97 to 3·33). Medical therapy was prescribed to 45·6% cases. Predisposed breeds included the Irish setter (odds ratio: 8·09; 95% confidence intervals: 3·15 to 20·80; PVeterinary Association.

  18. Demography and health of Pugs under primary veterinary care in England.

    Science.gov (United States)

    O'Neill, Dan G; Darwent, Elisabeth C; Church, David B; Brodbelt, Dave C

    2016-01-01

    The Pug is an ancient dog breed and was the fifth most commonly registered UK pedigree breed in 2014. However, the breed has been reported to be predisposed to several disorders including ocular, respiratory and dermatological problems. The VetCompass Programme collates de-identified clinical data from primary-care veterinary practices in the UK for epidemiological research. Using VetCompass clinical data, this study aimed to characterise the demography and common disorders of the general population of Pugs under veterinary care in England. Pugs comprised 2709 (1.03 %) of 264,260 study dogs under veterinary care from September 1(st), 2009 to 30(th) April, 2015. Annual proportional birth rates showed that Pugs rose from less than 1 % of annual birth cohorts before 2008 to comprise 2.8 % of the 2013 annual birth cohort. The most common colours of Pugs were fawn (63.1 %), black (27.7 %), apricot (7.6 %) and silver (2.1 %). Of the 1009 pugs under veterinary care in the study during 2013, 688 (68.19 %) had at least one disorder recorded. The most prevalent disorders recorded overall were overweight/obesity (number of events: 133, prevalence: 13.18 %, 95 % CI: 11.12-15.43), corneal disorder (88, 8.72 %, 95 % CI: 7.05-10.63) and otitis externa (76, 7.53 %, 95 % CI: 5.98-9.34). The most prevalent disorder groups were ophthalmological (n = 164, prevalence: 16.25 %, 95 % CI: 14.03-18.68), dermatological (157, 15.60 %, 95 % CI: 13.38-17.95) and aural (152, 15.06 %, 95 % CI: 12.91-17.42). The most prevalent body locations affected were the head-and-neck (n = 439, prevalence = 43.51 %, 95 % CI: 40.42-46.63) and abdomen (195, 19.33 %, 95 % CI: 16.93-21.90). The most prevalent organ systems affected were the integument (321, 31.81 %, 95 % CI: 28.15-35.72) and digestive (257, 25.47 %, 95 % CI: 22.54-28.65). The most prevalent pathophysiologic processes recorded were inflammation (386, 38.26 %, 95 % CI: 34.39-42.27) and congenital

  19. Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy.

    Science.gov (United States)

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

    2017-05-01

    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

  20. Safety and quality in critical patient care.

    Science.gov (United States)

    González-Méndez, María Isabel; López-Rodríguez, Luís

    The care quality has gradually been placed in the center of the health system, reaching the patient safety a greater role as one of the key dimensions of quality in recent years. The monitoring, measurement and improvement of safety and quality of care in the Intensive Care Unit represent a great challenge for the critical care community. Health interventions carry a risk of adverse events or events that can cause injury, disability and even death in patients. In Intensive Care Unit, the severity of the critical patient, communication barriers, a high number of activities per patient per day, the practice of diagnostic procedures and invasive treatments, and the quantity and complexity of the information received, among others, put at risk these units as areas for the occurrence of adverse events. This article presents some of the strategies and interventions proposed and tested internationally to optimize the care of critical patients and improve the safety culture in the Intensive Care Unit. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  1. Critical care medicine: landmarks and legends.

    Science.gov (United States)

    Rosengart, Matthew R

    2006-12-01

    Critical care medicine was born from the selective pressures of human disease, and with the perseverance and foresight of a select few pioneers, has become an independent field of medicine. This introduction travels back in time to evaluate those visionaries and their landmark contributions. Advancements in caring for the critically ill and organ failure occurred during the wars of the twentieth century. Landmark advances in the management of respiratory paralysis occurred in the polio epidemic of the 1940s. It was during this era that the world's first ICU was developed. Contemporary critical care differs considerably from that which marked its birth. Much of the technology we currently employ is assumed: invasive hemodynamic monitoring, mechanical ventilation, antisepsis, and antibiotics.

  2. Updates in the American Heart Association guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients.

    Science.gov (United States)

    Maton, Barbara L; Smarick, Sean D

    2012-04-01

    To review the updates in the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and identify potential applications to veterinary patients. Cardiopulmonary arrest is common in veterinary emergency and critical care, and consensus guidelines are lacking. Human resuscitation guidelines are continually evolving as new clinical and experimental studies support updated recommendations. Synthesis of human, experimental animal model, and veterinary literature support the potential for updates and advancement in veterinary CPR practices. This review serves to highlight updates in the AHA guidelines for CPR and evaluate their application to small animal veterinary patients. Interventions identified will be evaluated for trans-species potential, raise questions regarding best resuscitation recommendations, and offer opportunities for further research to continue to advance veterinary CPR. The prognosis for any patient undergoing cardiopulmonary arrest remains guarded. © Veterinary Emergency and Critical Care Society 2012.

  3. Nursing practice of palliative care with critically ill older adults.

    Science.gov (United States)

    Dacher, Joan E

    2014-03-01

    Palliative care is emerging as an alternative care paradigm for critically ill older patients in the critical care setting. Critical care nurses are well positioned to take on a leadership role in reconceptualizing care in the critical care unit, and creating the space and opportunity for palliative care. This article provides information on the practice of palliative care with critically ill older adults along with evidence-based content and resources, allowing critical care nurses to advocate for palliative care in their own work environments accompanied by the necessary resources that will support efficient implementation. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. A leadership programme for critical care.

    Science.gov (United States)

    Crofts, Linda

    2006-08-01

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

  5. Sleep neurobiology and critical care illness.

    Science.gov (United States)

    Drouot, Xavier; Quentin, Solene

    2015-07-01

    The intensive care unit (ICU) environment is not propitious for restoring sleep and many studies have reported that critically ill patients have severe sleep disruptions. However, sleep alterations in critically ill patients are specific and differ significantly from those in ambulatory patients. Polysomnographic patterns of normal sleep are frequently lacking in critically ill patients and the neurobiology of sleep is important to consider regarding alternative methods to quantify sleep in the ICU. This article discusses elements of sleep neurobiology affecting the specificity of sleep patterns and sleep alterations in patients admitted to the ICU. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Myasthenia gravis in dogs with an emphasis on treatment and critical care management.

    Science.gov (United States)

    Khorzad, Roxanna; Whelan, Megan; Sisson, Allen; Shelton, G D

    2011-06-01

    To review the human and veterinary literature on the pathophysiology of myasthenia gravis (MG) and describe treatment options for clinical use in people and animals. Human and veterinary clinical reports, studies and reviews, textbooks, and recent research findings in MG from 1996 present, with a focus on treatment and patient management. MG is a well-described condition in people with new research and treatment options available. Many of the newest therapeutic options available in veterinary medicine for MG are based on current strategies used in people with this condition. Seronegative MG is well described in people and provides insight to clinical cases encountered in veterinary medicine when the index of suspicion is high though serologic tests are negative. Previous studies in veterinary medicine focused on the use of acetylcholinesterase inhibitors as the main form of treatment in canine MG. Recent studies, mainly case series and case reports, emphasize the use of immunomodulatory treatments as an alternative for long-term treatment. However, there are no randomized, controlled studies on treatment with immunomodulatory therapy for MG in dogs available to assess the efficacy of this treatment strategy. Although early recognition of clinical signs is most important in the outcome of patients with MG, further understanding the pathophysiology of MG may lead to earlier diagnosis and novel treatment strategies. The discovery of additional autoantibodies against striated muscle proteins in dogs, should enhance our understanding of diseases affecting the neuromuscular junction. In addition, clinical data for canine MG could be applied to other autoimmune disorders. © Veterinary Emergency and Critical Care Society 2011.

  7. Critical Care Specialty Elective: Nursing 401A.

    Science.gov (United States)

    Jepson, Cheri A.

    This course guide describes an elective speciality course on critical/intensive care nursing. A rationale for the course is followed by general information, including a description of the theoretical and clinical course components, an enumeration of major goals and objectives, a detailed outline of the units of instruction, a calendar of…

  8. 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

  9. Understanding critical care nurses' autonomy in Jordan.

    Science.gov (United States)

    Maharmeh, Mahmoud

    2017-10-02

    Purpose The aim of this study was to describe Jordanian critical care nurses' experiences of autonomy in their clinical practice. Design/methodology/approach A descriptive correlational design was applied using a self-reported cross-sectional survey. A total of 110 registered nurses who met the eligibility criteria participated in this study. The data were collected by a structured questionnaire. Findings A majority of critical care nurses were autonomous in their decision-making and participation in decisions to take action in their clinical settings. Also, they were independent to develop their own knowledge. The study identified that their autonomy in action and acquired knowledge were influenced by a number of factors such as gender and area of practice. Practical implications Nurse's autonomy could be increased if nurses are made aware of the current level of autonomy and explore new ways to increase empowerment. This could be offered through classroom lectures that concentrate on the concept of autonomy and its implication in practice. Nurses should demonstrate autonomous nursing care at the same time in the clinical practice. This could be done through collaboration between educators and clinical practice to help merge theory to practice. Originality/value Critical care nurses were more autonomous in action and knowledge base. This may negatively affect the quality of patient care and nurses' job satisfaction. Therefore, improving nurses' clinical decision-making autonomy could be done by the support of both hospital administrators and nurses themselves.

  10. A primer on critical care pharmacy services.

    Science.gov (United States)

    Erstad, Brian L

    2008-12-01

    The intensive care unit (ICU) continues to be a major focus of decentralized pharmacy activities in health systems that care for critically ill patients. This is not surprising, given the need for rapid decision-making involving unstable patients, the large number of powerful medications typically used per patient, the high cost of many drugs used in the ICU and, most importantly, the evidence demonstrating the benefits of having a pharmacist as part of an interdisciplinary team. The purpose of this paper is to highlight important issues to consider when introducing or developing critical care pharmacy services beginning with the establishment of basic services and continuing through practitioner development, guideline/protocol development and implementation, patient safety, residency training, and research.

  11. Enrollment Challenges in Critical Care Nursing Research.

    Science.gov (United States)

    Sole, Mary Lou; Middleton, Aurea; Deaton, Lara; Bennett, Melody; Talbert, Steven; Penoyer, Daleen

    2017-09-01

    Enrollment challenges for critical care research are common. Contributing factors include short enrollment windows, the crisis nature of critical illness, lack of research staff, unavailable legal proxy, family dynamics, and language barriers. To describe enrollment statistics for an ongoing critical care nursing trial, barriers to recruitment, and strategies to enhance enrollment. Two years' worth of recruitment and enrollment data from an oral care intervention trial in critically ill adults receiving mechanical ventilation at 1 hospital were analyzed. Recruitment logs include number of patients screened, eligible, enrolled, and declined and patients' sex, race, and ethnicity. Target enrollment (15.5 patients per month) was based on experience and historical data. Strategies implemented to promote enrollment included providing study personnel at least 18 hours per day for 7 days per week, regular rounds, communication with direct care staff, and Spanish consent processes. In 2 years, 6963 patients were screened; 1551 (22%) were eligible. Consent was sought from 366 (24% of eligible patients). Enrollment averaged 13.3 patients per month (86% of projected target). The main factor impeding enrollment was unavailability of a legal proxy to provide consent (88%). The refusal rates of white (11%), black (13%), and Hispanic (16%) patients did not differ significantly. However, those classified as Asian or as more than 1 race declined significantly more often (35%) than did white or black patients (P = .02). Unavailability of a legal proxy within a short enrollment window was the major challenge to enrollment. Various factors influenced consent decisions. Clinical study design requires more conservative estimates. ©2017 American Association of Critical-Care Nurses.

  12. Experiential Learning in Primary Care: Impact on Veterinary Students' Communication Confidence

    Science.gov (United States)

    Barron, Daniella; Khosa, Deep; Jones-Bitton, Andria

    2017-01-01

    Experiential learning is essential in medical and veterinary student education and can improve students' communication with clients during medical appointments. There is limited research in veterinary education investigating the effectiveness of experiential learning environments to provide an "integrative approach" to teaching. The…

  13. [Burn out syndrome among critical care workers].

    Science.gov (United States)

    Le Gall, Jean Roger; Azoulay, Elie; Embriaco, Nathalie; Poncet, Marie Cécile; Pochard, Frédéric

    2011-02-01

    Burnout syndrome (BOS) is a psychological state resulting from prolonged exposure to job stressors. Because intensive care units (ICUs) are characterized by a high level of work-related stress, we reviewed the available literature on BOS among ICU-healthcare workers. Recent studies suggest that severe BOS (measured with the Maslach Burnout Inventory) is present in about half of all critical care physicians and one-third of critical care nurses. Interestingly, the determinants of BOS difer between the two groups of caregivers. Intensivists with severe BOS tend to be those with a large number of working hours (number of night shifts, and time since last vacation), whereas severe BOS among ICU nurses is mainly related to ICU organization and end-of-life care policy. ICU conflicts were independent predictors of severe BOS in both groups. Recent studies also identify potential preventive measures, such as ICU working groups, better communication during end-of-life care, and prevention and management of ICU conflicts.

  14. Critical care nutrition for feline patients.

    Science.gov (United States)

    Perea, Sally C

    2008-11-01

    Nutritional treatment in critical care patients is an important component of the complete treatment plan. Assessment of nutritional status and careful consideration of the disease course will help guide the selection of the most appropriate assisted-feeding method. Enteral nutrition is favored over parenteral nutrition when the gastrointestinal tract is functional. Common routes of enteral feeding include nasoesophageal, esophagostomy, gastrostomy, and jejunostomy feeding tubes. Parenteral nutrition is indicated for patients who cannot tolerate enteral feedings, or are poor anesthetic candidates for proper feeding tube placement. Appropriate diet selection and implementation of proper feeding guidelines and monitoring will aide in limiting complications associated with enteral and/or parenteral feeding.

  15. Metabolic encephalopathies in the critical care unit.

    Science.gov (United States)

    Frontera, Jennifer A

    2012-06-01

    This article summarizes the most common etiologies and approaches to management of metabolic encephalopathy. Metabolic encephalopathy is a frequent occurrence in the intensive care unit setting. Common etiologies include hepatic failure, renal failure, sepsis, electrolyte disarray, and Wernicke encephalopathy. Current treatment paradigms typically focus on supportive care and management of the underlying etiology. Directed therapies that target neurochemical and neurotransmitter pathways that mediate encephalopathy are not currently available and represent an important area for future research. Although commonly thought of as reversible neurologic insults, delirium and encephalopathy have been associated with increased mortality, prolonged length of stay and hospital complications, and worse long-term cognitive and functional outcomes. Recognition and treatment of encephalopathy is critical to improving outcomes in critically ill patients.

  16. Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges.

    Science.gov (United States)

    Memon, M A; Shmalberg, J; Adair, H S; Allweiler, S; Bryan, J N; Cantwell, S; Carr, E; Chrisman, C; Egger, C M; Greene, S; Haussler, K K; Hershey, B; Holyoak, G R; Johnson, M; Jeune, S Le; Looney, A; McConnico, R S; Medina, C; Morton, A J; Munsterman, A; Nie, G J; Park, N; Parsons-Doherty, M; Perdrizet, J A; Peyton, J L; Raditic, D; Ramirez, H P; Saik, J; Robertson, S; Sleeper, M; Dyke, J Van; Wakshlag, J

    2016-01-01

    Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

  17. Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges

    Science.gov (United States)

    Memon, M.A.; Shmalberg, J.; Adair, H.S.; Allweiler, S.; Bryan, J.N.; Cantwell, S.; Carr, E.; Chrisman, C.; Egger, C.M.; Greene, S.; Haussler, K.K.; Hershey, B.; Holyoak, G.R.; Johnson, M.; Jeune, S. Le; Looney, A.; McConnico, R.S.; Medina, C.; Morton, A.J.; Munsterman, A.; Nie, G.J.; Park, N.; Parsons-Doherty, M.; Perdrizet, J.A.; Peyton, J.L.; Raditic, D.; Ramirez, H.P.; Saik, J.; Robertson, S.; Sleeper, M.; Dyke, J. Van; Wakshlag, J.

    2016-01-01

    Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative. PMID:27200270

  18. Pressure Injury Knowledge in Critical Care Nurses.

    Science.gov (United States)

    Miller, Donna M; Neelon, Lisa; Kish-Smith, Kathleen; Whitney, Laura; Burant, Christopher J

    The purpose of this study was to identify pressure injury knowledge in critical care nurses related to prevention and staging following multimodal education initiatives. Postintervention descriptive study. The sample comprised 32 RNs employed in medical intensive care/coronary intensive care or surgical intensive care units. The study setting was a 237-bed Veterans Affairs acute care hospital in the Midwestern United States. Critical care RNs were asked to participate in this project over a 3-week period following a multimodal 2-year education initiative. Nurses completed the paper version of the 72-item Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) to determine pressure injury knowledge level. Calculated mean cumulative scores and subscores for items related to prevention and staging, respectively. Pearson correlations were used to examine associations between nursing staff characteristics and the PZ-PUKT prevention and staging scores. The cumulative score on the PZ-PUKT was 51.66 (72%); nurses with 5 to 10 years' experience had a higher mean score than nurses with experiences of 20 years or more (mean ± SD = 54.25 ± 4.37 vs 49.5 ± 7.12), but the difference was not statistically significant. Nurses scored higher on the staging system-related items as compared to the prevention-related items (81% vs 70%). Nurses achieved higher staging subscale scores if they were younger (r =-0.41, P care unit (r = 0.37, P < .05). Study findings indicate gaps in knowledge related to pressure injury practice; participants had greater knowledge of staging rather than prevention. Cumulative and subscale findings can be used to direct educational efforts needed to improve and maintain an effective pressure injury prevention program.

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

    Science.gov (United States)

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

    2016-07-01

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

  20. SARS among Critical Care Nurses, Toronto

    OpenAIRE

    Loeb, Mark; McGeer, Allison; Henry, Bonnie; Ofner, Marianna; Rose, David; Hlywka, Tammy; Levie, Joanne; McQueen, Jane; Smith, Stephanie; Moss, Lorraine; Smith, Andrew; Green, Karen; Walter, Stephen D.

    2004-01-01

    To determine factors that predispose or protect healthcare workers from severe acute respiratory syndrome (SARS), we conducted a retrospective cohort study among 43 nurses who worked in two Toronto critical care units with SARS patients. Eight of 32 nurses who entered a SARS patient’s room were infected. The probability of SARS infection was 6% per shift worked. Assisting during intubation, suctioning before intubation, and manipulating the oxygen mask were high-risk activities. Consistently ...

  1. Critical care in the emergency department.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle

    2012-02-01

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

  2. Critical care nursing practice and education in Rwanda | Munyiginya ...

    African Journals Online (AJOL)

    Critical care nursing practice and education in Rwanda is a young specialty. There are very few critical care nurses practising in either hospital or academic settings, and typically nurses taking care of critically ill patients receive only a brief period of informal education prior to practising. Intensive care units are found ...

  3. [Dementia screening in primary care: critical review].

    Science.gov (United States)

    Contador, Israel; Fernández-Calvo, Bernardino; Ramos, Francisco; Tapias-Merino, Ester; Bermejo-Pareja, Félix

    2010-12-01

    Primary care professionals need useful and simple tools to detect early cognitive impairment in patients with any clinical suspicion of dementia. AIM. This critical review attempts to analyze the psychometric properties of cognitive screening tests, commonly used for screening dementia in primary care setting, which have been adapted for Spanish speaking population in the Iberian Peninsula. Special emphasis has been placed on those instruments which met the following criteria: easy correction and short-term application (less than or equal to 10 minutes). Properties such as reliability, validity and especially the discriminating power of the instrument (older people with dementia vs. healthy older adults) have been detailed. The future of brief cognitive assessment in primary care setting requires the adaptation and validation of new tests for the Spanish population, improving the sensitivity of the tests in patients with mild cognitive impairment and searching for measures with an adequate cross-cultural validity.

  4. Improving verbal communication in critical care medicine.

    Science.gov (United States)

    Brindley, Peter G; Reynolds, Stuart F

    2011-04-01

    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.

  5. Exploiting big data for critical care research.

    Science.gov (United States)

    Docherty, Annemarie B; Lone, Nazir I

    2015-10-01

    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.

  6. Physiotherapy in Critical Care in Australia

    Science.gov (United States)

    Haines, Kimberley; Denehy, Linda

    2012-01-01

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

  7. Physiotherapy in critical care in australia.

    Science.gov (United States)

    Berney, Susan; Haines, Kimberley; Denehy, Linda

    2012-03-01

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

  8. Final-Year Students' and Clinical instructors' Experience of Workplace-Based Assessments Used in a Small-Animal Primary-Veterinary-Care Clinical Rotation.

    Science.gov (United States)

    Weijs, Cynthia A; Coe, Jason B; Hecker, Kent G

    2015-01-01

    Final-year veterinary students must meet baseline clinical competency upon completion of their training for entry to practice. Workplace-based assessments (WBAs), widely used in human medical training to assess post-graduate students' professionalism and clinical performance, have recently been adopted in undergraduate veterinary clinical teaching environments. WBAs should support veterinary trainees' learning in a clinical teaching environment, though utility of WBAs within veterinary education may differ from that in medical training due to differences in context and in learners' stage of clinical development. We conducted focus groups with final-year veterinary students and clinical instructors following the implementation of three WBAs (Direct Observation of Procedural Skills [DOPS], the Mini-Clinical evaluation exercise [Mini-CEX], and the In-Training Evaluation Report [ITER]) during a small-animal primary-veterinary-care rotation. Students and clinical instructors viewed the DOPS and Mini-CEX as feasible and valuable learning and assessment tools that offered an overall opportunity for timely in-the-moment feedback. Instructors viewed the ITER as less feasible in the context of a service-oriented veterinary clinical teaching environment. Students believed the ITER had potential to be informative, although in its existing application the ITER had limited utility due to time constraints on instructors that prevented them from providing students with individualized and specific feedback. In service-oriented veterinary clinical teaching environments, successful implementation of WBAs requires balancing provision of feedback to students, time demands on clinical instructors, and flexibility of assessment tools.

  9. Prescription errors in UK critical care units.

    Science.gov (United States)

    Ridley, S A; Booth, S A; Thompson, C M

    2004-12-01

    Drug prescription errors are a common cause of adverse incidents and may be largely preventable. The incidence of prescription errors in UK critical care units is unknown. The aim of this study was to collect data about prescription errors and so calculate the incidence and variation of errors nationally. Twenty-four critical care units took part in the study for a 4-week period. The total numbers of new and re-written prescriptions were recorded daily. Errors were classified according to the nature of the error. Over the 4-week period, 21,589 new prescriptions (or 15.3 new prescriptions per patient) were written. Eighty-five per cent (18,448 prescriptions) were error free, but 3141 (15%) prescriptions had one or more errors (2.2 erroneous prescriptions per patient, or 145.5 erroneous prescriptions per 1000 new prescriptions). The five most common incorrect prescriptions were for potassium chloride (10.2% errors), heparin (5.3%), magnesium sulphate (5.2%), paracetamol (3.2%) and propofol (3.1%). Most of the errors were minor or would have had no adverse effects but 618 (19.6%) errors were considered significant, serious or potentially life threatening. Four categories (not writing the order according to the British National Formulary recommendations, an ambiguous medication order, non-standard nomenclature and writing illegibly) accounted for 47.9% of all errors. Although prescription rates (and error rates) in critical care appear higher than elsewhere in hospital, the number of potentially serious errors is similar to other areas of high-risk practice.

  10. Optical fibre sensing during critical care

    Science.gov (United States)

    Hernandez, F. U.; Wang, T.; Korposh, S.; Correia, R.; Hayes-Gill, B. R.; Hromadka, J.; Mohd Hazlan, N. N.; Norris, A.; Evans, D.; Lee, S.-W.; Morgan, S. P.

    2017-04-01

    Optical fibre sensing is a platform technology for applications in biomedical and environmental monitoring. Fibre Bragg Gratings can be used to monitor parameters such as pressure and temperature. Alternatively, coating the fibres with functional layers, either at the tip of the fibre, on a U-shaped fibre, or a long period grating enables sensing of analytes in liquids and gases. This paper describes the application of optical fibre sensing techniques during mechanical ventilation via an endotracheal tube in critical care. Functional coatings on the fibres are used to monitor humidity of inspired air and can be used to monitor other analytes.

  11. Reptile Critical Care and Common Emergencies.

    Science.gov (United States)

    Music, Meera Kumar; Strunk, Anneliese

    2016-05-01

    Reptile emergencies are an important part of exotic animal critical care, both true emergencies and those perceived as emergencies by owners. The most common presentations for reptile emergencies are addressed here, with information on differential diagnoses, helpful diagnostics, and approach to treatment. In many cases, reptile emergencies are actually acute presentations originating from a chronic problem, and the treatment plan must include both clinical treatment and addressing husbandry and dietary deficiencies at home. Accurate owner expectations must be set in order to have owner compliance to long-term treatment plans. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. A critical discourse analysis of provision of end-of-life care in key UK critical care documents.

    Science.gov (United States)

    Pattison, Natalie

    2006-01-01

    This article highlights certain practical and professional difficulties in providing end-of-life (EOL) care for patients in critical care units and explores discourses arising from guidelines for critical care services. A significant number of patients die in critical care after decisions to withdraw or withhold treatment. Guidelines for provision of critical care suggest, wherever possible, moving patients out of critical care at the EOL. This may not necessarily be conducive to a 'good death' for patients or their loved ones. There is a moral responsibility for both nurses and doctors to ensure that decision-making around EOL issues is sensitively implemented, that decisions about care includes families, patients when able, nurses and doctors, and that good EOL care is provided. A critical discourse analysis (CDA) of four key UK critical care documents published since 1996. The key documents give little clear guidance about how to provide EOL care in critical care. Discourses include the power dynamic in critical care between professions, families and patients, and how this impacts on provision of EOL care. Difficulties encountered include dilemmas at discharge and paternalism in decision-making. The technological environment can act as a barrier to good EOL care, and critical care nurses are at risk of assuming the dominant medical model of care. Nurses, however, are in a prime position to ensure that decision-making is an inclusive process, patient needs are paramount, the practical aspects of withdrawal lead to a smooth transition in goals of care and that comfort measures are implemented.

  13. Nutrition in critical illness.

    Science.gov (United States)

    Chan, Daniel L; Freeman, Lisa M

    2006-11-01

    Malnutrition associated with critical illness has been unequivocally associated with increased morbidity and mortality in humans. Because malnutrition may similarly affect veterinary patients, the nutritional requirements of hospitalized critically ill animals must be properly addressed. Proper nutritional support is increasingly being recognized as an important therapeutic intervention in the care of critically ill patients. The current focus of veterinary critical care nutrition, and the major focus of this article, is on carefully selecting the patients most likely to benefit from nutritional support, deciding when to intervene, and optimizing nutritional support to individual patients.

  14. Use of the nursing interventions classification by critical care nurses.

    Science.gov (United States)

    Titler, M G; Bulechek, G M; McCloskey, J C

    1996-08-01

    A survey of 111 critical care nurses was carried out to determine the frequency with which they perform each of the 336 interventions in the NIC. Forty-nine interventions were used at least daily, indicating a set of core interventions unique to critical care practice. These findings have implications for critical care practice, education, and research.

  15. Physician staffing needs in critical care departments.

    Science.gov (United States)

    Gómez Tello, V; Ruiz Moreno, J; Weiss, M; González Marín, E; Merino de Cos, P; Franco Garrobo, N; Alonso Ovies, A; Montejo González, J C; Iber, T; Marx, G; Córcoles González, V; Gordo Vidal, F; Palencia Herrejón, E; Roca Guiseris, J

    Departments of Critical Care Medicine are characterized by high medical assistance costs and great complexity. Published recommendations on determining the needs of medical staff in the DCCM are based on low levels of evidence and attribute excessive significance to the structural/welfare approach (physician-to-beds ratio), thus generating incomplete and minimalistic information. The Spanish Society of Intensive Care Medicine and Coronary Units established a Technical Committee of experts, the purpose of which was to draft recommendations regarding requirements for medical professionals in the ICU. The Technical Committee defined the following categories: 1) Patient care-related aspects; 2) Activities outside the ICU; 3) Patient safety and clinical management aspects; 4) Teaching; and 5) Research. A subcommittee was established with experts pertaining to each activity category, defining criteria for quantifying the percentage time of the intensivists dedicated to each task, and taking into account occupational category. A quantitative method was applied, the parameters of which were the number of procedures or tasks and the respective estimated indicative times for patient care-related activities within or outside the context of the DCCM, as well as for teaching and research activities. Regarding non-instrumental activities, which are more difficult to evaluate in real time, a matrix of range versus productivity was applied, defining approximate percentages according to occupational category. All activities and indicative times were tabulated, and a spreadsheet was created that modified a previously designed model in order to perform calculations according to the total sum of hours worked and the hours stipulated in the respective work contract. The competencies needed and the tasks which a Department of Critical Care Medicine professional must perform far exceed those of a purely patient care-related character, and cannot be quantified using structural criteria

  16. Burnout syndrome in critical care nursing staff.

    Science.gov (United States)

    Poncet, Marie Cécile; Toullic, Philippe; Papazian, Laurent; Kentish-Barnes, Nancy; Timsit, Jean-Francçois; Pochard, Frédéric; Chevret, Sylvie; Schlemmer, Benoît; Azoulay, Elie

    2007-04-01

    Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff. To identify determinants of BOS in critical care nurses. We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data. Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96-0.99; p=0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52-0.91; p=0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56-0.97; p=0.03); (3) quality of working relations (1-10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16-1.30; p=0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86-0.98; p=0.02) or physicians (OR, 0.81; CI, 0.74-0.87; p=0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04-1.85; p=0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01-1.29; p=0.04). One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.

  17. Developing a Business Plan for Critical Care Pharmacy Services

    OpenAIRE

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

    2016-01-01

    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 ph...

  18. August 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Seth H

    2012-01-01

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

  19. Critical Care Nephrology: A Multidisciplinary Approach.

    Science.gov (United States)

    Rizo-Topete, Lilia; Ronco, Claudio

    2017-01-01

    Acute kidney injury (AKI) is a serious medical condition affecting millions of people. Patients in intensive care unit (ICU) who develop AKI have increased morbidity and mortality, prolonged length of stay in ICU and hospital and increased costs, especially when they require renal replacement therapy. In the latter case, morbidity and mortality increase further. In order to meet the needs of the critically ill patients, a multidisciplinary care team is required, combining the efforts of physicians and nurses from different disciplines as well as nephrologists and intensivists. A personalized patient management is strongly recommended as proposed by the recent criteria of precision medicine. Early identification of patients at risk and timely intervention in case of AKI diagnosis can be obtained by integrating the role of nephrologist in the ICU practice. An innovative model of organization by introducing the nephrology rapid response team is advocated to manage critically ill patients with kidney problems in order to make early diagnosis and interventions, to reduce progression toward CKD and improve renal recovery. The routine adoption of AKI biomarkers together with such a collegial teamwork may represent the pathway toward success. © 2016 S. Karger AG, Basel.

  20. [Education of clinical pharmacy specialists in critical care in Japan].

    Science.gov (United States)

    Maeda, Mikihiro

    2012-01-01

    In Japan, recent initiation of the reimbursement from the government to monitor patients in intensive care unit (ICU) and the foundation of certified emergency medicine and critical care specialist resulted in the increased number of ICU pharmacists. Because most pharmacy schools in Japan have provided few lectures or rotations related to critical care, pharmacy students may think critical care is a difficult field. Pharmacy students in the United States usually have basic didactic courses for critical care such as sepsis or sedation. They can also take critical care rotations as an elective advanced rotation. An organized postgraduate training programs, pharmacy practice residency programs (PGY1; post graduate year 1) and specialized pharmacy practice residency programs (PGY2), develop clinical knowledge and skills as clinical pharmacists. Critical care is one of the most popular areas in PGY2 specialty residency programs. Through three years pharmacy students and residents can develop required knowledge and skills in critical care such as patient monitoring skill. As a part of new pharmacists training, our institution provides a week of critical care rotation. The main objective is the introduction of critical care to be a pharmacy generalist and to develop patient monitoring skills. The critical care rotation is the first step to develop critical care clinical pharmacy specialists in the future.

  1. Critical Care Organizations: Building and Integrating Academic Programs.

    Science.gov (United States)

    Moore, Jason E; Oropello, John M; Stoltzfus, Daniel; Masur, Henry; Coopersmith, Craig M; Nates, Joseph; Doig, Christopher; Christman, John; Hite, R Duncan; Angus, Derek C; Pastores, Stephen M; Kvetan, Vladimir

    2017-12-16

    Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively. The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet. The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations. Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed. We present the rationale for critical

  2. Evaluation of a primary-care setting at a veterinary teaching hospital by a student business group: implementing business training within the curriculum.

    Science.gov (United States)

    Louisa Poon, W Y; Covington, Jennifer P; Dempsey, Lauren S; Goetgeluck, Scott L; Marscher, William F; Morelli, Sierra C; Powell, Jana E; Rivers, Elizabeth M; Roth, Ira G

    2014-01-01

    This article provides an introduction to the use of students' business skills in optimizing teaching opportunities, student learning, and client satisfaction in a primary health care setting at a veterinary teaching hospital. Seven veterinary-student members of the local chapter of the Veterinary Business Management Association (VBMA) evaluated the primary-care service at the University of Georgia (UGA) veterinary teaching hospital and assessed six areas of focus: (1) branding and marketing, (2) client experience, (3) staff and staffing, (4) student experience, (5) time management, and (6) standard operating procedures and protocols. For each area of focus, strengths, weaknesses, opportunities, and threats were identified. Of the six areas, two were identified as areas in need of immediate improvement, the first being the updating of standard operating protocols and the second being time management and the flow of appointments. Recommendations made for these two areas were implemented. Overall, the staff and students provided positive feedback on the recommended changes. Through such a student-centered approach to improving the quality of their education, students are empowered and are held accountable for their learning environment. The fact that the VBMA functions without a parent organization and that the primary-care service at UGA functions primarily as a separate entity from the specialty services at the College of Veterinary Medicine allowed students to have a direct impact on their learning environment. We hope that this model for advancing business education will be studied and promoted to benefit both veterinary education and business practice within academia.

  3. Year in review 2012: Critical Care--management.

    Science.gov (United States)

    Duggal, Abhijit; Rubenfeld, Gordon

    2013-11-22

    Outcomes research plays a key role in defining the effects of medical care in critical care. Last year Critical Care published a number of papers that evaluated patient-centered and policy-relevant outcomes. We present this review article focusing on key reported outcomes associated with severe community-acquired pneumonia, mortality associated with decisions regarding triage to the ICU, and both short-term and long-term mortality associated with ICU admissions. We further analyze the literature, assessing outcomes such as quality of life and the psychological burden associated with critical care. We also reviewed processes of care, and studies looking at cost analysis of treatment associated with critical care.

  4. Epidemiology of Diabetes Mellitus among 193,435 Cats Attending Primary-Care Veterinary Practices in England.

    Science.gov (United States)

    O'Neill, D G; Gostelow, R; Orme, C; Church, D B; Niessen, S J M; Verheyen, K; Brodbelt, D C

    2016-07-01

    Diabetes mellitus (DM) is a common endocrine disease of cats. The prevalence of DM in cats in England is not well-defined. To estimate the prevalence and identify risk factors for DM in a large population of cats attending primary-care practices. A cohort of 193,563 cats in the VetCompass Programme attending 118 primary-care practices in England. Cross-sectional analysis of cohort clinical data. Data were extracted covering September 1st 2009 and August 31st 2014. Period prevalence of DM was calculated. Associations between risk factors and DM were assessed using logistic regression modelling. Of 1,128 DM cases were identified among 194,563 cats (period prevalence 0.58%; 95% confidence interval [CI] 0.54-0.61). Multivariable modelling indicated that Tonkinese (OR 4.1; 95% CI 1.8-9.6; P = .001), Norwegian Forest (odds ratio [OR] 3.5; 95% CI 1.3-9.6; P = .001) and Burmese (OR 3.0; 95% CI 2.0-4.4; P Diabetes mellitus is an important component of the primary-care practice caseload with 1-in-200 cats affected. An increased risk of DM in certain cat breeds supports a genetic predisposition. These results can guide future research and preventative healthcare. Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  5. Implementing the SCCM Family-Centered Care Guidelines in Critical Care Nursing Practice.

    Science.gov (United States)

    Coombs, Maureen; Puntillo, Kathleen A; Franck, Linda S; Scruth, Elizabeth A; Harvey, Maurene A; Swoboda, Sandra M; Davidson, Judy E

    2017-01-01

    Family-centered care is an important component of holistic nursing practice, particularly in critical care, where the impact on families of admitted patients can be physiologically and psychologically burdensome. Family-centered care guidelines, developed by an international group of nursing, medical, and academic experts for the American College of Critical Care Medicine/Society of Critical Care Medicine, explore the evidence base in 5 key areas of family-centered care. Evidence in each of the guideline areas is outlined and recommendations are made about how critical care nurses can use this information in family-centered care practice. ©2017 American Association of Critical-Care Nurses.

  6. Reaching beyond our walls: library outreach to veterinary practitioners.

    Science.gov (United States)

    Sewell, Robin R; Funkhouser, Norma F; Foster, Christine L

    2011-01-01

    The Texas A&M University Medical Sciences Library (MSL) supports lifelong learning for Texas veterinarians and College of Veterinary Medicine and Biomedical Sciences (CVMBS) alumni through several ongoing outreach efforts. The MSL provides free document delivery and literature search services to practicing veterinarians in support of patient care. The MSL also responded to unique opportunities to expand services and increase its visibility through collaborations with the American Association of Equine Practitioners and CABI, provider of VetMed Resource. The MSL continues to explore ways to expand its mission-critical veterinary outreach work and market library services to veterinarians through participation in continuing education, regional meetings, and veterinary student instruction.

  7. November 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2012-12-01

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

  8. April 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2013-04-01

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

  9. Critical care pharmacy workforce: UK deployment and characteristics in 2015.

    Science.gov (United States)

    Borthwick, Mark; Barton, Greg; Bourne, Richard S; McKenzie, Catherine

    2017-10-11

    Clinical pharmacists reduce medication errors and optimize the use of medication in critically ill patients, although actual staffing level and deployment of UK pharmacists is unknown. The primary aim was to investigate the UK deployment of the clinical pharmacy workforce in critical care and compare this with published standards. An electronic data entry tool was created and distributed for UK critical care pharmacy services to record their critical care workforce deployment data. Data were received for 279 critical care units in 171 organizations. Clinical pharmacist input was identified for 98.6% of critical care units. The median weekday pharmacist input to critical care was 0.045 whole time equivalents per Level 3 (ICU) bed with significant interregional variation. Weekend services were sparse. Pharmacists spent 24.5% of time on the multidisciplinary team ward round, 58.5% of time on independent patient review and 17% of time on other critical care professional support activities. There is significant variation in staffing levels when services are stratified by highest level of competence of critical care pharmacist within an organization (P = 0.03), with significant differences in time spent on the multi-disciplinary ward round (P = 0.010) and on other critical care activities (P = 0.009), but not on independent patient review. Investment in pharmacy services is required to improve access to clinical pharmacy expertise at weekends, on MDT ward rounds and for other critical care activities. © 2017 Royal Pharmaceutical Society.

  10. Caring behaviours directly and indirectly affect nursing students' critical thinking.

    Science.gov (United States)

    Chen, Shu-Yueh; Chang, Hsing-Chi; Pai, Hsiang-Chu

    2017-05-24

    The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self-reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self-reflection and critical thinking. For this descriptive, correlational, cross-sectional study, we recruited 293 fifth-year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self-reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q-sort, and a Chinese version of the Self-Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test. The results showed that caring behaviours significantly positively affected critical thinking (β = 0.56, t = 12.37, p critical thinking (β = 0.34, t = 6.48, p critical thinking. Caring behaviours did not, however, moderate the relationship between self-reflection (β = 0.001, t = 0.021, p > 0.05) and critical thinking. Caring behaviours directly affect self-reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self-reflection and insight. © 2017 Nordic College of Caring Science.

  11. SARS among Critical Care Nurses, Toronto

    Science.gov (United States)

    McGeer, Allison; Henry, Bonnie; Ofner, Marianna; Rose, David; Hlywka, Tammy; Levie, Joanne; McQueen, Jane; Smith, Stephanie; Moss, Lorraine; Smith, Andrew; Green, Karen; Walter, Stephen D.

    2004-01-01

    To determine factors that predispose or protect healthcare workers from severe acute respiratory syndrome (SARS), we conducted a retrospective cohort study among 43 nurses who worked in two Toronto critical care units with SARS patients. Eight of 32 nurses who entered a SARS patient’s room were infected. The probability of SARS infection was 6% per shift worked. Assisting during intubation, suctioning before intubation, and manipulating the oxygen mask were high-risk activities. Consistently wearing a mask (either surgical or particulate respirator type N95) while caring for a SARS patient was protective for the nurses, and consistent use of the N95 mask was more protective than not wearing a mask. Risk was reduced by consistent use of a surgical mask, but not significantly. Risk was lower with consistent use of a N95 mask than with consistent use of a surgical mask. We conclude that activities related to intubation increase SARS risk and use of a mask (particularly a N95 mask) is protective. PMID:15030692

  12. Prevalence of and risk factors for degenerative mitral valve disease in dogs attending primary-care veterinary practices in England.

    Science.gov (United States)

    Mattin, M J; Boswood, A; Church, D B; López-Alvarez, J; McGreevy, P D; O'Neill, D G; Thomson, P C; Brodbelt, D C

    2015-01-01

    To date, epidemiological studies on degenerative mitral valve disease (DMVD) in dogs have largely reported referral caseloads or been limited to predisposed breeds. Analysis of primary-care data to identify factors associated with DMVD would help clinicians identify high-risk individuals and improve understanding. To estimate the prevalence of and identify risk factors for DMVD in dogs attending primary-care veterinary practices in England. Cases were identified within the electronic patient records of 111,967 dogs attending 93 practices. Four hundred and 5 dogs were diagnosed with DMVD (diagnosed cases) and a further 3,557 dogs had a heart murmur (HM) consistent with DMVD (possible cases). Retrospective cross-sectional study design. Prevalence was adjusted for the sampling approach. Mixed effects logistic regression models identified factors associated with DMVD. Prevalence estimates of diagnosed DMVD and HMs consistent with DMVD (both diagnosed and possible cases) were 0.36% (95% confidence interval [CI]: 0.29-0.45) and 3.54% (95% CI: 3.26-3.84) respectively. In the multivariable analysis, males had higher odds of diagnosed DMVD than did females (odds ratio [OR] 1.40, 95% CI: 1.12-1.74). Insured dogs had increased odds of DMVD compared with noninsured dogs (OR 3.56, 95% CI: 2.79-4.55) and dogs ≥20 kg had approximately half the odds of DMVD diagnosis compared with dogs dogs. Knowledge of identified risk factors for DMVD could improve clinical diagnosis and direct future research. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  13. Morbidity: Changing the Outcome Paradigm for Pediatric Critical Care.

    Science.gov (United States)

    Heneghan, Julia A; Pollack, Murray M

    2017-10-01

    The focus of critical care has evolved from saving lives to preservation of function. Morbidity rates in pediatric critical care are approximately double mortality rates. Morbidity includes complications of disease and medical care. In pediatric critical care, functional status morbidity is an intermediate outcome in the progression toward death and is the result of the same factors associated with mortality, including physiologic profiles and case-mix factors. The Functional Status Scale developed by Collaborative Pediatric Critical Care Research Network is a validated, granular, age-independent measure of functional status that has proved valuable and practical even in large outcome studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Critical care admission of South African (SA) surgical patients ...

    African Journals Online (AJOL)

    Table 3 highlights the critical care organ support and severity of critical care illness. SOFA score, KDIGO scores and PaO2/FiO2 ratio are listed as organ dysfunction scores. Very few critically ill patients. (2.5%) were planned to receive renal replacement therapy (RRT) on admission and only 2.3% received RRT at 48 hours.

  15. Risk factors associated with struvite urolithiasis in dogs evaluated at general care veterinary hospitals in the United States.

    Science.gov (United States)

    Okafor, Chika C; Pearl, David L; Lefebvre, Sandra L; Wang, Mansen; Yang, Mingyin; Blois, Shauna L; Lund, Elizabeth M; Dewey, Cate E

    2013-12-15

    To identify factors associated with development of struvite urolithiasis in dogs evaluated at general care veterinary hospitals in the United States. Retrospective case-control study. 508 dogs with a first-time diagnosis of struvite urolithiasis and 7,135 control dogs. Electronic medical records of all dogs evaluated at 787 general care veterinary hospitals in the United States between October 2007 and December 2010 were reviewed to identify dogs that developed struvite urolithiasis and 2 groups of control dogs with no history of urolithiasis. Information extracted included diet, age, sex, neuter status, breed size category, hospital location, and date of diagnosis. Urinalysis results, urolith composition, and other disease conditions were recorded if applicable. Potential risk factors were assessed with univariable and multivariable regression analysis. Toy- or small-sized breeds had significantly greater odds of struvite urolithiasis, compared with medium- or large-sized breeds. Neutering significantly increased the odds of this outcome in females only; sexually intact females were more likely to develop struvite urolithiasis than were sexually intact males, but only up to 5 years of age. Urinary factors significantly associated with the outcome were basic (vs acidic) pH, presence of RBCs or WBCs, protein concentration > 30 mg/dL, and ketone concentration ≥ 5 mg/dL. Evaluation of demographic characteristics and urinalysis results may be useful in the early identification of struvite urolithiasis in dogs. Periodic urinalysis in dogs is recommended because of the potential health impact of a late diagnosis of urolithiasis.

  16. The epidemiology of patellar luxation in dogs attending primary-care veterinary practices in England.

    Science.gov (United States)

    O'Neill, Dan G; Meeson, Richard L; Sheridan, Adam; Church, David B; Brodbelt, Dave C

    2016-01-01

    Canine patellar luxation is one of the most common orthopaedic disorders of dogs and is a potential welfare concern because it can lead to lameness, osteoarthritis and pain. However, there are limited epidemiological data on the disorder relating to the general population of dogs in England. This study aimed to investigate the VetCompass Programme database of dogs attending primary-care veterinary practices in England to report on the prevalence, risk factors and clinical management of diagnosed patellar luxation cases. The study included all dogs with at least one electronic patient record in the VetCompass database from September 1(st), 2009 to August 31(st), 2014. Candidate patellar luxation cases were identified using free-text word searching of the clinical notes and VeNom diagnosis term fields. Univariable and multivariable binary logistic regression modelling was used for risk factor analysis. The overall dataset comprised 210,824 dogs attending 119 clinics in England. The prevalence of patellar luxation diagnosis in dogs was 1.30 % (95 % confidence interval (CI) 1.21-1.39). Of the 751 incident cases, 293 (39.0 %) received medical management, 99 (13.2 %) received surgical intervention and 28 (3.7 %) were referred for further management. Multivariable modelling documented 11 breeds with increased odds of patellar luxation compared with crossbred dogs, including the Pomeranian (odds ratio [OR]: 6.5, 95 % CI 4.0-10.7, P < 0.001), Chihuahua (OR: 5.9, 95 % CI 4.4-7.9, P < 0.001), Yorkshire Terrier (OR: 5.5, 95 % CI 4.3-7.1, P < 0.001) and French Bulldog (OR: 5.4, 95 % CI 3.1-9.3, P < 0.001). Dogs with bodyweight below their mean for breed and sex had a 1.4 times odds of diagnosis (95 % CI 1.2-1.6, P < 0.001). Dogs aged ≥ 12.0 years showed 0.4 times the odds (95 % CI 0.3-0.5, P < 0.001) compared with dogs aged < 3.0 years. Females had 1.3 times the odds (95 % CI 1.1-1.5, P < 0.001), neutered dogs had 2.4 times

  17. [Physicians' attitudes and perceptions regarding the critical care and critical care specialty].

    Science.gov (United States)

    Santana Cabrera, L; Sánchez-Palacios, M; Rodríguez González, F; Hernández Medina, E; Casamitjana Ortega, A; Fernández Arroyo, M

    2008-10-01

    To evaluate the attitudes and perceptions of the doctors of a hospital regarding critical care and the speciality of Intensive Medicine. Prospective, descriptive study during 3 months. Insular University Hospital in Gran CanaRia, Canary Islands, Spain. Medical specialists and residents. Anonymous survey. Demographic data of the interviewed doctors were collected and they were asked about their labour or personal previous relation with the Intensive Care Unit (ICU), the attitudes of the critical care doctors' of their hospital and their perceptions regarding the critical care speciality. We interviewed 116 doctors, 75 staff and 41 residents. Less of the third part believed that the ICU was a ward for potentially critical patients. A high percentage of the doctors whom had been refused some admission were not to agree with the arguments that they received. More than 40% of the interviewed ones affirmed had not requested bed in the ICU for any patient who had benefited from it, especially because they were thinking that the admission would be refused. Some doctors think that the professio - nals employed at the ICU are doctors of different specialities. The speciality of Intensive Medicine is perceived by a high level of stress among the professionals. We detect the ignorance of other professionals about the function of a Service of Intensive Medicine and the model of ICU of our country. Also we find high rates of dissatisfaction among the professionals who was refused some admission in the unit, because of we believe that clinical guides about the criteria of admission must be elaborated and to announce them among the doctors of the hospital. The professionals perceive that we suffer a high level of stress.

  18. Murine models in critical care research.

    Science.gov (United States)

    Haouzi, Philippe

    2011-10-01

    therapeutic approaches applicable in critical care patients should be understood in light of the specificity of the metabolic, respiratory, and circulatory responses of mice to a hypoxic insult, since many of these adaptations have no clear equivalent in humans.

  19. The Culture of Nurses in a Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Suegnèt Scholtz

    2016-02-01

    Full Text Available Critical care nurses have to adapt to a fast-paced and stressful environment by functioning within their own culture. The objective of this study was to explore and describe the culture of critical care nurses with the purpose of facilitating recognition of wholeness in critical care nurses. The study had a qualitative, exploratory, descriptive, and contextual design. The ethnographic study included data triangulation of field notes written during 12 months of ethnographic observations, 13 interviews from registered nurses, and three completed diaries. Coding and analysis of data revealed patterns of behavior and interaction. The culture of critical care nurses was identified through patterns of patient adoption, armor display, despondency because of the demands to adjust, sibling-like teamwork, and non-support from management and medical doctors. An understanding of the complexity of these patterns of behavior and interaction within the critical care nursing culture is essential for transformation in the practice of critical care nursing.

  20. The Culture of Nurses in a Critical Care Unit

    Science.gov (United States)

    Scholtz, Suegnèt; Nel, Elsabe W.; Poggenpoel, Marie; Myburgh, Chris P. H.

    2016-01-01

    Critical care nurses have to adapt to a fast-paced and stressful environment by functioning within their own culture. The objective of this study was to explore and describe the culture of critical care nurses with the purpose of facilitating recognition of wholeness in critical care nurses. The study had a qualitative, exploratory, descriptive, and contextual design. The ethnographic study included data triangulation of field notes written during 12 months of ethnographic observations, 13 interviews from registered nurses, and three completed diaries. Coding and analysis of data revealed patterns of behavior and interaction. The culture of critical care nurses was identified through patterns of patient adoption, armor display, despondency because of the demands to adjust, sibling-like teamwork, and non-support from management and medical doctors. An understanding of the complexity of these patterns of behavior and interaction within the critical care nursing culture is essential for transformation in the practice of critical care nursing. PMID:28462324

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

    Science.gov (United States)

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

    2016-09-01

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

  2. The critical care nurse's role in end-of-life care: issues and challenges.

    Science.gov (United States)

    Efstathiou, Nikolaos; Clifford, Collette

    2011-01-01

    The purpose of this article is to discuss the challenges critical care nurses face when looking after patients needing End-of-Life (EoL) care in critical care environments. Critical care nurses frequently provide care to patients who fail to respond to treatments offered to support and prolong life. The dying phase for individuals in critical care settings, commonly after withholding/withdrawing treatment, is very short posing great demands on critical care nurses to provide physical and emotional support to both patients and their families. Despite the existence of recognized care planning frameworks that may help nurses in providing EoL care, these are not used by all units and many nurses rely on experience to inform practice. A number of aspects such as communication, patient/family-centred decision-making, continuity of care, emotional/spiritual support and support for health professionals have been indicated as contributing factors towards the provision of effective EoL care. These are considered from the perspective of critical care nursing. Skills development in key aspects of care provision may improve the provision of EoL care for critical care patients and their families. Critical care nurses have an essential role in the provision of effective EoL care; however, this dimension of their role needs further exploration. It is noted that educational opportunities need to be provided for critical care nurses to increase the knowledge on planning and delivering EoL care. To inform this evaluation of current EoL care provision in critical care is necessary to address a knowledge deficit of the needs of nurses who seek to support patients and their families at a critical time. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care Nurses.

  3. Prevalence of disorders recorded in Cavalier King Charles Spaniels attending primary-care veterinary practices in England.

    Science.gov (United States)

    Summers, Jennifer F; O'Neill, Dan G; Church, David B; Thomson, Peter C; McGreevy, Paul D; Brodbelt, David C

    2015-01-01

    Concerns have been raised over breed-related health issues in purebred dogs, but reliable prevalence estimates for disorders within specific breeds are sparse. Electronically stored patient health records from primary-care practice are emerging as a useful source of epidemiological data in companion animals. This study used large volumes of health data from UK primary-care practices participating in the VetCompass animal health surveillance project to evaluate in detail the disorders diagnosed in a random selection of over 50% of dogs recorded as Cavalier King Charles Spaniels (CKCSs). Confirmation of breed using available microchip and Kennel Club (KC) registration data was attempted. In total, 3624 dogs were recorded as CKCSs within the VetCompass database of which 143 (3.9%) were confirmed as KC-registered via microchip identification linkage of VetCompass to the KC database. 1875 dogs (75 KC registered and 1800 of unknown KC status, 52% of both groups) were randomly sampled for detailed clinical review. Clinical data associated with veterinary care were recorded in 1749 (93.3%) of these dogs. The most common specific disorders recorded during the study period were heart murmur (541 dogs, representing 30.9% of study group), diarrhoea of unspecified cause (193 dogs, 11.0%), dental disease (166 dogs, 9.5%), otitis externa (161, 9.2%), conjunctivitis (131, 7.4%) and anal sac infection (129, 7.4%). The five most common disorder categories were cardiac (affecting 31.7% of dogs), dermatological (22.2%), ocular (20.6%), gastrointestinal (19.3%) and dental/periodontal disorders (15.2%). Study findings suggest that many of the disorders commonly affecting CKCSs are largely similar to those affecting the general dog population presented for primary veterinary care in the UK. However, cardiac disease (and MVD in particular) continues to be of particular concern in this breed. This work highlights the value of veterinary practice based breed-specific epidemiological studies

  4. Influence of veterinary care on the urinary corticoid:creatinine ratio in dogs.

    Science.gov (United States)

    van Vonderen, I K; Kooistra, H S; Rijnberk, A

    1998-01-01

    Physical and emotional stresses are known to increase the production and secretion of glucocorticoids by the adrenal cortex in both humans and experimental animals. The urinary corticoid: creatinine (C:C) ratio is increasingly used as a measure of adrenocortical function. In this study we investigated whether a visit to a veterinary practice for vaccination, a visit to a referral clinic for orthopedic examination, or hospitalization in a referral clinic for 1.5 days resulted in increases of the urinary C:C ratio in pet dogs. In experiment 1, owners collected voided urine samples from 19 healthy pet dogs at specified times before and after taking the dogs to a veterinary practice for yearly vaccination. In experiment 2, 12 pet dogs were evaluated in a similar way before and after an orthopedic examination at a referral clinic. In experiment 3, 9 healthy pet dogs were hospitalized for 1.5 days and urine samples were collected before, during, and after this stay. Basal urinary C:C ratios in all experiments ranged from 0.8 to 8.3 x 10(-6). In experiment 1, the urinary C:C ratio after the visit to the veterinary practice ranged from 0.9 to 22.0 x 10(-6). Six dogs had a significantly increased urinary C:C ratio (responders), but in 5 of these dogs the ratio was dogs responded significantly with urinary C:C ratios ranging from 3.1 to 27.0 x 10(-6). In experiment 3, 8 of 9 dogs had significantly increased urinary C:C ratios, ranging from 2.4 to 24.0 x 10(-6), in some or all urine samples collected during hospitalization. In 4 dogs urinary C:C ratios 12 hours after hospitalization were still significantly higher than the initial values. Thus, a visit to a veterinary practice, an orthopedic examination in a referral clinic, and hospitalization can be considered stressful conditions for dogs. A large variation occurs in response, and in individual dogs the increases in urinary C:C ratios can exceed the cutoff level for the diagnosis of hyperadrenocorticism. Therefore, urine

  5. Systems modeling and simulation applications for critical care medicine

    Science.gov (United States)

    2012-01-01

    Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area. PMID:22703718

  6. Enhancing critical thinking in clinical practice: implications for critical and acute care nurses.

    Science.gov (United States)

    Shoulders, Bridget; Follett, Corrinne; Eason, Joyce

    2014-01-01

    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.

  7. Association between radiographic assessment of hip status and subsequent incidence of veterinary care and mortality related to hip dysplasia in insured Swedish dogs.

    Science.gov (United States)

    Malm, Sofia; Fikse, Freddy; Egenvall, Agneta; Bonnett, Brenda N; Gunnarsson, Lotta; Hedhammar, Ake; Strandberg, Erling

    2010-02-01

    Our objective was to evaluate the association between grading of hip status as assessed by radiographic examination (hip screening) and subsequent incidence of veterinary care and mortality related to hip dysplasia (HD) in five breeds of insured dogs in Sweden. Screening results for hip status from the Swedish Kennel Club and data on veterinary care and mortality from the insurance company Agria were merged based on the registration number of the dog. Dogs of five breeds (Bernese Mountain Dogs, German Shepherds, Golden Retrievers, Labrador Retrievers, and Rottweilers) screened during 1995-2004 and covered by an insurance plan for veterinary care or life at the time of screening were included. The study populations included between 1667 and 10,663 dogs per breed. Breed-specific multivariable Cox proportional-hazards analyses were performed to evaluate the impact of radiographic hip status on time from hip screening to first HD-related veterinary and life claim, respectively. The effects of gender, birth season, and a time-varying covariate of year were also studied. Additional analyses, on the five breeds combined, were performed to investigate the effects of hip status, breed, and the interaction between hip status and breed. The effect of hip status was highly significant (Phip status. Dogs with moderate or severe hip status at screening had a markedly increased hazard of HD-related veterinary care and mortality compared with dogs assessed as free or mild. The time-varying covariate of year showed a significantly higher HR in the last time period for German Shepherds and Labrador Retrievers in the analyses of veterinary claims. In the analyses on all five breeds, German Shepherds had the highest HR for both veterinary care and mortality related to HD, followed by Bernese Mountain Dogs. Golden and Labrador Retrievers had the lowest HR. The effect of hip status on the hazard was the same irrespective of breed. However, as a consequence of differences between breeds

  8. Spiritual Experiences of Muslim Critical Care Nurses.

    Science.gov (United States)

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

    2017-12-01

    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.

  9. Critical Caring for People and Place

    Science.gov (United States)

    Schindel, Alexandra; Tolbert, Sara

    2017-01-01

    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…

  10. Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

    Science.gov (United States)

    Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

    2011-01-01

    Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

  11. 2006 profile of postgraduate critical care nursing research in South ...

    African Journals Online (AJOL)

    2007-11-19

    Nov 19, 2007 ... Cardiac patients' experience of music. -. - therapy. Cardiac surgery patients' experiences of. -. - music therapy in an ICU of a public hospital in Gauteng. Critical care nurses' knowledge regarding. -. - legal liability issues. Critical care nurses' knowledge regarding. -. - patients with pulmonary embolism in the.

  12. Critical Care Performance in a Simulated Military Aircraft Cabin Environment

    Science.gov (United States)

    2007-01-01

    significantly contribute cognitive performance in this study with the exception of Critical Care Time 14, Defibrillates 1st time. The regression for CRRT 14 with...this study with the exception of Critical Care Time 14, Defibrillates 1 t time. The regression for CRRT 14 with altitude and noise as was

  13. The Evolution of Critical Care Nephrology in Edmonton.

    Science.gov (United States)

    Bagshaw, Sean M; Gibney, R T Noel

    2016-01-01

    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. © 2016 S. Karger AG, Basel.

  14. The critical care nursing workforce in Western Cape hospitals - a ...

    African Journals Online (AJOL)

    Background. A global shortage of registered nurses (RNs) has been reported internationally, and confirmed in South Africa by the National Audit of Critical Care services. Critical care nurses (CCNs) especially are in great demand and short supply. Purpose. The purpose of this study was to quantify the nursing workforce ...

  15. Investigation into the occurrence in food of veterinary medicines, pharmaceuticals, and chemicals used in personal care products.

    Science.gov (United States)

    Fussell, Richard J; Garcia Lopez, Monica; Mortimer, David N; Wright, Stuart; Sehnalova, Monika; Sinclair, Chris J; Fernandes, Alwyn; Sharman, Matthew

    2014-04-30

    Human exposure to emerging contaminants by indirect routes is of increasing interest. This study assessed the contamination of food by chemicals used in human pharmaceuticals (HPs), veterinary medicines (VMs), and personal care products (PCPs). A prioritization study was undertaken to identify the chemicals and food-producing scenarios most likely to result in contamination of food. Around 400 samples of mushrooms, vegetables, aquaculture products, and animal tissues were collected from sites in the United Kingdom, along with aquaculture products imported from Southeast Asia. A number of multianalyte methods were developed and validated for the analysis of the prioritized compounds in these samples. The analysis of all sample-method combinations required approximately 18000 determinations. Around 325 individual residues, including parabens, musk compounds, and antibiotics, were detected in 118 individual samples, but mostly at low nanograms per gram concentrations. Results suggest that the limited contamination of target chemicals occurred in the realistic food-producing scenarios investigated.

  16. Stability in shifting sands: contemporary leadership roles in critical care.

    Science.gov (United States)

    Endacott, R; Boulanger, C; Chamberlain, W; Hendry, J; Ryan, H; Chaboyer, W

    2008-10-01

    Contemporary nursing leadership roles in critical care are a reflection of the changing environment in which critical care is provided. In the UK, critical care nursing faces challenges in the form of: reduced number and seniority of medical staff cover for acute wards; mandated responsibility for management of patients outside of critical care units, without corresponding responsibility for managing staff; increased public and political awareness of deficits in critical care; increased use of Assistant Practitioners; and emphasis on longer-term outcomes from intensive care. New leadership roles have met these challenges head on with two main foci: patient management across the acute/critical care interface and hospital wide policies and practice. The leadership roles examined in this paper highlight three underpinning goals: improved quality and safety of patient care; improved communication between professionals; and empowerment of junior nurses and doctors. There has been considerable investment in strategic leadership roles for critical care nursing; evidence is developing of the return on this investment for patient and service outcomes. Consideration must now be given to the preparation, mentorship and development of leadership roles for the next generation of nurse leaders.

  17. Risk factors associated with calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States.

    Science.gov (United States)

    Okafor, Chika C; Lefebvre, Sandra L; Pearl, David L; Yang, Mingyin; Wang, Mansen; Blois, Shauna L; Lund, Elizabeth M; Dewey, Cate E

    2014-08-01

    Calcium oxalate urolithiasis results from the formation of aggregates of calcium salts in the urinary tract. Difficulties associated with effectively treating calcium oxalate urolithiasis and the proportional increase in the prevalence of calcium oxalate uroliths relative to other urolith types over the last 2 decades has increased the concern of clinicians about this disease. To determine factors associated with the development of calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States, a retrospective case-control study was performed. A national electronic database of medical records of all dogs evaluated between October 1, 2007 and December 31, 2010 at 787 general care veterinary hospitals in the United States was reviewed. Dogs were selected as cases at the first-time diagnosis of a laboratory-confirmed urolith comprised of at least 70% calcium oxalate (n=452). Two sets of control dogs with no history of urolithiasis diagnosis were randomly selected after the medical records of all remaining dogs were reviewed: urinalysis examination was a requirement in the selection of one set (n=1808) but was not required in the other set (n=1808). Historical information extracted included urolith composition, dog's diet, age, sex, neuter status, breed size category, hospital location, date of diagnosis, and urinalysis results. Multivariable analysis showed that the odds of first-time diagnosis of calcium oxalate urolithiasis were significantly (P30 mg/dL (OR: 1.55, 1.04-2.30). Patient demographics and urinalysis results are important factors that can support risk assessment and early identification of canine oxalate urolithiasis. Therefore, periodic urolith screening and monitoring of urine parameters should be encouraged for dogs at risk of developing these uroliths. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Epidemiology of Cranial Cruciate Ligament Disease Diagnosis in Dogs Attending Primary-Care Veterinary Practices in England.

    Science.gov (United States)

    Taylor-Brown, Frances E; Meeson, Richard L; Brodbelt, Dave C; Church, David B; McGreevy, Paul D; Thomson, Peter C; O'Neill, Dan G

    2015-08-01

    To estimate the prevalence and risk factors for a diagnosis of cranial cruciate ligament (CCL) disease in dogs and to describe the management of such cases attending primary-care veterinary practices. Historical cohort with a nested case-control study. Nine hundred and fifty-three dogs diagnosed with CCL disease from 171,522 dogs attending 97 primary-care practices in England. Medical records of dogs attending practices participating in the VetCompass project that met selection criteria were assessed. Univariate and multivariate logistic regression methods were used to evaluate association of possible risk factors with diagnosis of CCL disease. The prevalence of CCL disease diagnosis was estimated at 0.56% (95% confidence interval 0.52-0.59). Compared with crossbred dogs, Rottweilers, West Highland White Terriers, Golden Retrievers, Yorkshire Terriers, and Staffordshire Bull Terriers showed increased odds of CCL disease diagnosis while Cocker Spaniels showed reduced odds. Increasing bodyweight within breeds was associated with increased odds of diagnosis. Dogs aged over 3 years had increased odds of diagnosis compared with dogs aged less than 3 years. Neutered females had 2.1 times the odds of diagnosis compared with entire females. Insured dogs had 4 times the odds of diagnosis compared with uninsured dogs. Two-thirds of cases were managed surgically, with insured and heavier dogs more frequently undergoing surgery. Overall, 21% of cases were referred, with referral more frequent in heavier and insured dogs. Referred dogs more frequently had surgery and an osteotomy procedure. Breed predispositions and demographic factors associated with diagnosis and case management of CCL disease in dogs identified in this study can be used to help direct future research and management strategies. © Copyright 2015 by The American College of Veterinary Surgeons.

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

    Science.gov (United States)

    Toms, Robin

    2011-01-01

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

  20. Critical care nursing organizations and activities: a fourth worldwide review.

    Science.gov (United States)

    Williams, G; Fulbrook, P; Kleinpell, R; Schmollgruber, S; Alberto, L

    2015-12-01

    To examine the activities and concerns of critical care nurses and professional critical care nursing organizations around the world and to identify expectations held of nursing leaders and policy makers to help address their concerns. This study is the fourth worldwide review of its type. Previous surveys were undertaken in 2001, 2005 and 2009. An online descriptive survey was emailed to 88 potential participants from countries with critical care nursing organizations or known critical care nursing leaders. Responses were downloaded into Survey Monkey™ (Version 22) and analysed by geographical region and income level. Fifty-nine respondents from 58 countries completed the questionnaire, of whom 43 had critical care nursing organizations established in their countries and 29 were members of the World Federation of Critical Care Nurses. The services provided by the organizations to be of most value were national conferences, website, professional representation, and practice standards and guidelines. Professional policies had been developed by some organizations on workforce, education and practice, while almost half provided their members with either a newsletter or journal. Collectively, the most important issues for critical care nurses were working conditions, provision of formal practice guidelines and competencies, staffing levels and access to quality education programmes. Important issues continue to challenge the specialty of critical care nursing as new developments, priorities, clinical issues and other global events and influences impact critical care nursing worldwide. This study will help guide nursing leaders and policy makers to address the needs of critical care nurses and their patients. Collaborative approaches between the specialty, nursing leaders and health policy advisors will assist to inform appropriate change in areas recommended for further action. © 2015 International Council of Nurses.

  1. Nursing challenges with a severely injured patient in critical care.

    Science.gov (United States)

    Crossan, Lisa; Cole, Elaine

    2013-09-01

    Patients with severe, multiple, traumatic injuries are challenging to manage in critical care. Early identification of injuries and optimal resuscitation is essential for favourable outcomes. Trauma-related haemorrhage can lead to the lethal triad of hypothermia, coagulopathy and acidosis. Many trauma patients require urgent haemorrhage control and structural fixation through operative intervention. However, metabolic derangement and cardiovascular instability may delay surgery, resulting in an ongoing cycle of deterioration. Damage control surgery (DCS) may be used as a temporizing measure until the patient is stabilized in critical care. The aim of this case study is to discuss the complex issues faced in the critical care management of a severely injured patient. We conducted a patient case study, with analysis of care using published evidence. The key terms used to search for evidence were trauma, injury, damage control surgery, spinal fixation, critical/intensive care and nurse. We report the care of a trauma patient with complex, conflicting injuries requiring management of the lethal triad and DCS. The delay in subsequent definitive repair of spinal column fractures provided many challenges for critical care nurses including restricted patient mobilization, positioning and pressure ulcer prevention. A review of contemporary evidence relating to DCS reveals that whilst this technique is used increasingly in trauma, the research focuses on single system injuries. Evidence and guidelines are required to support DCS for critical care patients with multiple, conflicting injuries including spinal fractures. For patients with delayed surgical intervention, rotational bed therapy may assist critical care nurses in meeting needs. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

  2. How do critical care nurses define the discharge planning process?

    Science.gov (United States)

    Watts, Rosemary J; Pierson, Jane; Gardner, Heather

    2005-02-01

    Professional, political and organisational factors have focused attention on the discharge planning process in the Victorian health care sector. Discharge planning for patients, as part of continuity of care, is seen as a key concept in the delivery of nursing care. However, there is no question that discharge planning has emerged as a complex area of practice, and is, perhaps, most complex in the critical care area. The study reported here is part of a larger thesis exploring critical care nurses' perceptions and understanding of the discharge planning process in the health care system in the state of Victoria, Australia. As part of the survey participants were asked to define discharge planning as it related to the critical care environment in which they worked. Utilising an exploratory descriptive approach, 502 Victorian critical care nurses were approached to take part in the study. The resultant net total of 218 participants completed the survey, which represented a net response rate of 43.4%. The data were analysed using quantitative and qualitative methodologies. Three common themes emerged. A significant number of participants did not believe that discharge planning occurred in critical care, and therefore, thought that they could not provide a definition. There was uncertainty as to what the discharge planning process actually referred to in terms of discharge from critical care to the general ward or discharge from the hospital. There was an emphasis on movement of the patient to the general ward, which was considered in three main ways by first, getting the patient ready for transfer; second, ensuring a smooth transition to the ward and third, transfer of the patient to the ward often occurred because the critical care bed was needed for another patient. The findings presented here suggest at a nursing level, the discharge planning process is not well understood and some degree of mutual exclusivity still remains. There is a need for further education of

  3. The factors influencing burnout and job satisfaction among critical care nurses: a study of Saudi critical care nurses.

    Science.gov (United States)

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

    2016-09-01

    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.

  4. Severe Burnout Is Common Among Critical Care Physician Assistants.

    Science.gov (United States)

    Bhatt, Muneer; Lizano, Danny; Carlese, Anthony; Kvetan, Vladimir; Gershengorn, Hayley Beth

    2017-11-01

    To determine the prevalence of and risk factors for burnout among critical care medicine physician assistants. Online survey. U.S. ICUs. Critical care medicine physician assistant members of the Society of Critical Care Medicine coupled with personal contacts. None. We used SurveyMonkey to query critical care medicine physician assistants on demographics and the full 22-question Maslach Burnout Inventory, a validated tool comprised of three subscales-emotional exhaustion, depersonalization, and achievement. Multivariate regression was performed to identify factors independently associated with severe burnout on at least one subscale and higher burnout scores on each subscale and the total inventory. From 431 critical care medicine physician assistants invited, 135 (31.3%) responded to the survey. Severe burnout was seen on at least one subscale in 55.6%-10% showed evidence of severe burnout on the "exhaustion" subscale, 44% on the "depersonalization" subscale, and 26% on the "achievement" subscale. After multivariable adjustment, caring for fewer patients per shift (odds ratio [95% CI]: 0.17 [0.05-0.57] for 1-5 vs 6-10 patients; p = 0.004) and rarely providing futile care (0.26 [0.07-0.95] vs providing futile care often; p = 0.041) were independently associated with having less severe burnout on at least one subscale. Those caring for 1-5 patients per shift and those providing futile care rarely also had a lower depersonalization scores; job satisfaction was independently associated with having less exhaustion, less depersonalization, a greater sense of personal achievement, and a lower overall burnout score. Severe burnout is common in critical care medicine physician assistants. Higher patient-to-critical care medicine physician assistant ratios and provision of futile care are risk factors for severe burnout.

  5. Challenges of traction in critical care: a case study.

    Science.gov (United States)

    Harvey, C V

    1998-08-01

    Traction can sometimes seem like an overwhelming challenge in the critical care setting not only to the patient and family, but also to the nurse. Critical care nurses must know the principles, purposes, methods, and patient care considerations necessary to be able to provide appropriate care and teaching for the patient in traction. This article describes these principles and then illustrates them through a case study. The case describes a patient who experiences multiple trauma and focuses on the nurse's role in the care of this patient in traction.

  6. The impact of aging physiology in critical care.

    Science.gov (United States)

    Walker, Mandi; Spivak, Mark; Sebastian, Mary

    2014-03-01

    Aging physiology greatly impacts care delivery in the geriatric patient population. Consideration should be given to addressing the patient-specific needs regarding the systemic changes seen in the aging patient. Each major body system presents its own unique challenges to the critical care practitioner, and a comprehensive understanding of these changes is necessary to effectively care for this patient population. This article summarizes these changes and provides key points for the practitioner to consider when caring for the aging patient in the critical care arena. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Stroke: Critical appraissal of intensive care management ...

    African Journals Online (AJOL)

    Background: Stroke is a common medical condition in the medical units.Stroke patients are usually managed on the medical wards while some that needs organ support are admitted into the intensive care unit.However there is conflicting data on the benefits or otherwise of admitting stroke patients into the intensive care ...

  8. Critical care in Africa: A surgical intensivist perspective | Macleod ...

    African Journals Online (AJOL)

    Critical care services often fall far outside the focus of mainstream health care agendas. The disease specific list held by many health care stakeholders, including the funding agencies, results in a funneling of political attention and funds predominantly in those directions. Infectious diseases, in particular tuberculosis and ...

  9. ORIGINAL ARTICLES National audit of critical care resources in ...

    African Journals Online (AJOL)

    2007-11-30

    Nov 30, 2007 ... transportation increases morbidity, mortality and cost of care.5,6. The majority of hospitals in South Africa do not have intensive care facilities. As a result, critically ill patients are commonly transferred to hospitals that do have facilities. Patients who are in an intensive care unit (ICU) may also be transferred ...

  10. Oral hygiene care in critically ill patients | Human | Southern African ...

    African Journals Online (AJOL)

    Oral hygiene care includes a combination of nursing activities that are often placed very low on the priority care list for a critically ill patient. This may have detrimental implications for the patient. A literature review was done to identify and describe the available evidence related to the beneficial effects of oral hygiene care ...

  11. Year in review 2010: Critical Care - infection

    DEFF Research Database (Denmark)

    Pagani, Leonardo; Afshari, Arash; Harbarth, Stephan

    2011-01-01

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

  12. Sleep deprivation among critical care patients.

    Science.gov (United States)

    Fontana, Christine J; Pittiglio, Laura I

    2010-01-01

    To gain an understanding and increased knowledge regarding the presence and affects of ambient stressors on patients' sleep and the efficacy of implementing sleep promotion measures within the intensive care unit environment, the author reviewed 10 empirical studies. Research indicates that ambient stressors within the intensive care unit have detrimental effects on patients' sleep, and nursing interventions that focus on the abatement of ambient stressors enhance patients' sleep. In the intensive care unit, optimizing the environment to promote sleep requires the active removal of ambient stressors.

  13. Pediatric Critical Care Nursing Research Priorities-Initiating International Dialogue.

    Science.gov (United States)

    Tume, Lyvonne N; Coetzee, Minette; Dryden-Palmer, Karen; Hickey, Patricia A; Kinney, Sharon; Latour, Jos M; Pedreira, Mavilde L G; Sefton, Gerri R; Sorce, Lauren; Curley, Martha A Q

    2015-07-01

    To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice. One-day consensus conference. By using a conceptual framework by Benner et al describing domains of practice in critical care nursing, nine international nurse researchers presented state-of-the-art lectures. Each identified knowledge gaps in their assigned practice domain and then poised three research questions to fill that gap. Then, meeting participants prioritized the proposed research questions using an interactive multivoting process. Seventh World Congress on Pediatric Intensive and Critical Care in Istanbul, Turkey. Pediatric critical care nurses and nurse scientists attending the open consensus meeting. Systematic review, gap analysis, and interactive multivoting. The participants prioritized 27 nursing research questions in nine content domains. The top four research questions were 1) identifying nursing interventions that directly impact the child and family's experience during the withdrawal of life support, 2) evaluating the long-term psychosocial impact of a child's critical illness on family outcomes, 3) articulating core nursing competencies that prevent unstable situations from deteriorating into crises, and 4) describing the level of nursing education and experience in pediatric critical care that has a protective effect on the mortality and morbidity of critically ill children. The consensus meeting was effective in organizing pediatric critical care nursing knowledge, identifying knowledge gaps and in prioritizing nursing research initiatives that could be used to advance nursing science across world regions.

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

    Science.gov (United States)

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

    2016-06-01

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

  15. Feline hyperthyroidism reported in primary-care veterinary practices in England: prevalence, associated factors and spatial distribution.

    Science.gov (United States)

    Stephens, M J; O'Neill, D G; Church, D B; McGreevy, P D; Thomson, P C; Brodbelt, D C

    2014-11-08

    Feline hyperthyroidism is a commonly diagnosed endocrinopathy that can have a substantial deleterious impact on the welfare of affected cats. This study aimed to estimate the prevalence, associated factors and geographical distribution for feline hyperthyroidism in England, using primary-care veterinary practice clinical data from the VetCompass Animal Surveillance Project. Prevalence was estimated from the overall cat cohort. Associated factor analysis used an age-matched, nested, case-control design with multivariable logistic regression. There were 2,276 cases of feline hyperthyroidism identified from 95,629 cats attending 84 practices from September 2009 to December 2011. Cases were aged 6-25 years. 3.7 per cent of cases and 9.9 per cent of controls were purebred, 56.4 per cent of cases and 56.5 per cent of controls were female, and 88.1 per cent of cases and 86.0 per cent of controls were neutered. The apparent prevalence was 2.4 per cent (95% CI 2.3 to 2.5 per cent) overall, and 8.7 per cent (95% CI 8.3 to 9.0 per cent) in cats aged 10 years or above. Burmese (OR 0.15, 95% CI 0.07 to 0.32, Phyperthyroidism than non-purebred cats. Insured cats had increased odds (OR 1.78, 95% CI 1.56 to 2.03, Phyperthyroidism as a high-prevalence disease in England, and reports reduced odds of diagnosis in certain breeds and purebred cats overall. British Veterinary Association.

  16. Prevalence of onychectomy in cats presented for veterinary care near Raleigh, NC and educational attitudes toward the procedure.

    Science.gov (United States)

    Lockhart, Laura E; Motsinger-Reif, Alison A; Simpson, Wendy M; Posner, Lysa P

    2014-01-01

    The current prevalence of onychectomy (declawing) in cats is unknown, and education regarding the procedure appears to vary greatly among veterinary schools. The purpose of this project was to determine the prevalence of onychectomized cats near Raleigh, NC and to document the frequency and style (laboratory or lecture) with which the procedure is taught in USA veterinary schools. One thousand seven hundred ninety four cats ranging in age from 8 days to 21 years, of which 938 (52.3%) were female and 1719 (95.8%) were sterilized. Data were collected over a 10-week period regarding cats seen for appointments in five veterinary facilities (two cat-only, two general, and one tertiary). Data collection included signalment and onychectomy status. During this time, 28 veterinary schools were polled regarding education of veterinary students in onychectomy. Three hundred and seventy four (20.8%) cats had undergone onychectomy. A significantly higher percentage of declawed cats were seen in the general practices compared with the other practice types (p declawed. Less than 50% of veterinary schools in the USA include a mandatory lecture or laboratory to teach the procedure. There appears to be a discrepancy between the popularity of the onychectomy procedure and the emphasis placed on relevant instruction in veterinary schools in the USA. © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  17. The critical care work environment and nurse-reported health care-associated infections.

    Science.gov (United States)

    Kelly, Deena; Kutney-Lee, Ann; Lake, Eileen T; Aiken, Linda H

    2013-11-01

    Critically ill patients are susceptible to health care-associated infections because of their illnesses and the need for intravenous access and invasive monitoring. The critical care work environment may influence the likelihood of infection in these patients. To determine whether or not the critical care nurse work environment is predictive of nurse-reported health care-associated infections. A retrospective, cross-sectional design was used with linked nurse and hospital survey data. Nurses assessed the critical care work environment and provided the frequencies of ventilator-associated pneumonias, urinary tract infections, and infections associated with central catheters. Logistic regression models were used to determine if critical care work environments were predictive of nurse-reported frequent health care-associated infections, with controls for nurse and hospital characteristics. Results The final sample consisted of 3217 critical care nurses in 320 hospitals. Compared with nurses working in poor work environments, nurses working in better work environments were 36% to 41% less likely to report that health care-associated infections occurred frequently. Health care-associated infections are less likely in favorable critical care work environments. These findings, based on the largest sample of critical care nurses to date, substantiate efforts to focus on the quality of the work environment as a way to minimize the frequency of health care-associated infections.

  18. The iCritical Care Podcast: A Novel Medium for Critical Care Communication and Education

    Science.gov (United States)

    Savel, Richard H.; Goldstein, Evan B.; Perencevich, Eli N.; Angood, Peter B.

    2007-01-01

    Podcasting is a recent creation combining old and new technologies allowing rapid, inexpensive delivery of media content (primarily audio) to the end user, both via the desktop environment and personal media players. The authors’ group (the Society of Critical Care Medicine) saw the educational and communication potential for the podcasting concept, and have successfully designed and implemented the first podcast of a national medical society. As of this writing, there are an average of (mean ± SD) 664 ± 290 total downloads per podcast, and their podcast feed has been hit over 68,000 times in its first seven months. In this manuscript, the authors provide documentation of their successful endeavor, as well as a structured framework for other organizations to create similar products. PMID:17068348

  19. Critical care: Are we customer friendly?

    Science.gov (United States)

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

    2015-09-01

    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.

  20. Southern African Journal of Critical Care: Submissions

    African Journals Online (AJOL)

    Authorship should be based on: (i) substantial contribution to conceptualisation, design, analysis and interpretation of data; (ii) drafting or critical revision of important scientific ... If authors' names are added or deleted after submission of an article, or the order of the names is changed, all authors must agree to this in writing.

  1. Critical care ultrasonography in circulatory shock

    NARCIS (Netherlands)

    Koster, Geert; van der Horst, Iwan C. C.

    Purpose of review The objective was to define the role of ultrasound in the diagnosis and the management of circulatory shock by critical appraisal of the literature.Recent findings Assessment of any patient's hemodynamic profile based on clinical examination can be sufficient in several cases, but

  2. practice gap in critical care nursing students

    African Journals Online (AJOL)

    2012-04-13

    Apr 13, 2012 ... and narrative descriptions were also used as means to collect data. Themes that emerged ... critical analysis of feelings and changed perspective experienced. .... to a guide the process of guided reflection as a semi- ..... from experience', Journal of Humanisfic Psychology 23(2), 99–117. http://dx.doi.

  3. Ethical problems in pediatric critical care: consent.

    Science.gov (United States)

    Zawistowski, Christine A; Frader, Joel E

    2003-05-01

    Informed consent constitutes one of the important considerations included in the myriad ethical dilemmas in the pediatric intensive care unit. Traditionally, the law has viewed children as incompetent to make medical decisions, and society has authorized parents or guardians to act on behalf of children. Empirical evidence has revealed that children may be more capable of participating in their medical decisions than previously thought. Some scholars now think that parents have the right to give informed permission and that professionals should seek the child's assent in many circumstances. Physicians in the intensive care unit should seriously consider consulting adolescent patients about the direction of their care and may wish to seek the input of younger patients in appropriate circumstances.

  4. Identifying the key predictors for retention in critical care nurses.

    Science.gov (United States)

    Sawatzky, Jo-Ann V; Enns, Carol L; Legare, Carol

    2015-10-01

    The aim of this study was to explore the key predictors of retention in nurses working in critical care areas. The shortage of critical care nurses is reaching crisis proportions in Canada and throughout the industrialized world. Identifying the key influencing (i.e. person and organizational) factors and intermediary factors (i.e. job satisfaction, engagement, professional quality of life and caring) that affect intent to leave is central to developing optimal retention strategies for critical care nurses. As part of a larger mixed-methods study, we used a quantitative, cross-sectional research design. A novel framework: the Conceptual Framework for Predicting Nurse Retention was used to guide this study. On-line survey data were collected from on a convenience sample of 188 registered nurses working in critical care areas of hospitals in the province of Manitoba, CANADA in 2011. Twenty-four per cent of the respondents reported that they would probably/definitely leave critical care in the next year. Based on bivariate and regression analyses, the key influencing factors that were significantly related to the intermediary factors and intent to leave critical care and nursing included: professional practice, management, physician/nurse collaboration, nurse competence, control/responsibility and autonomy. Of the intermediary factors, all but compassion satisfaction were related to intent to leave both critical care and nursing. This study highlights the importance of exploring multiple organizational and intermediary factors to determine strategies to retain critical care nurses. The findings also support the Conceptual Framework for Predicting Nurse Retention as a theoretical basis for further research. © 2015 John Wiley & Sons Ltd.

  5. Critical care nursing in acute postoperative neurosurgical patients.

    Science.gov (United States)

    Brooks, Christin

    2015-03-01

    The nursing discipline is vital throughout patients' hospital progression. One of the most critical moments in the hospital stay is the postoperative period. Neurosurgical patients require a high level of nursing care and vigilance and additional postoperative monitoring in intensive care units designed specifically for this demographic. In the postoperative setting, patient care must be transferred from anesthesia to nursing in a manner that is continuous and safe. This article focuses on neurosurgical patients in the postoperative period, the assessment of these patients, and critical care nursing, with emphasis on common issues and interventions for this dynamic patient population. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. [Technology and humanization in critical care environments].

    Science.gov (United States)

    Marques, Isaac Rosa; Souza, Agnaldo Rodrigues de

    2010-01-01

    Because of the advances made with the industrial revolution through technological discoveries in machinery, professional-patient relationship has become increasingly automated, leaving the humanization in the background. The purpose of this paper was to reflect about the humanization process in intensive environments and its relation with the technology insertion. Technology contributes as an effective way to treat patients who require extreme care. However, if it is associated with humanization can achieves satisfactory results, improving the host of customer who receives the care provided by technology.

  7. Impact of the introduction of a specialist critical care pharmacist on the level of pharmaceutical care provided to the critical care unit

    OpenAIRE

    Richter, A.; Bates, I.; Thacker, M; Jani, Y.; O'Farrell, B; Edwards, C; Taylor, H; Schulman, R

    2016-01-01

    Objectives To evaluate the impact of a dedicated specialist critical care pharmacist service on patient care at a UK critical care unit (CCU). Methods Pharmacist intervention data was collected in two phases. Phase 1 was with the provision of a non-specialist pharmacist chart review service and Phase 2 was after the introduction of a specialist dedicated pharmacy service. Two CCUs with established critical care pharmacist services were used as controls. The impact of pharmacist interventions ...

  8. Legal considerations during pediatric emergency mass critical care events.

    Science.gov (United States)

    Courtney, Brooke; Hodge, James G

    2011-11-01

    Recent public health emergencies, such as the 2009 Influenza A/H1N1 Pandemic and Hurricane Katrina, underscore the importance of developing healthcare response plans and protocols for disasters impacting large populations. Significant research and scholarship, including the 2009 Institute of Medicine report on crisis standards of care and the 2008 Task Force for Mass Critical Care recommendations, provide guidance for healthcare responses to catastrophic emergencies. Most of these efforts recognize but do not focus on the unique needs of pediatric populations. In 2008, the Centers for Disease Control and Prevention supported the formation of a task force to address pediatric emergency mass critical care response issues, including legal issues. Liability is a significant concern for healthcare practitioners and facilities during pediatric emergency mass critical care that necessitates a shift to crisis standards of care. This article describes the legal considerations inherent in planning for and responding to catastrophic health emergencies and makes recommendations for pediatric emergency mass critical care legal preparedness. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010, to review the pediatric emergency mass critical care recommendations developed by a 17-member steering committee. During the meeting, experts determined that the recommendations would be strengthened by a manuscript addressing legal issues. Authors drafted the manuscript through consensus-based study of peer-reviewed research, literature reviews, and expert opinion. The manuscript was reviewed by Pediatric Emergency Mass Critical Care Steering Committee members and additional legal counsel and revised. While the legal issues associated with providing pediatric emergency mass critical care are not unique within the overall context of disaster healthcare

  9. Oral hygiene care in critically ill patients

    African Journals Online (AJOL)

    2007-11-19

    Nov 19, 2007 ... Often mouthwash and foam swabs rather than toothbrushes are available, or the toothbrushes provided are of poor quality, large, and not readily accessible.5. Communication barriers are related to both to language and treatment. Practice experience shows that the care activities related to oral hygiene ...

  10. Physiotherapy in Critical Care in Australia

    OpenAIRE

    Berney, Susan; Haines, Kimberley; Denehy, Linda

    2012-01-01

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

  11. Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end-of-life care.

    Science.gov (United States)

    Ramasamy Venkatasalu, Munikumar; Whiting, Dean; Cairnduff, Karen

    2015-09-01

    To explore the experiences, challenges and practices of critical care practitioners since the discontinuation of the Liverpool Care Pathway in critical care settings. The Liverpool Care Pathway was widely used with an aim to improve communication and care for dying individuals and their relatives. However, widespread media criticism prompted a review, which resulted in the discontinuation of the Liverpool Care Pathway across all UK clinical settings. A qualitative study. The study was carried out in two large acute hospitals in England. Semi-structured interviews were conducted with 14 critical care practitioners, 6 months after discontinuation of the Liverpool Care Pathway. Transcribed verbatim data were analysed using framework analysis. Three key themes emerged: 'lessons learned', 'uncertainties and ambivalences' and 'the future'. Critical care practitioners reported that life after the Liverpool Care Pathway in critical care settings often involved various clinical ambivalences, uncertainties and inconsistencies in the delivery of end-of-life care, especially for less experienced practitioners. Critical care practitioners had 'become accustomed' to the components of the Liverpool Care Pathway, which still guide them in principle to ensure quality end-of-life care. The Liverpool Care Pathway's structured format was perceived to be a useful clinical tool, but was also criticized as a 'tick-box exercise' and for lacking in family involvement. This study posits two key conclusions. Despite experienced critical care practitioners being able to deliver quality end-of-life care without using the Liverpool Care Pathway, junior nursing and medical staff need clear guidelines and support from experienced mentors in practice. Evidence-based guidelines related to family involvement in end-of-life care planning in critical care settings are also needed to avoid future controversies. © 2015 John Wiley & Sons Ltd.

  12. [Current role of albumin in critical care].

    Science.gov (United States)

    Aguirre Puig, P; Orallo Morán, M A; Pereira Matalobos, D; Prieto Requeijo, P

    2014-11-01

    The use of colloids in fluid therapy has been, and still continues to be a controversial topic, particularly when referring to the critical patient. The choice of the fluid that needs to be administered depends on several factors, many of which are theoretical, and continue being an object of debate. The interest in the clinical use of the albumin has emerged again, immediately after recent publications in the search of the most suitable colloid. It is the most abundant protein in the plasma, being responsible for 80% of the oncotic pressure. It regulates the balance between the intra- and extra-vascular volumes. Recent multicenter studies question the supposed lack of safety that was previously assigned to it. Furthermore, in vitro studies demonstrate other important actions besides oncotic, for example neutralization of free radicals, and exogenous (drugs) and endogenous substances (bile pigments, cholesterol). Being aware of these secondary properties of albumin, and evaluating the pathophysiology of the critical patient (in particular, sepsis), to maintain plasma albumin levels within the normal range, could be of great importance. Based on the most recent publications, the aim of this review is to briefly analyze the pathophysiology of albumin, as well as to discuss its possible indications in the critical patient. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Critical care: how should we evaluate our progress?

    Science.gov (United States)

    Civetta, J M

    1992-12-01

    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

  14. Developing a Business Plan for Critical Care Pharmacy Services.

    Science.gov (United States)

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

    2016-11-01

    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.

  15. Major publications in the critical care pharmacotherapy literature in 2015.

    Science.gov (United States)

    Wong, Adrian; Erdman, Michael; Hammond, Drayton A; Holt, Tara; Holzhausen, Jenna M; Horng, Michelle; Huang, Lori Lynn; Jarvis, Jennifer; Kram, Bridgette; Kram, Shawn; Lesch, Christine; Mercer, Jessica; Rech, Megan A; Rivosecchi, Ryan; Stump, Brian; Teevan, Colleen; Day, Sarah

    2017-03-01

    Recently published practice guidelines and research reports on pharmacotherapy in critical care patient populations are summarized. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group is composed of over 50 experienced critical care pharmacists who evaluate 31 peer-reviewed journals monthly to identify literature pertaining to pharmacotherapy in critical care populations. Articles are chosen for summarization in a monthly CCPLU Group publication on the basis of applicability and relevance to clinical practice and strength of study design. From January to December 2015, a total of 121 articles were summarized; of these, 3 articles presenting clinical practice guidelines and 12 articles presenting original research findings were objectively selected for inclusion in this review based on their potential to change or reinforce current evidence-based practice. The reviewed guidelines address the management of intracranial hemorrhage (ICH), adult advanced cardiac life support (ACLS) and post-cardiac arrest care, and the management of supraventricular tachycardia (SVT). The reviewed research reports address topics such as nutrition in critically ill adults, administration of β-lactams for severe sepsis, anticoagulant selection in the context of continuous renal replacement therapy, early goal-directed therapy in septic shock, magnesium use for neuroprotection in acute stroke, and progesterone use in patients with traumatic brain injury. Important recent additions to the critical care pharmacy literature include updated joint clinical practice guidelines on the management of spontaneous ICH, ACLS, and SVT. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  16. March 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Stander P

    2013-04-01

    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: http://livingwithmcl.com/BitterPill.pdf (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 …

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

    Science.gov (United States)

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

    2016-07-01

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

  18. Obstetric critical care services in South Africa | Buga | South African ...

    African Journals Online (AJOL)

    More than half of all global maternal deaths occur in Africa. A large percentage of these deaths are preventable, and lack of access to adequate critical care facilities is a contributing factor. There are limited published data on the clinical and management challenges presented by the critically ill obstetric patient admitted to ...

  19. Supplies and equipment for pediatric emergency mass critical care

    Science.gov (United States)

    Bohn, Desmond; Kanter, Robert K.; Burns, Jeffrey; Barfield, Wanda D.; Kissoon, Niranjan

    2015-01-01

    Introduction Epidemics of acute respiratory disease, such as severe acute respiratory syndrome in 2003, and natural disasters, such as Hurricane Katrina in 2005, have prompted planning in hospitals that offer adult critical care to increase their capacity and equipment inventory for responding to a major demand surge. However, planning at a national, state, or local level to address the particular medical resource needs of children for mass critical care has yet to occur in any coordinated way. This paper presents the consensus opinion of the Task Force regarding supplies and equipment that would be required during a pediatric mass critical care crisis. Methods In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations. Steering Committee members established subcommittees by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6 –7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29 –30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature. Task Force

  20. Designing a Resilience Program for Critical Care Nurses.

    Science.gov (United States)

    Mealer, Meredith; Hodapp, Rachel; Conrad, David; Dimidjian, Sona; Rothbaum, Barbara O; Moss, Marc

    2017-01-01

    Workplace stress can affect job satisfaction, increase staff turnover and hospital costs, and reduce quality of patient care. Highly resilient nurses adapt to stress and use a variety of skills to cope effectively. To gain data on a mindfulness-based cognitive therapy resilience intervention for intensive care unit nurses to see if the intervention program would be feasible and acceptable. Focus-group interviews were conducted by videoconference with critical care nurses who were members of the American Association of Critical-Care Nurses. The interview questions assessed the feasibility and acceptability of a mindfulness-based cognitive therapy program to reduce burnout syndrome in intensive care unit nurses. Thirty-three nurses participated in 11 focus groups. Respondents identified potential barriers to program adherence, incentives for adherence, preferred qualifications of instructors, and intensive care unit-specific issues to be addressed. The mindfulness-based cognitive therapy pilot intervention was modified to incorporate thematic categories that the focus groups reported as relevant to intensive care unit nurses. Institutions that wish to design a resilience program for intensive care unit nurses to reduce burnout syndrome need an understanding of the barriers and concerns relevant to their local intensive care unit nurses. ©2017 American Association of Critical-Care Nurses.

  1. Prevalence of disorders recorded in dogs attending primary-care veterinary practices in England.

    Science.gov (United States)

    O Neill, Dan G; Church, David B; McGreevy, Paul D; Thomson, Peter C; Brodbelt, Dave C

    2014-01-01

    Purebred dog health is thought to be compromised by an increasing occurence of inherited diseases but inadequate prevalence data on common disorders have hampered efforts to prioritise health reforms. Analysis of primary veterinary practice clinical data has been proposed for reliable estimation of disorder prevalence in dogs. Electronic patient record (EPR) data were collected on 148,741 dogs attending 93 clinics across central and south-eastern England. Analysis in detail of a random sample of EPRs relating to 3,884 dogs from 89 clinics identified the most frequently recorded disorders as otitis externa (prevalence 10.2%, 95% CI: 9.1-11.3), periodontal disease (9.3%, 95% CI: 8.3-10.3) and anal sac impaction (7.1%, 95% CI: 6.1-8.1). Using syndromic classification, the most prevalent body location affected was the head-and-neck (32.8%, 95% CI: 30.7-34.9), the most prevalent organ system affected was the integument (36.3%, 95% CI: 33.9-38.6) and the most prevalent pathophysiologic process diagnosed was inflammation (32.1%, 95% CI: 29.8-34.3). Among the twenty most-frequently recorded disorders, purebred dogs had a significantly higher prevalence compared with crossbreds for three: otitis externa (P = 0.001), obesity (P = 0.006) and skin mass lesion (P = 0.033), and popular breeds differed significantly from each other in their prevalence for five: periodontal disease (P = 0.002), overgrown nails (P = 0.004), degenerative joint disease (P = 0.005), obesity (P = 0.001) and lipoma (P = 0.003). These results fill a crucial data gap in disorder prevalence information and assist with disorder prioritisation. The results suggest that, for maximal impact, breeding reforms should target commonly-diagnosed complex disorders that are amenable to genetic improvement and should place special focus on at-risk breeds. Future studies evaluating disorder severity and duration will augment the usefulness of the disorder prevalence information reported

  2. Prevalence of disorders recorded in dogs attending primary-care veterinary practices in England.

    Directory of Open Access Journals (Sweden)

    Dan G O Neill

    Full Text Available Purebred dog health is thought to be compromised by an increasing occurence of inherited diseases but inadequate prevalence data on common disorders have hampered efforts to prioritise health reforms. Analysis of primary veterinary practice clinical data has been proposed for reliable estimation of disorder prevalence in dogs. Electronic patient record (EPR data were collected on 148,741 dogs attending 93 clinics across central and south-eastern England. Analysis in detail of a random sample of EPRs relating to 3,884 dogs from 89 clinics identified the most frequently recorded disorders as otitis externa (prevalence 10.2%, 95% CI: 9.1-11.3, periodontal disease (9.3%, 95% CI: 8.3-10.3 and anal sac impaction (7.1%, 95% CI: 6.1-8.1. Using syndromic classification, the most prevalent body location affected was the head-and-neck (32.8%, 95% CI: 30.7-34.9, the most prevalent organ system affected was the integument (36.3%, 95% CI: 33.9-38.6 and the most prevalent pathophysiologic process diagnosed was inflammation (32.1%, 95% CI: 29.8-34.3. Among the twenty most-frequently recorded disorders, purebred dogs had a significantly higher prevalence compared with crossbreds for three: otitis externa (P = 0.001, obesity (P = 0.006 and skin mass lesion (P = 0.033, and popular breeds differed significantly from each other in their prevalence for five: periodontal disease (P = 0.002, overgrown nails (P = 0.004, degenerative joint disease (P = 0.005, obesity (P = 0.001 and lipoma (P = 0.003. These results fill a crucial data gap in disorder prevalence information and assist with disorder prioritisation. The results suggest that, for maximal impact, breeding reforms should target commonly-diagnosed complex disorders that are amenable to genetic improvement and should place special focus on at-risk breeds. Future studies evaluating disorder severity and duration will augment the usefulness of the disorder prevalence information

  3. Critical care nursing practice and education in Rwanda

    African Journals Online (AJOL)

    Intensive care units are found predominantly in the state tertiary hospitals, located primarily in Kigali city. The purpose of ... article is to describe the current state of critical care nursing in Rwanda, including challenges and opportunities faced by these nurses, as well ..... Epidemiology, Outcomes, and Prognostication for ICU.

  4. Oral hygiene care in critically ill patients | Human | Southern African ...

    African Journals Online (AJOL)

    A discussion of the available research evidence to guide oral hygiene care activities includes aspects of timing as well as recommended 'tools'. While some nursing-led research has been published on this topic, there is scope for further investigation into oral hygiene care practices in the critically ill. Southern African ...

  5. Basic Shock Physiology and Critical Care.

    Science.gov (United States)

    Roberts, Brian K

    2016-05-01

    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.

  6. Global veterinary leadership.

    Science.gov (United States)

    Wagner, G Gale; Brown, Corrie C

    2002-11-01

    The public needs no reminder that deadly infectious diseases such as FMD could emerge in any country at any moment, or that national food security could be compromised by Salmonella or Listeria infections. Protections against these risks include the knowledge that appropriate and equivalent veterinary education will enable detection and characterization of emerging disease agents, as well as an appropriate response, wherever they occur. Global veterinary leadership is needed to reduce the global threat of infectious diseases of major food animal and public health importance. We believe that the co-curriculum is an excellent way to prepare and train veterinarians and future leaders who understand and can deal with global issues. The key to the success of the program is the veterinarian's understanding that there is a cultural basis to the practice of veterinary medicine in any country. The result will be a cadre of veterinarians, faculty, and other professionals who are better able (language and culture) to understand the effects of change brought about by free trade and the importance of interdisciplinary and institutional relationships to deal effectively with national and regional issues of food safety and security. New global veterinary leadership programs will build on interests, experience, ideas, and ambitions. A college that wishes to take advantage of this diversity must offer opportunities that interest veterinarians throughout their careers and that preferably connect academic study with intensive experiential training in another country. At its best, the global veterinary leadership program would include a partnership between veterinarians and several international learning centers, a responsiveness to the identified international outreach needs of the profession, and attention to critical thinking and reflection. The global veterinary leadership program we have described is intended to be a set of ideas meant to promote collaboration, coalitions, and

  7. Factors Influencing Active Family Engagement in Care Among Critical Care Nurses.

    Science.gov (United States)

    Hetland, Breanna; Hickman, Ronald; McAndrew, Natalie; Daly, Barbara

    2017-01-01

    Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing work-flow partially mediated the relationships between the intensive care unit environment and nurses' attitudes and between patient acuity and nurses' attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit. ©2017 American Association of Critical-Care Nurses.

  8. May 2016 Phoenix critical care journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-06-01

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

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

    OpenAIRE

    Shiau, Shu-Jen; Chen, Chung-Hey

    2008-01-01

    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 conc...

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

    Science.gov (United States)

    Dellefield, Mary Ellen

    2006-01-01

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

  11. From bronchiolitis guideline to practice: A critical care perspective

    Science.gov (United States)

    Lin, James A; Madikians, Andranik

    2015-01-01

    Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance. PMID:26261767

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

    Directory of Open Access Journals (Sweden)

    Yvette Nagel

    2016-02-01

    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

    2015-01-01

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

  14. Compartment syndrome: pathophysiology, clinical presentations, treatment, and prevention in human and veterinary medicine.

    Science.gov (United States)

    Nielsen, Lindsey K; Whelan, Megan

    2012-06-01

    To review the human and veterinary literature pertaining to all forms of compartment syndrome (CS). Data sources included scientific reviews and original research publications from the human and veterinary literature. While CS affecting the extremities has been recognized in people for decades, other forms of CS in the abdominal and thoracic cavities are recently gaining more attention. The role of CS in critically ill people is a rapidly growing area of interest. More research on prevention and treatment of CS is being conducted in people because some studies have found mortality rates as high as 80% for those suffering from these conditions. While a significant amount of experimental studies of CS have been performed on small animals, there is a marked lack of primary veterinary studies. The majority of the veterinary literature includes case reports and series, and many of these studies were published over a decade ago. However, the increased recognition of CS in people has sparked an interest in veterinary critical care medicine and this has been demonstrated by the recent increased evaluation of compartment pressures in veterinary patients. CS is a complex clinical condition where increased pressure within a compartment can cause significant adverse effects within the compartment as well as throughout the body. Systemic inflammatory responses and local ischemia-reperfusion elements can contribute to the detrimental effects seen in CS. This cascade of events results in increased mortality rates and contributes to the development of CS elsewhere. A better understanding of CS will help veterinarians improve patient care and outcome. Future studies on incidence, prevention, and treatment of CSs in the critical care patient are needed in veterinary medicine. © Veterinary Emergency and Critical Care Society 2012.

  15. New media and critical care ultrasound

    Directory of Open Access Journals (Sweden)

    Michał Pawlak

    2014-12-01

    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.

  16. Bolstering medical education to enhance critical care capacity in Cambodia.

    Science.gov (United States)

    Albert, Tyler J; Fassier, Thomas; Chhuoy, Meng; Bounchan, Youttiroung; Tan, Sokhak; Ku, No; Chhor, Nareth; LoGerfo, James P; West, T Eoin

    2015-04-01

    The capacity to care for the critically ill has long been viewed as a fundamental element of established and comprehensive health care systems. Extending this capacity to health care systems in low- and middle-income countries is important given the burden of disease in these regions and the significance of critical care in overall health system strengthening. However, many practicalities of improving access and delivery of critical care in resource-limited settings have yet to be elucidated. We have initiated a program to build capacity for the care of critically ill patients in one low-income Southeast Asian country, Cambodia. We are leveraging existing international academic partnerships to enhance postgraduate critical care education in Cambodia. After conducting a needs assessment and literature review, we developed a three-step initiative targeting training in mechanical ventilation. First, we assessed and revised the current resident curriculum pertaining to mechanical ventilation. We addressed gaps in training, incorporated specific goals and learning objectives, and decreased the hours of lectures in favor of additional bedside training. Second, we are incorporating e-learning, e-teaching, and e-assessment into the curriculum, with both live, interactive and independent, self-paced online instruction. Third, we are developing a train-the-trainer program defined by bidirectional international faculty exchanges to provide hands-on, case-based, and bedside training to achieve competency-based outcomes. In targeting specific educational needs and a key population-the next generation of Cambodian intensivists-this carefully designed approach should address some existing gaps in the health care system and hopefully yield a lasting impact.

  17. January 2014 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2014-02-01

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

  18. September 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2012-10-01

    Full Text Available No abstract available. Article truncated at 150 words. We had a great group of attending discussants at this Journal Club – thanks to all who participated including Drs. Jay Blum, Al Thomas, Clement Singarajah, Rick Robbins, Tom Bajo, Huw Owen Reece, and Roxanne Garcia Orr. Winters B, Custer J, Galvagno SM Jr, et al. Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf 2012 Jul 24. [Epub ahead of print]The authors reviewed 45 years of autopsy studies of ICU patients to determine the most common missed diagnoses. Thirty-one studies including 5863 autopsies were included. Eight percent revealed a missed diagnosis with an adverse impact survival that would likely have changed therapy. More than 80% of these were vascular events (such as pulmonary embolism or acute myocardial infarction and infections. Strangely, the authors detail all diagnostic categories except infection – this seems to have been an oversight error on their part. The authors …

  19. Current nursing practice of point-of-care laboratory diagnostic testing in critical care units.

    Science.gov (United States)

    Lamb, L S; Parrish, R S; Goran, S F; Biel, M H

    1995-11-01

    The development of user-friendly laboratory analyzers, combined with the need for rapid assessment of critically ill patients, has led to the performance of in vitro diagnostic testing at the point of care by personnel without formal laboratory training. To determine the range of laboratory testing performed by critical care nurses and their attitudes toward this role. A survey of critical care nursing consultants was conducted, using a modified Likert scale, to assess objective measures of point-of-care testing practice in critical care units and to determine nurses' attitudes toward the practice of point-of-care testing. Statistical analysis was performed to determine significant trends in responses. Of the units responding to the survey, 35% used critical care nurses exclusively to perform point-of-care testing, 32.5% used laboratory technicians and critical care nurses, and 25% used other personnel. Of critical care nurses performing laboratory testing, 95.5% performed blood glucose analysis; 18.7%, arterial blood gas analysis; 4.5%, electrolyte analysis; 4.5%, hematology profiles; and 22.7%, other testing. Most agreed that stat tests were not reported promptly, thereby necessitating bedside testing. Respondents indicated that they would prefer that laboratory personnel operate in vitro diagnostic equipment and that requirements for critical care nurses to perform laboratory testing detracted from other patient care duties. Most nurses who perform point-of-care testing responded that it was necessary and helpful in patient management. However, they would prefer, because of their other patient care responsibilities, that laboratory personnel take this responsibility.

  20. Exploring critical thinking in critical care nursing education: a pilot study.

    Science.gov (United States)

    Rogal, Sonya M; Young, Jeanne

    2008-01-01

    Critical care nurses process vast amounts of information and require well developed critical-thinking skills to make clinical decisions. Using a pretest posttest design, the critical-thinking skills of 31 postgraduate nurses were evaluated using the California Critical Thinking Skills Test (CCTST). For the total group, mean critical-thinking scores improved slightly over time. The CCTST revealed a mean pretest score of 18.5 and a mean posttest score of 19.7, both of which were higher than the established norms for the test. Overall, no significant difference was observed between pretest and posttest. However, statistical significance was observed posttest for nurses whose critical-thinking scores improved (p nurses improved their critical-thinking skills during the course of their study.

  1. Critical care providers' opinion on unsafe abortion in Argentina.

    Science.gov (United States)

    Vasquez, Daniela N; Das Neves, Andrea V; Golubicki, José L; Di Marco, Ingrid; Loudet, Cecilia I; Roberti, Javier E; Palacios-Jaraquemada, Jose; Basualdo, Natalia; Varaglia, Ruben; Vidal, Laura

    2012-03-01

    To survey the opinion of critical care providers in Argentina about abortion. An anonymous questionnaire was distributed to critical care providers attending the 20th National Critical Care Conference in Argentina. 149 of 1800 attendees completed the questionnaire, 69 (46.3%) of whom were members of the Argentine Society of Critical Care (ASCC). 122 (81.9%) supported abortion decriminalization in situations excluded from the current law; 142 (95.3%) in cases of congenital defects; 133 (89.3%) in cases of rape; 115 (77.2%) when women's mental health is at risk; 71 (47.7%) when pregnancy is unintended; and 61 (40.9%) for economic reasons. 126 (84.6%) supported abortion in public and private institutions, and 121 (81.2%) before 12 weeks of pregnancy. Variables independently associated with abortion support among female versus male attendees were abortion to preserve women's mental health (OR 4.47; 95% CI, 1.61-12.42; P=0.004) and abortion before 12 weeks of pregnancy (OR 3.93; 95% CI, 1.29-11.94; P=0.015). Abortion at request was independently associated with ASCC membership (OR 2.63; 95% CI, 1.07-6.45; P=0.034). Critical care providers would support abortion in situations excluded from the current abortion law and before 12 weeks of pregnancy, in both public and private hospitals. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Graduating Surgical Residents Lack Competence in Critical Care Ultrasound.

    Science.gov (United States)

    Tripu, Renuka; Lauerman, Margaret H; Haase, Daniel; Fatima, Syeda; Glaser, Jacob; Cardarelli, Cassandra; Scalea, Thomas M; Murthi, Sarah

    2017-10-13

    Ultrasound provides accessible imaging for bedside diagnostics and procedural guidance, but may lead to misdiagnosis in untrained users. The main objective of this study was to determine observed and self-perceived competence with critical care ultrasound in graduated general surgery residents. The design of this study was a retrospective review. Ultrasound training program records were reviewed for number of prior ultrasound examinations performed, self-perceived competence, observed competence on faculty examinations, and intended future use of individual critical care ultrasound examinations. This study was undertaken at the R Adams Cowley Shock Trauma Center, which is a tertiary care center in Baltimore, MD. Graduated general surgery residents were identified at the beginning of their surgical critical care fellowship at our institution, and were included if they participated in our critical care ultrasound education program. Fifteen graduated general surgery residents were included. Prior ultrasound experience ranged from 100% for focused assessment of sonography for trauma (FAST) to 13.3% for advanced cardiac assessment. Self-perceived competence ranged from 46.7% with FAST to 0% for advanced cardiac assessment. Observed competence ranged from 20.0% for FAST examinations to 0% for basic cardiac assessment, advanced cardiac assessment, and inferior vena cava (IVC) assessment. All participants intended to use ultrasound in the future for FAST, pneumothorax detection and basic cardiac assessment, and 86.7% for IVC assessment and advanced cardiac assessment. Of participants with self-perceived competence, 28.6% had observed competence with FAST, 0% with IVC assessment, and 100% with pneumothorax detection. Graduated general surgery residents are not competent in multiple critical care ultrasound examinations despite universally planning to use critical care ultrasound in future practice. Current exposure to ultrasound in residency may give a false sense of

  3. Competence in intensive and critical care nursing: a literature review.

    Science.gov (United States)

    Aäri, Riitta-Liisa; Tarja, Suominen; Helena, Leino-Kilpi

    2008-04-01

    This literature review defines and describes the concept of competence in adult intensive care nursing, with special reference to clinical and professional competence. The aim was to see whether and how the studies reviewed defined or described the concept of competence, and which domains of competence have been investigated in intensive and critical care nursing research. The review focuses on empirical studies retrieved from the COCHRANE and MEDLINE (1994-2005) databases. The final analysis comprised 45 studies. The studies were analysed by inductive content analysis. Very few (n=7) of the studies offered any definitions or descriptions of the concept of competence. Clinical and professional competence in intensive and critical care nursing can be defined as a specific knowledge base, skill base, attitude and value base and experience base of intensive and critical care nursing. Clinical competence can be divided into three and professional competence into four constituent domains. In clinical competence, these are the principles of nursing care; clinical guidelines; and nursing interventions. In professional competence, the domains are ethical activity; decision-making; development work; and collaboration. More empirical research is needed to examine competence in intensive and critical care nursing.

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

    Science.gov (United States)

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

    2016-07-01

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

  5. Critical thinking in respiratory care practice: a qualitative research study.

    Science.gov (United States)

    Mishoe, Shelley C

    2003-05-01

    Recent publications indicate that critical thinking should be an integral part of respiratory care education. However, we know very little about critical thinking in the context of respiratory care. The critical thinking abilities and decision-making characteristics of practicing respiratory therapists have not been studied. Identify and describe the critical thinking skills and traits of respiratory therapists, using a qualitative, descriptive research methodology. Critical thinking was defined as the combination of logical reasoning, problem-solving, and reflection. The sample was selected through nominations of experts, using reputational-case selection. The research involved observations of 18 registered respiratory therapists, followed by in-depth interviews. Data were collected over a 1-year period and there were 125 hours of observation and 36 hours of interview. The observations were the basis for identifying and describing context-bound situations that require critical thinking, as well as the essential skills and related traits. The data set consists of over 600 single-spaced pages of interview transcripts and participant-observation field notes, in addition to 36 audio tapes. Field notes and interview transcripts were continuously analyzed throughout the study, using the constant-comparative method described by Glaser and Strauss. The findings suggest that critical thinking in respiratory care practice involves the abilities to prioritize, anticipate, troubleshoot, communicate, negotiate, reflect, and make decisions.

  6. Critical Thinking in Critical Care: Five Strategies to Improve Teaching and Learning in the Intensive Care Unit.

    Science.gov (United States)

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

    2017-04-01

    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.

  7. Measuring the level of agreement between a veterinary and a human point-of-care glucometer and a laboratory blood analyzer in Hispaniolan Amazon parrots (Amazona ventralis).

    Science.gov (United States)

    Acierno, Mark J; Schnellbacher, Rodney; Tully, Thomas N

    2012-12-01

    Although abnormalities in blood glucose concentrations in avian species are not as common as they are in mammals, the inability to provide point-of-care glucose measurement likely results in underreporting and missed treatment opportunities. A veterinary glucometer that uses different optimization codes for specific groups of animals has been produced. To obtain data for a psittacine bird-specific optimization code, as well as to calculate agreement between the veterinary glucometer, a standard human glucometer, and a laboratory analyzer, blood samples were obtained from 25 Hispaniolan Amazon parrots (Amazona ventralis) in a 2-phase study. In the initial phase, blood samples were obtained from 20 parrots twice at a 2-week interval. For each sample, the packed cell volume was determined, and the blood glucose concentration was measured by the veterinary glucometer. The rest of each sample was placed into a lithium heparin microtainer tube and centrifuged, and plasma was removed and frozen at -30 degrees C. Within 5 days, tubes were thawed, and blood glucose concentrations were measured with a laboratory analyzer. The data from both procedures were used to develop a psittacine bird-specific code. For the second phase of the study, the same procedure was repeated twice at a 2-week interval in 25 birds to determine agreement between the veterinary glucometer, a standard human glucometer, and a laboratory analyzer. Neither glucometer was in good agreement with the laboratory analyzer (veterinary glucometer bias, 9.0; level of agreement, -38.1 to 56.2; standard glucometer bias, 69.4; level of agreement -17.8 to 156.7). Based on these results, the use of handheld glucometers in the diagnostic testing of Hispaniolan Amazon parrots and other psittacine birds cannot be recommended.

  8. Development of the Critical Care Pharmacotherapy Trials Network.

    Science.gov (United States)

    Bauer, Seth R; Abraham, Prasad E; Barletta, Jeffrey F; Brophy, Gretchen M; Erstad, Brian L; Gonzales, Jeffrey P; Haas, Curtis E; MacLaren, Robert; Mueller, Eric W; Olsen, Keith M; Lat, Ishaq

    2017-03-01

    The development of the Critical Care Pharmacotherapy Trials Network (CCPTN) as a model for practice-based pharmacotherapy research is described. The CCPTN was formed in 2010 as a collaborative research network dedicated to scientific investigation in the field of critical care pharmacotherapy. The CCPTN organizational structure is consistent with many professional pharmacy and interdisciplinary organizations and organized into 3 primary domains: executive committee, working committees, and network membership. The network membership consists of critical care investigators dedicated to the mission and vision of the CCPTN and is open to anyone expressing an interest in contributing to high-level research. Network member sites represent the breadth of U.S. critical care practice environments. In addition, network members include individuals with demonstrated expertise in patient safety, administration, research design, grantsmanship, database management, peer review, and scientific writing. In 2015, there were more than 100 site investigators from around the United States and Canada. Projects to date have yielded numerous abstracts, platform presentations, and peer-reviewed publications in high-impact journals. The CCPTN has expanded to form collaborations with researchers in the United Kingdom, Australia, and New Zealand. The CCPTN has identified new potential partnerships and field-based areas for inquiry. Numerous opportunities for continued growth and scientific inquiry in the field of critical care pharmacotherapy research exist for the CCPTN to foster in the coming years. The CCPTN has been a successful model for practice-based pharmacotherapy research and assists its members in expanding critical care pharmacotherapy knowledge. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  9. Strategic Planning for Research in Pediatric Critical Care.

    Science.gov (United States)

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

    2016-11-01

    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

  10. Internet-based learning and applications for critical care medicine.

    Science.gov (United States)

    Wolbrink, Traci A; Burns, Jeffrey P

    2012-01-01

    Recent changes in duty hour allowances and economic constraints are forcing a paradigm shift in graduate medical education in the United States. Internet-based learning is a rapidly growing component of postgraduate medical education, including the field of critical care medicine. Here, we define the key concepts of Internet-based learning, summarize the current literature, and describe how Internet-based learning may be uniquely suited for the critical care provider. A MEDLINE/PubMed search from January 2000 to July 2011 using the search terms: "e-learning," "Web-based learning," "computer-aided instruction," "adult learning," "knowledge retention," "intensive care," and "critical care." The growth of the Internet is marked by the development of new technologies, including more user-derived tools. Nonmedical fields have embraced Internet-based learning as a valuable teaching tool. A recent meta-analysis described Internet-based learning in the medical field as being more effective than no intervention and likely as efficacious as traditional teaching methods. Web sites containing interactive features are aptly suited for the adult learner, complementing the paradigm shift to more learner-centered education. Interactive cases, simulators, and games may allow for improvement in clinical care. The total time spent utilizing Internet-based resources, as well as the frequency of returning to those sites, may influence educational gains. Internet-based learning may provide an opportunity for assistance in the transformation of medical education. Many features of Web-based learning, including interactivity, make it advantageous for the adult medical learner, especially in the field of critical care medicine, and further work is necessary to develop a robust learning platform incorporating a variety of learning modalities for critical care providers.

  11. Critical thinking: a foundation for consumer-focused care.

    Science.gov (United States)

    Snyder, M

    1993-01-01

    Both providers and recipients of health care services are now focusing attention on not only what is provided but also how services are provided. The goal is consumer satisfaction, with pressure on the provider of services to meet customer demands. This shift in focus challenges the knowledge and skills of nurses, and their ability to solve problems in collaboration with their customers. To provide consumer-focused care, nurses will need to develop critical thinking skills that utilize logical/analytical and intuitive/creative approaches to solving problems. Critical thinking skills that integrate these two approaches will provide practitioners expertise in flexible, individualized, and situation-specific problem solving. Nursing staff who are able to focus on the consumer will be better prepared to meet the demands of today's competitive health care market. The challenge facing educators is to prepare nurses with a foundation from which to provide this care.

  12. Hereditary Hemorrhagic Telangiectasia: A Primer for Critical Care Nurses.

    Science.gov (United States)

    Sacco, Kathleen M; Barkley, Thomas W

    2016-06-01

    Hereditary hemorrhagic telangiectasia is a rare, autosomal dominant genetic disease that causes abnormal growth of blood vessels and, subsequently, life-threatening arteriovenous malformations in vital organs. Epistaxis may be one of the initial clues that a patient has more serious, generalized arteriovenous malformations. Recommended treatment involves careful evaluation to determine the severity and risk of spontaneous rupture of the malformations and the management of various signs and symptoms. The disease remains undiagnosed in many patients, and health care providers may miss the diagnosis until catastrophic events happen in multiple family members. Prompt recognition of hereditary hemorrhagic telangiectasia and early intervention can halt the dangerous course of the disease. Critical care nurses can assist with early diagnosis within families with this genetic disease, thus preventing early death and disability. ©2016 American Association of Critical-Care Nurses.

  13. Team training: implications for emergency and critical care pediatrics.

    Science.gov (United States)

    Eppich, Walter J; Brannen, Melissa; Hunt, Elizabeth A

    2008-06-01

    The field of team training is quickly evolving and data are emerging to support the close relationship between effective teamwork and patient safety in medicine. This paper provides a review of the literature on team training with specific emphasis on the perspectives of emergency and critical care pediatricians. Errors in medicine are most frequently due to an interaction of human factors like poor teamwork and poor communication rather than individual mistakes. Critical care settings and those in which patients are at the extremes of age are particularly high-risk, making emergency and critical care pediatrics a special area of concern. Team training is one approach for reducing error and enhancing patient safety. Currently, there is no single standard for team training in medicine, but multiple disciplines, including anesthesiology, emergency medicine and neonatology, have adapted key principles from other high-reliability industries such as aviation into crisis resource management training. Team training holds promise to improve patient safety in pediatric emergency departments and critical care settings. We must carefully delineate the optimal instructional strategies to improve team behaviors and combine these with rigorous outcomes assessment to diagnose team problems and prescribe targeted solutions, and determine their long-term impact on patient safety.

  14. Epidemiology of hyperadrenocorticism among 210,824 dogs attending primary-care veterinary practices in the UK from 2009 to 2014.

    Science.gov (United States)

    O'Neill, D G; Scudder, C; Faire, J M; Church, D B; McGreevy, P D; Thomson, P C; Brodbelt, D C

    2016-07-01

    To estimate prevalence and risk factors for diagnosis with hyperadrenocorticism in dogs attending primary-care veterinary practices in the UK from 2009 to 2014. Cases were identified by searching the de-identified electronic patient records from UK primary-care veterinary practices participating in the VetCompass Programme. The estimated prevalence for hyperadrenocorticism diagnosis in dogs was 0·28% (95% confidence interval: 0·25 to 0·31). Multivariable logistic regression analysis revealed four associated risk factors: breed, breed-relative bodyweight, age and insurance status. The bichon frise had 6·5 times the odds (95% CI: 3·5 to 12·1, PDogs weighing more than or equal to their breed mean had 1·7 times the odds (95% CI: 1·3 to 2·3, Pdogs weighing less than the breed mean. Dogs aged 12·0 years and above showed 5·7 times the odds (95% CI: 3·7 to 8·7, Pdogs aged 6·0 to 8·9 years. Insured dogs had 4·0 times the odds (95% CI: 2·8 to 5·6, Pdogs. This is the first epidemiological report of a non-referral hospital population of dogs diagnosed with hyperadrenocorticism in the UK and describes important breed, age and bodyweight associations with this disorder which may improve diagnosis and enhance understanding of the underlying pathophysiology. © 2016 British Small Animal Veterinary Association.

  15. Acute and critical care nurses' perceptions of palliative care competencies: a pilot study.

    Science.gov (United States)

    White, Kenneth R; Roczen, Marisa L; Coyne, Patrick J; Wiencek, Clareen

    2014-06-01

    Competency development among acute and critical care nurses has focused primarily on the provision of life-sustaining care and less on the care of patients who fail to respond to life-prolonging treatments. Examining nurses' beliefs, perceptions, and experiences with patients' palliative care needs may improve continuing education programs, practice resources, educational curricula, and professional nursing practice. Survey methodology was used to conduct this pilot study. Forty-nine nurses completed a 33-item survey instrument in 2012. Respondents consisted of nurses attending a critical care continuing education event and graduate nursing students in an acute care nurse practitioner program. Statistical tests were used to examine differences in perceived importance of core competencies in palliative care. Findings from this study demonstrate variation in palliative care knowledge and perceived relative importance of core competencies needed in palliative care practice. This study provides preliminary data about knowledge differences among different nursing groups and a foundation for further study. Copyright 2014, SLACK Incorporated.

  16. Teaching in crisis. Patient and family education in critical care.

    Science.gov (United States)

    Palazzo, M O

    2001-03-01

    Although the critical care setting is not always a positive teaching environment, it is possible to achieve the goal of optimal patient and family education. The critical care nurse must understand the unique learning needs of patients and families who are experiencing a life crisis a recognize that there are substantial obstacles to overcome to educate in this setting. In addition, it takes experience and resources to develop the teaching skills of the bedside nurse, so that those teachable moments are easily recognized and suitably used to give patients and family members valuable information in small doses. The advanced practice nurse is an essential nursing resource who can spearhead the development of teaching skills for all members of the health care team. In addition, the advanced practice nurse is a clinical expert who can assess the educational needs of patients and their families and provide more detailed and individualized health information from a different perspective. Achieving good patient and family education outcomes is possible when patient care continuity is a priority and the advanced practice nurse is an active part of the nursing team. Exploring the use of new technologies and resources to meet patient and family education needs is absolutely necessary. As hospitals continue to evolve and react to the financial demands placed on them, nursing leadership and critical care nurses will need to articulate clearly all of the essential components of patient care, including patient and family education. In keeping with the rich nursing tradition of patient and family education, critical care nurses and advanced practice nurses have the opportunity to demonstrate their unique teaching skills and continue to promote health education as a priority of patient care.

  17. Factors Influencing Active Family Engagement in Care Among Critical Care Nurses

    Science.gov (United States)

    Hetland, Breanna; Hickman, Ronald; McAndrew, Natalie; Daly, Barbara

    2017-01-01

    Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing workflow partially mediated the relationships between the intensive care unit environment and nurses’ attitudes and between patient acuity and nurses’ attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit. PMID:28592476

  18. High frequency of visceral leishmaniasis in dogs under veterinary clinical care in an intense transmission area in the state of Tocantins, Brazil

    Directory of Open Access Journals (Sweden)

    Helcileia Dias Santos

    Full Text Available ABSTRACT: A direct search for parasites were used as the diagnostic test to determine the frequency of Leishmania spp. infection in dogs ( Canis lupus familiaris under veterinary clinical care in the city of Araguaína, Tocantins, Brazil. For this approach, lymph node cell samples were collected using needle aspiration from 649 dogs of different breeds and ages. Two hundred and sixty four (40.7% dogs tested positive for amastigote forms of Leishmania spp. Furthermore, 202 (76.5% dogs that tested positive showed some clinical sign of disease, while 62 (28.4% dogs were asymptomatic. Dogs <2 years old or those that lived alongside poultry species in peri-domicile areas had a greater chance of infection (P<0.05. Our results revealed the importance of frequently monitoring leishmaniasis in dogs, and the need to train veterinary professionals who work in high-transmission areas on the clinical diagnosis of canine visceral leishmaniasis.

  19. Care of terminally-ill patients: an opinion survey among critical care ...

    African Journals Online (AJOL)

    EB

    Conclusion: Training background and level of seniority in critical care provider does not impact opinion on most of end of life issues related to care of ... Patient's age, diagnosis, ICU stay and religious factors have been identified as factors ..... medical and nursing care for patients labeled no code. Intensivists practicing in the ...

  20. Performance-enhancing sports supplements: role in critical care.

    Science.gov (United States)

    Weitzel, Lindsay-Rae B; Sandoval, Paul A; Mayles, W Jonathan; Wischmeyer, Paul E

    2009-10-01

    Many performance-enhancing supplements and/or drugs are increasing in popularity among professional and amateur athletes alike. Although the uncontrolled use of these agents can pose health risks in the general population, their clearly demonstrated benefits could prove helpful to the critically ill population in whom preservation and restoration of lean body mass and neuromuscular function are crucial. Post-intensive care unit weakness not only impairs post-intensive care unit quality of life but also correlates with intensive care unit mortality. This review covers a number of the agents known to enhance athletic performance, and their possible role in preservation of muscle function and prevention/treatment of post-intensive care unit weakness in critically ill patients. These agents include testosterone analogues, growth hormone, branched chain amino acid, glutamine, arginine, creatine, and beta-hydryoxy-beta-methylbutyrate. Three of the safest and most effective agents in enhancing athletic performance in this group are creatine, branched-chain amino acid, and beta-hydryoxy-beta-methylbutyrate. However, these agents have received very little study in the recovering critically ill patient suffering from post-intensive care unit weakness. More placebo-controlled studies are needed in this area to determine efficacy and optimal dosing. It is very possible that, under the supervision of a physician, many of these agents may prove beneficial in the prevention and treatment of post-intensive care unit weakness.

  1. Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians.

    Science.gov (United States)

    von Vopelius-Feldt, Johannes; Benger, Jonathan

    2014-12-01

    Emergency medical services in the UK are facing the challenge of responding to an increasing number of calls, often for non-emergency care, while also providing critical care to the few severely ill or injured patients. In response, paramedic training in the UK has been extended and there are regional strategies to improve prehospital critical care (PHCC). We describe the clinical competencies of three groups of prehospital providers in the UK with the aim of informing future planning of the delivery of PHCC. We used a data triangulation approach to obtain lists of competencies for paramedics, critical care paramedics (CCPs) and PHCC physicians of the Great Western Ambulance Service. Data sources were professional guidance documents, equipment available to the provider, log sheets of prehospital care episodes, direct observations and a survey of providers. We identified 389, 441 and 449 competencies for paramedics, CCPs and PHCC physicians, respectively. Competencies of CCPs and PHCC physicians which exceeded those of paramedics can be arranged in four distinct clusters: induction and maintenance of anaesthesia, procedural sedation, advanced cardiovascular management and complex invasive interventions. Paramedics possess a considerable number of competencies which allow them to diagnose and treat a variety of conditions. CCPs and PHCC physicians possess a few additional critical care competencies which are potentially life-saving but are required infrequently and can carry significant risks. Concentration of training and clinical exposure for a small group of providers in critical care teams can help optimising benefits and reducing risks of PHCC. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Reflection and critical thinking of humanistic care in medical education.

    Science.gov (United States)

    Shiau, Shu-Jen; Chen, Chung-Hey

    2008-07-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Shu-Jen Shiau

    2008-07-01

    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.

  4. Care of the Critically Ill Burn Patient. An Overview from the Perspective of Optimizing Palliative Care.

    Science.gov (United States)

    Ray, Daniel E; Karlekar, Mohana B; Crouse, Donnelle L; Campbell, Margaret; Curtis, J Randall; Edwards, Jeffrey; Frontera, Jennifer; Lustbader, Dana R; Mosenthal, Anne C; Mulkerin, Colleen; Puntillo, Kathleen A; Weissman, David E; Boss, Renee D; Brasel, Karen J; Nelson, Judith E

    2017-07-01

    Burn specialists have long recognized the need for and have role modeled a comprehensive approach incorporating relief of distress as part of care during critical illness. More recently, palliative care specialists have become part of the healthcare team in many U.S. hospitals, especially larger academic institutions that are more likely to have designated burn centers. No current literature describes the intersection of palliative care and burn care or integration of primary and specialist palliative care in this unique context. This Perspective gives an overview of burn care; focuses on pain and other symptoms in burn intensive care unit settings; addresses special needs of critically ill burned patients, their families, and clinicians for high-quality palliative care; and highlights potential benefits of integrating primary and specialist palliative care in burn critical care. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched, and an e-mail survey was used to obtain information from U.S. Burn Fellowship Program directors about palliative medicine training. The Improving Palliative Care in the Intensive Care Unit Project Advisory Board synthesized published evidence with their own research and clinical experience in preparing this article. Mortality and severe morbidity for critically ill burned patients remains high. American Burn Association guidelines lay the foundation for a robust system of palliative care delivery, embedding palliative care principles and processes in intensive care by burn providers. Understanding basic burn care, challenges for symptom management and communication, and the culture of the particular burn unit, can optimize quality and integration of primary and specialist palliative care in this distinctive setting.

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

    African Journals Online (AJOL)

    Comforting patients was the only technique of anxiety management used consistently by more than 50% of the nurses. Of all the nurses who managed anxiety consistently, 68% of them had attained a Higher Diploma in Critical Care. Of these, those who consistently reduced noise (60%), switched off lights (50%), comforted ...

  6. Blood Products Provided to Patients Receiving Futile Critical Care.

    Science.gov (United States)

    Neville, Thanh H; Ziman, Alyssa; Wenger, Neil S

    2017-09-01

    The number of hospitalized patients receiving treatment perceived to be futile is not insignificant. Blood products are valuable resources that are donated to help others in need. We aimed to quantify the amount of blood transfused into patients who were receiving treatment that the critical care physician treating them perceived to be futile. During a 3-month period, critical care physicians in 5 adult intensive care units completed a daily questionnaire to identify patients perceived as receiving futile treatment. Of 1136 critically ill patients, physicians assessed 123 patients (11%) as receiving futile treatment. Fifty-nine (48%) of the 123 patients received blood products after they were assessed to be receiving futile treatment: 242 units of packed red blood cells (PRBCs) (7.6% of all PRBC units transfused into critical care patients during the 3-month study period); 161 (9.9%) units of plasma, 137 (12.1%) units of platelets, and 21 (10.5%) units of cryoprecipitate. Explicit guidelines on the use of blood products should be developed to ensure that the use of this precious resource achieves meaningful goals. © 2017 Society of Hospital Medicine.

  7. Endotracheal tube cuff pressure management in adult critical care ...

    African Journals Online (AJOL)

    Objectives. To explore and describe the existing practice related to ETT cuff pressure management by professional nurses in adult critical care units (CCUs) in the public and private healthcare sectors. Method. A quantitative survey was used. Data were collected from professional nurses from adult CCUs in the public and ...

  8. Endotracheal tube cuff pressure management in adult critical care ...

    African Journals Online (AJOL)

    related to cuff over- and under-inflation. Objectives. To explore and describe the existing practice related to ETT cuff pressure management by professional nurses in adult critical care units (CCUs) in the public and private healthcare sectors. Method. A quantitative survey was used. Data were collected from professional ...

  9. Critical care in Malawi: The ethics of beneficence and justice

    African Journals Online (AJOL)

    2017-09-25

    Sep 25, 2017 ... critical care. 2005;11(6):568-75. 4. Requejo JH, Merialdi M, Bustreo F. Improving global maternal health: progress, challenges, and promise. Current opinion in obstetrics. & gynecology. 2011;23(6):465-70. 5. Cheng AC, West TE, Limmathurotsakul D, Peacock SJ. Strategies to reduce mortality from bacterial ...

  10. Metabolic acid-base disorders in the critical care unit.

    Science.gov (United States)

    de Morais, Helio Autran; Bach, Jonathan F; DiBartola, Stephen P

    2008-05-01

    The recognition and management of acid-base disorders is a commonplace activity in the critical care unit, and the role of weak and strong acids in the genesis of metabolic acid-base disorders is reviewed. The clinical approach to patients with metabolic alkalosis and metabolic acidosis is discussed in this article.

  11. 2006 profile of postgraduate critical care nursing research in South ...

    African Journals Online (AJOL)

    Aim. The aim of the study was to compile a profile of postgraduate critical care nursing research completed during 2006 in the nursing departments of South African universities, and to determine the extent to which this research contributes to the development of a unique body of specialist South African nursing knowledge.

  12. Impact of the introduction of a specialist critical care pharmacist on the level of pharmaceutical care provided to the critical care unit.

    Science.gov (United States)

    Richter, Anja; Bates, Ian; Thacker, Meera; Jani, Yogini; O'Farrell, Bryan; Edwards, Caroline; Taylor, Helen; Shulman, Rob

    2016-08-01

    To evaluate the impact of a dedicated specialist critical care pharmacist service on patient care at a UK critical care unit (CCU). Pharmacist intervention data was collected in two phases. Phase 1 was with the provision of a non-specialist pharmacist chart review service and Phase 2 was after the introduction of a specialist dedicated pharmacy service. Two CCUs with established critical care pharmacist services were used as controls. The impact of pharmacist interventions on optimising drug therapy or preventing harm from medication errors was rated on a 4-point scale. There was an increase in the mean daily rate of pharmacist interventions after the introduction of the specialist critical care pharmacist (5.45 versus 2.69 per day, P critical care pharmacist intervened on more medication errors preventing potential harm and optimised more medications. There was no significant change to intervention rates at the control sites. Across all study sites the majority of pharmacist interventions were graded to have at least moderate impact on patient care. The introduction of a specialist critical care pharmacist resulted in an increased rate of pharmacist interventions compared to a non-specialist pharmacist service thus improving the quality of patient care. © 2016 The Authors. IJPP © 2016 Royal Pharmaceutical Society.

  13. 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.

  14. Effect of Meaningful Recognition on Critical Care Nurses' Compassion Fatigue.

    Science.gov (United States)

    Kelly, Lesly A; Lefton, Cindy

    2017-11-01

    As caregivers in high-pressure environments, critical care nurses are at risk for burnout and secondary trauma-components of compassion fatigue. Recent findings have increased understanding of the phenomena, specifically that satisfaction and meaningful recognition may play a role in reducing burnout and raising compassion satisfaction; however, no large multisite studies of compassion fatigue have been conducted. To examine the effect of meaningful recognition and other predictors on compassion fatigue in a multicenter national sample of critical care nurses. A quantitative, descriptive online survey was completed by 726 intensive care unit nurses in 14 hospitals with an established meaningful recognition program and 410 nurses in 10 hospitals without such a program. Site coordinators at each hospital coordinated distribution of the survey to nurses to assess multiple predictors against outcomes, measured by the Professional Quality of Life Scale. Cross-validation and linear regression modeling were conducted to determine significant predictors of burnout, secondary traumatic stress, and compassion satisfaction. Similar levels of burnout, secondary traumatic stress, compassion satisfaction, overall satisfaction, and intent to leave were reported by nurses in hospitals with and without meaningful recognition programs. Meaningful recognition was a significant predictor of decreased burnout and increased compassion satisfaction. Additionally, job satisfaction and job enjoyment were highly predictive of decreased burnout, decreased secondary traumatic stress, and increased compassion satisfaction. In addition to acknowledging and valuing nurses' contributions to care, meaningful recognition could reduce burnout and boost compassion satisfaction. ©2017 American Association of Critical-Care Nurses.

  15. 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.

  16. Clinical examination, critical care ultrasonography and outcomes in the critically ill

    DEFF Research Database (Denmark)

    Hiemstra, Bart; Eck, Ruben J; Koster, Geert

    2017-01-01

    PURPOSE: In the Simple Intensive Care Studies-I (SICS-I), we aim to unravel the value of clinical and haemodynamic variables obtained by physical examination and critical care ultrasound (CCUS) that currently guide daily practice in critically ill patients. We intend to (1) measure all available ......) expansion of the registry to other departments or centres; and (4) exploring possibilities of integration of a randomised clinical trial superimposed on the registry. STUDY REGISTRATION NUMBER: NCT02912624; Pre-results.......PURPOSE: In the Simple Intensive Care Studies-I (SICS-I), we aim to unravel the value of clinical and haemodynamic variables obtained by physical examination and critical care ultrasound (CCUS) that currently guide daily practice in critically ill patients. We intend to (1) measure all available....... The overall purpose is to investigate the diagnostic and prognostic value of clinical and haemodynamic variables. PARTICIPANTS: The SICS-I includes all patients acutely admitted to the ICU of a tertiary teaching hospital in the Netherlands with an ICU stay expected to last beyond 24 hours. Inclusion started...

  17. When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care?

    Science.gov (United States)

    Richards, Claire A; Starks, Helene; O'Connor, M Rebecca; Bourget, Erica; Lindhorst, Taryn; Hays, Ross; Doorenbos, Ardith Z

    2017-01-01

    Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting. To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants. Semistructured interviews were conducted with 22 attending physicians from neonatal, pediatric, and cardiothoracic ICUs in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analyses. We identified 2 themes related to the indicators for involving palliative care consultants: (1) palliative care expertise including support and bridging communication and (2) organizational factors influencing communication including competing priorities and fragmentation of care. Palliative care was most beneficial for families at risk of experiencing communication problems that resulted from organizational factors, including those with long lengths of stay and medical complexity. The ability of palliative care consultants to bridge communication was limited by some of these same organizational factors. Physicians valued the involvement of palliative care consultants when they improved efficiency and promoted harmony. Given the increasing number of children with complex chronic conditions, it is important to support the capacity of ICU clinical teams to provide primary palliative care. We suggest comprehensive system changes and critical care physician training to include topics related to chronic illness and disability.

  18. Compassionate care? A critical discourse analysis of accreditation standards.

    Science.gov (United States)

    Whitehead, Cynthia; Kuper, Ayelet; Freeman, Risa; Grundland, Batya; Webster, Fiona

    2014-06-01

    We rely upon formal accreditation and curricular standards to articulate the priorities of professional training. The language used in standards affords value to certain constructs and makes others less apparent. Leveraging standards can be a useful way for educators to incorporate certain elements into training. This research was designed to look for ways to embed the teaching and practice of compassionate care into Canadian family medicine residency training. We conducted a Foucauldian critical discourse analysis of compassionate care in recent formal family medicine residency training documents. Critical discourse analysis is premised on the notion that language is connected to practices and to what is accorded value and power. We assembled an archive of texts and examined them to analyse how compassionate care is constructed, how notions of compassionate care relate to other key ideas in the texts, and the implications of these framings. There were very few words, metaphors or statements that related to concepts of compassionate care in our archive. Even potential proxies, notably the doctor-patient relationship and patient-centred care, were not primarily depicted in ways that linked them to ideas of compassion or caring. There was a reduction in language related to compassionate care in the 2013 standards compared with the standards published in 2006. Our research revealed negative findings and a relative absence of the construct of compassionate care in our archival documents. This work demonstrates how a shift in curricular focus can have the unintended consequence of making values that are taken for granted less visible. Given that standards shape training, we must pay attention not only to what we include, but also to what we leave out of formal documents. We risk losing important professional values from training programmes if they are not explicitly highlighted in our standards. © 2014 John Wiley & Sons Ltd.

  19. Veterinary Parasitology

    OpenAIRE

    Rondon, F. C. M.; Bevilaqua, C.M.L.; Franke,C.R.; Barros, R. S.; Oliveira,F.R.; Alcântara, Adriano Costa de; Diniz, A. T.

    2008-01-01

    Acesso restrito: Texto completo. p. 24-31 Visceral leishmaniasis (VL) is one of the most important reemerging parasitic disease in the world. The domestic dog is the main reservoir in urban environments. The aim of this work was to extend the knowledge on canine Leishmania infection in the city of Fortaleza in northeastern Brazil, identifying the risk factors inherent in dog susceptibility to the infection. Two populations were analyzed, domestic dogs from clinics and the Veterinary ...

  20. Occupational stress in intensive care nurses who provide direct care to critical patients

    National Research Council Canada - National Science Library

    Inoue, Kelly Cristina; Versa, Gelena Lucinéia Gomes da Silva; Murassaki, Ana Cláudia Yassuko; Melo, Willian Augusto de; Matsuda, Laura Misue

    2013-01-01

    In order to identify the stress level of nurses that provide direct care to critically ill patients, it was carried out a descriptive and exploratory study in five hospitals of the western region of the state of Paraná...

  1. Clinical examination, critical care ultrasonography and outcomes in the critically ill

    DEFF Research Database (Denmark)

    Hiemstra, Bart; Eck, Ruben J; Koster, Geert

    2017-01-01

    PURPOSE: In the Simple Intensive Care Studies-I (SICS-I), we aim to unravel the value of clinical and haemodynamic variables obtained by physical examination and critical care ultrasound (CCUS) that currently guide daily practice in critically ill patients. We intend to (1) measure all available...... clinical and haemodynamic variables, (2) train novices in obtaining values for advanced variables based on CCUS in the intensive care unit (ICU) and (3) create an infrastructure for a registry with the flexibility of temporarily incorporating specific (haemodynamic) research questions and variables....... The overall purpose is to investigate the diagnostic and prognostic value of clinical and haemodynamic variables. PARTICIPANTS: The SICS-I includes all patients acutely admitted to the ICU of a tertiary teaching hospital in the Netherlands with an ICU stay expected to last beyond 24 hours. Inclusion started...

  2. Rethinking Preconception Care: A Critical, Women's Health Perspective.

    Science.gov (United States)

    Thompson, Erika L; Vázquez-Otero, Coralia; Vamos, Cheryl A; Marhefka, Stephanie L; Kline, Nolan S; Daley, Ellen M

    2017-05-01

    Objectives Preconception care aims to provide care to reproductive aged individuals in order to improve pregnancy and birth outcomes. Given that preconception care is a public health priority, it is important to evaluate the evolution of this health paradigm and the promotion of preconception messages that are obtained by the public. We identified online preconception health messages, which were critically assessed through a women's health perspective. Methods We searched for "preconception care" on three major search engines. Websites were included if they were U.S.-based, provided content in English, and mentioned preconception care. Blogs and journal articles were excluded. The final sample included 52 websites. Using a content analysis approach, we assessed the presence of gender bias and identified other emergent themes. Results The majority of websites focused on preconception care for women only (67%). The recommendations centered on: (1) health behaviors for women (e.g., folic acid, drinking, smoking); (2) visiting healthcare providers; and (3) evaluating medical risks. Moreover, most content implied that women desired, or should desire, pregnancy. Overall, the messages used biomedical language and rarely mentioned other important health topics, such as social support and violence. Conclusions The primary messages presented on preconception care websites emphasized biomedical aspects of women's health. The current context of preconception care medicalizes this pre-pregnancy period by defining it as a biomedical condition requiring lifestyle changes and interventions. Additionally, the biases presented in these messages assumed women want and are capable of pregnancies and excluded an integral factor for heteronormative reproduction-men.

  3. Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses.

    Science.gov (United States)

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

    2015-08-01

    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.

  4. Incorporating best practices into undergraduate critical care nursing education.

    Science.gov (United States)

    Brenner, Zara R; Iafrati, Nancy S

    2014-02-01

    Incorporation of best clinical practices into the baccalaureate critical care nursing curriculum is important. At The College at Brockport, best clinical practices are introduced early in the semester and are reinforced throughout the semester in both class and clinical settings. Among the best clinical practices included are those recommended by the American Association of Critical-Care Nurses, The Centers for Medicare and Medicaid Services, the Institute for Healthcare Improvement, The Joint Commission, Quality and Safety Education for Nurses, the Surviving Sepsis Campaign, and the Institute for Safe Medication Practices. The culminating assignment of the semester requires students to focus on patient safety. Students describe the use of the National Patient Safety Goals and other best practices in the critical care setting. The role of the nurse leader and exploration of near-miss and work-around events also are described. Nursing students need to provide safe competent nursing care by incorporating best practices into their clinical practice now and in the future when they become registered professional nurses.

  5. Critical care physician cognitive task analysis: an exploratory study.

    Science.gov (United States)

    Fackler, James C; Watts, Charles; Grome, Anna; Miller, Thomas; Crandall, Beth; Pronovost, Peter

    2009-01-01

    For better or worse, the imposition of work-hour limitations on house-staff has imperiled continuity and/or improved decision-making. Regardless, the workflow of every physician team in every academic medical centre has been irrevocably altered. We explored the use of cognitive task analysis (CTA) techniques, most commonly used in other high-stress and time-sensitive environments, to analyse key cognitive activities in critical care medicine. The study objective was to assess the usefulness of CTA as an analytical tool in order that physician cognitive tasks may be understood and redistributed within the work-hour limited medical decision-making teams. After approval from each Institutional Review Board, two intensive care units (ICUs) within major university teaching hospitals served as data collection sites for CTA observations and interviews of critical care providers. Five broad categories of cognitive activities were identified: pattern recognition; uncertainty management; strategic vs. tactical thinking; team coordination and maintenance of common ground; and creation and transfer of meaning through stories. CTA within the framework of Naturalistic Decision Making is a useful tool to understand the critical care process of decision-making and communication. The separation of strategic and tactical thinking has implications for workflow redesign. Given the global push for work-hour limitations, such workflow redesign is occurring. Further work with CTA techniques will provide important insights toward rational, rather than random, workflow changes.

  6. Ten good reasons to practice ultrasound in critical care.

    Science.gov (United States)

    Lichtenstein, Daniel; van Hooland, Simon; Elbers, Paul; Malbrain, Manu L N G

    2014-01-01

    Over the past decade, critical care ultrasound has gained its place in the armamentarium of monitoring tools. A greater understanding of lung, abdominal, and vascular ultrasound plus easier access to portable machines have revolutionised the bedside assessment of our ICU patients. Because ultrasound is not only a diagnostic test, but can also be seen as a component of the physical exam, it has the potential to become the stethoscope of the 21st century. Critical care ultrasound is a combination of simple protocols, with lung ultrasound being a basic application, allowing assessment of urgent diagnoses in combination with therapeutic decisions. The LUCI (Lung Ultrasound in the Critically Ill) consists of the identification of ten signs: the bat sign (pleural line); lung sliding (seashore sign); the A-lines (horizontal artefact); the quad sign and sinusoid sign indicating pleural effusion; the fractal and tissue-like sign indicating lung consolidation; the B-lines and lung rockets indicating interstitial syndromes; abolished lung sliding with the stratosphere sign suggesting pneumothorax; and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. The BLUE protocol (Bedside Lung Ultrasound in Emergency) is a fast protocol (advantage of lung ultrasound is that the patient is not exposed to radiation, and so the LUCI-FLR project (LUCI favouring limitation of radiation) can be unfolded in trauma patients. Although it has been practiced for 25 years, critical care ultrasound is a relatively young but expanding discipline and can be seen as the stethoscope of the modern intensivist. In this review, the usefulness and advantages of ultrasound in the critical care setting are discussed in ten points. The emphasis is on a holistic approach, with a central role for lung ultrasound.

  7. Knowledge and nursing practice of critical care nurses caring for patients with delirium in intensive care units in Jordan.

    Science.gov (United States)

    Hamdan-Mansour, Ayman M; Farhan, Ne'ameh Abbas; Othman, Elham Hani; Yacoub, Mohammed Ibrahim

    2010-12-01

    Delirium can have serious consequences in terms of morbidity, mortality, and increased health care costs. An extensive literature review showed that delirium is not well understood, recognized, or managed by medical and nursing professionals. The goal for this study was to determine the level of knowledge and management skills among critical care nurses caring for patients with delirium who were treated in intensive care units (ICUs) in Jordan. A total of 232 critical care nurses, employed in different ICUs in Jordan, completed self-reported questionnaires. The nurses in critical care units who completed the questionnaires identified a need for more delirium-specific knowledge and skills to assess and manage this condition more effectively. To enhance health outcomes for patients treated in the ICU who have delirium, nurses need to receive education on current assessment and management modalities. These regular education programs should be complemented with evaluative research focusing on both nursing care and patient outcomes. Copyright 2010, SLACK Incorporated.

  8. Critical care nurses' information-seeking behaviour during an unfamiliar patient care task.

    Science.gov (United States)

    Newman, Kristine M; Doran, Diane

    2012-01-01

    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.

  9. Specialist palliative care nursing and the philosophy of palliative care: a critical discussion.

    Science.gov (United States)

    Robinson, Jackie; Gott, Merryn; Gardiner, Clare; Ingleton, Christine

    2017-07-02

    Nursing is the largest regulated health professional workforce providing palliative care across a range of clinical settings. Historically, palliative care nursing has been informed by a strong philosophy of care which is soundly articulated in palliative care policy, research and practice. Indeed, palliative care is now considered to be an integral component of nursing practice regardless of the specialty or clinical setting. However, there has been a change in the way palliative care is provided. Upstreaming and mainstreaming of palliative care and the dominance of a biomedical model with increasing medicalisation and specialisation are key factors in the evolution of contemporary palliative care and are likely to impact on nursing practice. Using a critical reflection of the authors own experiences and supported by literature and theory from seminal texts and contemporary academic, policy and clinical literature, this discussion paper will explore the influence of philosophy on nursing knowledge and theory in the context of an evolving model of palliative care.

  10. Critical thinking a new approach to patient care.

    Science.gov (United States)

    Sullivan, David L; Chumbley, Christopher

    2010-04-01

    As EMS responders, we're challenged with complex patient care situations, and we often make decisions using past experiences, protocols and medical consultation to guide us through treatment "mazes." Using our natural problem-solving process, we tend to see a problem and think about similar past experiences, which we believe will help us implement a workable solution to the problem.(1,2,3) As we strive toward patient care excellence, however, we need to also look for the best solution for our patient care needs. Research continues to reveal that EMS responders may benefit from increasing their practice of critical thinking, problem-solving and decision-making in initial and continuing education.(4-13) Studies are finding that increased practice and exposure to triage, airway management and medication administration decision-making will allow us to achieve an increased quality of patient care.(7,14-22) Research has also found many reasons for patient care deficiencies, but a common theme is that EMS students and providers may not be getting enough practice or exposure to thinking "outside of the box" in difficult, critical-thinking scenarios.(12,14,18,20,21,23-25) This lack of exposure is why EMS educators should continue to challenge students with skills practice and competency assessments. Even with minimal time and practice in the classroom and clinical settings, EMS educators and instructors should infuse the curriculum with complex scenarios and problems to stimulate students' critical thinking and problem-solving skills.(26-30) This can be accomplished by using patient simulation, team-based thinking scenarios, realistic scenarios with variable outcomes and student-group-facilitated presentations.(12) All of these combined will have a greater meaning to students as they navigate through the many requirements to achieve competence and real-life experience in the patient care setting.(31) In response to this need, EMS educational materials are placing more

  11. Music therapy in critical care: indications and guidelines for intervention.

    Science.gov (United States)

    Chlan, L; Tracy, M F

    1999-06-01

    Music therapy is an effective intervention for critically ill patients for such purposes as anxiety reduction and stress management. The therapy is readily accepted by patients and is an intervention patients thoroughly enjoy. The MAIT is one resource that nurses caring for critically ill patients can use to implement music therapy in clinical practice. Patients can be given the opportunity to select a musical tape they prefer and to negotiate with the nurse for uninterrupted music-listening periods. Allowing patients control over music selection and providing uninterrupted time for music listening gives the patients an enhanced sense of control in an environment that often controls them.

  12. Respiratory Acid-Base Disorders in the Critical Care Unit.

    Science.gov (United States)

    Hopper, Kate

    2017-03-01

    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 Pco 2 may have a significant impact on outcome. Monitoring Pco 2 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.

  13. Outcome measures for adult critical care: a systematic review.

    Science.gov (United States)

    Hayes, J A; Black, N A; Jenkinson, C; Young, J D; Rowan, K M; Daly, K; Ridley, S

    2000-01-01

    1. To identify generic and disease specific measures of impairment, functional status and health-related quality of life that have been used in adult critical care (intensive and high-dependency care) survivors. 2. To review the validity, reliability and responsiveness of the measures in adult critical care survivors. 3. To consider the implications for future policy and to make recommendations for further methodological research. 4. To review what is currently known of the outcome of adult critical care. Searches of electronic databases (MEDLINE, EMBASE, CINAHL, PsycLIT, The Cochrane Library and SIGLE) from 1970 to August 1998. Manual searches of five journals (1985-98) not indexed in electronic databases and relevant conference proceedings (1993-98). Reference lists of six existing reviews, plus snowballing from reference lists of all relevant articles identified. Randomised trials, non-randomised trials (cohort studies) and case series that included data on outcomes after discharge from adult (16 years and over) critical care. If reported, the following data were extracted from each paper: patient characteristics (age, gender, severity of illness, diagnostic category) number of patients eligible for study, follow-up period, number of deaths before follow-up, number and proportion of survivors included in follow-up method of presentation of outcome data - proportion normal as defined by reference values, or aggregate value (e.g. mean or median), or aggregate values plus an indication of variance (e.g. standard deviation or inter-quartile range). Evidence for three measurement properties was sought for each outcome measure that had been used in at least two studies - their validity, reliability and responsiveness in adult critical care. If the authors did not report these aspects explicitly, an attempt was made to use the data provided to provide these measurement properties. For measures that were used in at least ten studies, information on actual reported

  14. Patient's dignity in intensive care unit: A critical ethnography.

    Science.gov (United States)

    Bidabadi, Farimah Shirani; Yazdannik, Ahmadreza; Zargham-Boroujeni, Ali

    2017-01-01

    Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit. The study was conducted using a critical ethnographic method proposed by Carspecken. Participants and research context: Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. Ethical Consideration: Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity". The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

  15. Toward Designing Information Display to Support Critical Care

    Science.gov (United States)

    Dunbar, Sherry; Macpherson, Brekk C; Moretti, Eugene W; Del Fiol, Guillherme; Bolte, Jean; Taekman, Jeffrey M; Segall, Noa

    2016-01-01

    Summary Objectives Electronic health information overload makes it difficult for providers to quickly find and interpret information to support care decisions. The purpose of this study was to better understand how clinicians use information in critical care to support the design of improved presentation of electronic health information. Methods We conducted a contextual analysis and visioning project. We used an eye-tracker to record 20 clinicians‘ information use activities in critical care settings. We played video recordings back to clinicians in retrospective cued interviews and queried: 1) context and goals of information use, 2) impacts of current display design on use, and 3) processes related to information use. We analyzed interview transcripts using grounded theory-based content analysis techniques and identified emerging themes. From these, we conducted a visioning activity with a team of subject matter experts and identified key areas for focus of design and research for future display designs. Results Analyses revealed four unique critical care information use activities including new patient assessment, known patient status review, specific directed information seeking, and review and prioritization of multiple patients. Emerging themes were primarily related to a need for better representation of dynamic data such as vital signs and laboratory results, usability issues associated with reducing cognitive load and supporting efficient interaction, and processes for managing information. Visions for the future included designs that: 1) provide rapid access to new information, 2) organize by systems or problems as well as by current versus historical patient data, and 3) apply intelligence toward detecting and representing change and urgency. Conclusions The results from this study can be used to guide the design of future acute care electronic health information display. Additional research and collaboration is needed to refine and implement

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

    Science.gov (United States)

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

    2015-04-01

    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

  17. Pathology of apprenticeships for masters of nursing critical care.

    Science.gov (United States)

    Ghaffari, Fatemeh; Nayeri, Nahid Dehghan; Norouzinezhad, Faezeh; Tayebi, Zahra

    2017-01-01

    The increasing complexity of patient care conditions in intensive care units, along with the development of these units, has increased the need for qualified nurses and health professionals. Therefore, due to recent changes and in response to the shortage of capable nurses, a master's major in intensive care nursing has been created. One of the main challenges of this curriculum is to ensure that graduates have the required competencies. The current study aimed to explain the pathology of apprenticeships for a masters in nursing critical care. This qualitative study was conducted for masters in nursing critical care students of Tehran University of Medical Sciences in 2014-2015. The sampling was purposeful. Data were collected through face-to-face interviews with 15 students. Conventional content analysis was used to analyze the data. Three categories "ineffective management, unfavorable context for achieving skills, and lack of clinical instructors and sufficient competence" were extracted. Preparing settings for entering students such as having an adequate training field and expert educators, providing conditions for orientation of educators and participation in the related workshops, and recruitment of experienced instructors in the apprenticeships field can increase the quality of MS levels.

  18. Pathology of apprenticeships for masters of nursing critical care

    Science.gov (United States)

    Ghaffari, Fatemeh; Nayeri, Nahid Dehghan; Norouzinezhad, Faezeh; Tayebi, Zahra

    2017-01-01

    Introduction The increasing complexity of patient care conditions in intensive care units, along with the development of these units, has increased the need for qualified nurses and health professionals. Therefore, due to recent changes and in response to the shortage of capable nurses, a master’s major in intensive care nursing has been created. One of the main challenges of this curriculum is to ensure that graduates have the required competencies. The current study aimed to explain the pathology of apprenticeships for a masters in nursing critical care. Methods This qualitative study was conducted for masters in nursing critical care students of Tehran University of Medical Sciences in 2014–2015. The sampling was purposeful. Data were collected through face-to-face interviews with 15 students. Conventional content analysis was used to analyze the data. Results Three categories “ineffective management, unfavorable context for achieving skills, and lack of clinical instructors and sufficient competence” were extracted. Conclusion Preparing settings for entering students such as having an adequate training field and expert educators, providing conditions for orientation of educators and participation in the related workshops, and recruitment of experienced instructors in the apprenticeships field can increase the quality of MS levels. PMID:28243401

  19. Critical thinking, delegation, and missed care in nursing practice.

    Science.gov (United States)

    Bittner, Nancy Phoenix; Gravlin, Gayle

    2009-03-01

    The aim of this study was to understand how nurses use critical thinking to delegate nursing care. Nurses must synthesize large amounts of information and think through complex and often emergent clinical situations when making critical decisions about patient care, including delegation. A qualitative, descriptive study was used in this article. Before delegating, nurses reported considering patient condition, competency, experience, and workload of unlicensed assistive personnel (UAP). Nurses expected UAP to report significant findings and have higher level knowledge, including assessment and prioritizing skills. Successful delegation was dependent on the relationship between the RN and the UAP, communication, system support, and nursing leadership. Nurses reported frequent instances of missed or omitted routine care. Findings from this project provide insight into factors that influence delegation effectiveness. These can guide CNOs and frontline nurse leaders to focus on implementing strategies to mitigate the consequence of missed care. Ineffective delegation of basic nursing care can result in poor patient outcomes, potentially impacting quality measures, satisfaction, and reimbursement for the institution.

  20. [Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units].

    Science.gov (United States)

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

    2014-01-01

    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.

  1. Clinical research in critical care. Difficulties and perspectives.

    Science.gov (United States)

    Latour-Pérez, J

    2017-09-21

    In the field of Intensive Care Medicine, improved survival has resulted from better patient care, the early detection of clinical deterioration, and the prevention of iatrogenic complications, while research on new treatments has been followed by an overwhelming number of disappointments. The origins of these fiascos must be sought in the conjunction of methodological problems - common to other disciplines - and the particularities of critically ill patients. The present article discusses both aspects and suggests some options for progress. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  2. Intensive care organisation : Should there be a separate intensive care unit for critically injured patients?

    NARCIS (Netherlands)

    T.K. Timmers (Tim); M.H.J. Verhofstad (Michiel); L.P.H. Leenen (Luke)

    2016-01-01

    textabstractAbstract: In the last two decennia, the mixed population general intensive care unit (ICU) with a ‘closed format’ setting has gained in favour compared to the specialized critical care units with an ‘open format’ setting. However, there are still questions whether surgical patients

  3. Restraint use in acute and critical care settings: changing practice.

    Science.gov (United States)

    Martin, Beth

    2002-05-01

    Reduction of physical restraint use in the acute and critical care setting is a complex issue. Ethical considerations, regulatory and professional standards, legal liability concerns, healthcare team members' knowledge and attitudes, and unit culture and practice traditions must all be considered. Restraint reduction programs may use a process improvement format that engages the support of the organization's leadership. Specific interventions for restraint reduction, such as understanding the meaning of a patient's behavior, using a team approach, and involving the family can be evaluated and modified for application in the acute and critical care setting. Successful initiatives to decrease the use of restraint in this setting require an understanding of the many factors that support and oppose this practice.

  4. The role of melatonin in anaesthesia and critical care

    Directory of Open Access Journals (Sweden)

    Madhuri S Kurdi

    2013-01-01

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

  5. Critical care monitoring considerations for the diabetic patient.

    Science.gov (United States)

    Connally, Heather E

    2002-05-01

    Diabetes mellitus (DM) is a common endocrine disease encountered in the emergency and critical care setting. The diabetic Ketoacidotic (DKA) animal represents an extreme of the DM patient with regard to hyperglycemia and acid-base and electrolyte derangements. Prompt diagnosis of DKA in a critical patient and rapid initiation of appropriate therapy are necessary for a positive outcome. The steps of treatment, in order of importance, include initiation of intravenous fluid therapy, insulin therapy, electrolyte replacement, and reversal of the metabolic acidosis. The main goals of therapy--including correction of dehydration, electrolyte abnormalities and acidosis via aggressive fluid therapy with electrolyte supplementation and correction of ketoacidosis and hyperglycemia via initiation of insulin therapy--can be achieved if these steps are followed. Because of the severity of metabolic alterations in the DKA animal, frequent and careful monitoring are paramount because they will allow the clinician to tailor treatment to each case.

  6. The challenges of caring in a technological environment: critical care nurses' experiences.

    Science.gov (United States)

    McGrath, Mary

    2008-04-01

    This paper presents and discusses the findings from a phenomenological study which illuminated the lived experiences of experienced critical care nurses caring within a technological environment. While nursing practice is interwoven with technology, much of the literature in this area is speculative. Moreover, there is a debate as to whether and how 'high tech' and 'high touch' are reconcilable; this orientation is referred to as the optimism vs. pessimism debate. On a personal level, the motivation for this study came from the author's 13 years' experience in the critical care area. Following ethical approval, 10 experienced nurses from two cardiothoracic critical care units in Ireland participated in the study. A Heideggerian phenomenological methodology was used. Data collection consisted of unstructured interviews. A method of data analysis described by Walters was used. The findings provide research-based evidence to illuminate further the optimistic/pessimistic debate on technology in nursing. While the study demonstrates that the debate is far from resolved, it reveals a new finding: life-saving technology that supports the lives of critically ill patients can bring experienced nurses very close to their patients/families. The three main themes that emerged: 'alien environment', 'pulling together' and 'sharing the journey' were linked by a common thread of caring. Experienced critical care nurses are able to transcend the obtrusive nature of technology to deliver expert caring to their patients. However, the journey to proficiency in technology is very demanding and novice nurses have difficulty in caring with technology. Relevance to clinical practice. It is recommended that more emphasis be placed on supporting, assisting and educating inexperienced nurses in the critical care area and that the use of technology in nursing be given serious consideration.

  7. Conversations in end-of-life care: communication tools for critical care practitioners.

    Science.gov (United States)

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

    2011-01-01

    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.

  8. Effects of technology on nursing care and caring attributes of a sample of Iranian critical care nurses.

    Science.gov (United States)

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

    2017-04-01

    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.

  9. Pediatric Critical Care Telemedicine Program: A Single Institution Review.

    Science.gov (United States)

    Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P

    2016-01-01

    Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.

  10. Critical care admission of South African (SA) surgical patients ...

    African Journals Online (AJOL)

    Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study. D.L. Skinner, K de Vasconcellos, R Wise, T.M. Esterhuizen, C Fourie, A Goolam Mahomed, P.D. Gopalan, I Joubert, H Kluyts, L.R. Mathivha, B Mrara, J.P. Pretorius, G Richards, O Smith, M.G.L. Spruyt, R.M. Pearse, ...

  11. Risk perception of musculoskeletal injury among critical care nurses.

    Science.gov (United States)

    Lee, Soo-Jeong; Faucett, Julia; Gillen, Marion; Krause, Niklas; Landry, Lynette

    2013-01-01

    Nursing is known as an occupation with high risk of musculoskeletal injury. Nurses' perceptions about the risk of injury may have a role in preventing such injury. The aim of this study was to investigate how nurses perceived the risk of musculoskeletal injury from work and identify factors associated with their risk perception. In a cross-sectional study using a postal survey, 361 critical care nurses reported on risk perception, physical workload, psychosocial job factors, safety climate, musculoskeletal symptoms, and safe work behavior. Of all critical care nurse respondents, 83% perceived that they were more likely than not to have a musculoskeletal injury within 1 year. On average, nurses perceived the risk of musculoskeletal injury as lower to themselves than to coworkers. This more positive perception of risk to self had stronger correlations with symptom experiences. Multiple linear regression analysis revealed that higher risk perception of injury was associated with greater job strain, greater physical workload, lack of availability of lifting devices or lifting teams, and more symptoms. Study findings indicated that most critical care nurses were concerned about their ergonomic job risks. Their risk perceptions about musculoskeletal injury risk were affected by physical work exposures, psychosocial job stressors, and experience with musculoskeletal symptoms, but not by perceived workplace safety climate. The findings underscore the need for management efforts to improve physical and psychosocial working conditions and create a safe work environment.

  12. The Critical Care Communication project: improving fellows' communication skills.

    Science.gov (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

    2015-04-01

    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.

  13. Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey.

    Science.gov (United States)

    Ludin, Salizar Mohamed

    2018-02-01

    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 (pthinking and clinical decision-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.

  14. Concise Definitive Review: Focused Critical Care Echocardiography in the ICU

    Science.gov (United States)

    Oren-Grinberg, Achikam; Talmor, Daniel; Brown, Samuel M.

    2013-01-01

    Objective Portable ultrasound is now used routinely in many intensive care units (ICUs) for various clinical applications. Echocardiography performed by non-cardiologists, both transesophageal (TEE) and transthoracic (TTE), has evolved to broad applications in diagnosis, monitoring, and management of critically ill patients. This review provides a current update on Focused Critical Care Echocardiography (FCCE) for the management of critically ill patients. Method Source data were obtained from a PubMed search of the medical literature, including the PubMed “related articles” search methodology. Summary and Conclusions While studies demonstrating improved clinical outcomes for critically ill patients managed by FCCE are generally lacking, there is evidence to suggest that some intermediate outcomes are improved. Furthermore, non-cardiologists can learn FCCE and adequately interpret the information obtained. Non-cardiologists can also successfully incorporate FCCE into advanced cardiopulmonary life support (ACLS). Formal training and proctoring are important for safe application of FCCE in clinical practice. Further outcomes-based research is urgently needed to evaluate the efficacy of FCCE PMID:23989172

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

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2013-09-01

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

  16. Vitamin B12: the forgotten micronutrient for critical care.

    Science.gov (United States)

    Manzanares, William; Hardy, Gil

    2010-11-01

    To analyse the anti-inflammatory and antioxidant properties of vitamin B12 and evaluate current evidence on vitamin B12 status in the critically ill with systemic inflammation. Data on vitamin B12 status of intensive care unit patients are scarce. Cobalamins could potentially be useful agents for inhibiting nitric oxide synthase and nitric oxide production, controlling nuclear factor-kappa B activation, and restoring optimal bacteriostasis and phagocytosis in which transcobalamins play a proven role. The antioxidant properties of vitamin B12, with a glutathione-sparing effect, are secondary to stimulation of methionine synthase activity and reaction with free oxygen or nitrogen radicals. Large parenteral doses are routinely administered for cyanide poisoning, with only mild, reversible side-effects. Current evidence suggests that high-dose parenteral vitamin B12 may prove an innovative approach to treat critically ill systemic inflammatory response syndrome patients, especially those with severe sepsis/septic shock. In this setting, vitamin B12 and transcobalamins could modulate systemic inflammation contributing to the anti-inflammatory cascade and potentially improve outcome. Despite evidence from animal studies, so far there are no clinical intervention trials that have studied vitamin B12 as a pharmaconutrient strategy for critical care. Well designed animal and clinical studies are required to clarify several outstanding questions on the optimal posology, safety, and efficacy of high-dose vitamin B12 in the critically ill.

  17. Nursing care in a high-technological environment: Experiences of critical care nurses.

    Science.gov (United States)

    Tunlind, Adam; Granström, John; Engström, Åsa

    2015-04-01

    Management of technical equipment, such as ventilators, infusion pumps, monitors and dialysis, makes health care in an intensive care setting more complex. Technology can be defined as items, machinery and equipment that are connected to knowledge and management to maximise efficiency. Technology is not only the equipment itself, but also the knowledge of how to use it and the ability to convert it into nursing care. The aim of this study is to describe critical care nurses' experience of performing nursing care in a high technology healthcare environment. Qualitative, personal interviews were conducted during 2012 with eight critical care nurses in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. Three themes with six categories emerged. The technology was described as a security that could facilitate nursing care, but also one that could sometimes present obstacles. The importance of using the clinical gaze was highlighted. Nursing care in a high technological environment must be seen as multi-faceted when it comes to how it affects CCNs' experience. The advanced care conducted in an ICU could not function without high-tech equipment, nor could care operate without skilled interpersonal interaction and maintenance of basal nursing. That technology is seen as a major tool and simultaneously as a barrier to patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Dental Education in Veterinary Medicine

    Directory of Open Access Journals (Sweden)

    Diana L. Eubanks

    2011-02-01

    Full Text Available Periodontal disease is among the most prevalent canine dis-eases affecting over 75% of dogs. Strengthening of the human-animal bond and the increasing education of the aver-age pet owner, have fostered a heightened awareness of periodontal care in dogs and cats. Industry support has further assisted the small animal veterinarian in providing quality dental treatments and prevention. As recently as the 1990’s, veterinary curriculums contained little or no dental training. That trend is changing as nearly every one of the 28 US Colleges of Veterinary Medicine offers some level of small animal dentistry during the four-year curriculum. Primary areas of focus are on client education, the treatment of periodontal disease, dental prophylaxis, dental radiology, endodontics, exodontics and pain control. Students receive instruction in dental anatomy during their di-dactic curriculum and later experience clinical cases. Graduate DVMs can attend a variety of continuing education courses and even choose to specialize in veterinary dentistry in both small animals and horses. Through the efforts of organizations such as the American Veterinary Dental So-ciety, The American Veterinary Dental College and The Academy of Veterinary Dentistry, many veterinarians have been able to advance their skills in dentistry and improve animal welfare. Increasing ex-pectations of the pet-owning public coupled with the recent advancements of training opportunities available for vete-rinary students, graduate DVMs and certified veterinary technicians make veterinary dentistry an emerging practice-builder among the most successful small animal hospitals.

  19. [Burnout and perceived health in Critical Care nursing professionals].

    Science.gov (United States)

    Ríos Risquez, M I; Peñalver Hernández, F; Godoy Fernández, C

    2008-01-01

    To assess the level of burnout syndrome in a sample of critical care nursing professionals and analyze its relation with the perception of general health and other sociodemographic and work characteristics. Cross-sectional descriptive study. SITE: Intensive Care Unit of the University Hospital Morales Meseguer, Murcia-Spain. Three evaluation tools were used. These included a sociodemographic and work survey, the validated Maslach Burnout Inventory (MBI) questionnaires and the General Health Questionnaire (GHQ-28) in order to assess professional burnout and the general health condition perceived, respectively. Only 42 out of the 56 questionnaires included in the study were valid. This means an answering rate of 75%. The mean score obtained on the emotional tiredness dimension (25.45 6 11.15) stands out. About 42.9% of the sample presented psychological or psychosomatic symptoms that could require specialized care. Correlation between burnout and general health perception was statistically significant (r = 0.536; p burnout found was moderate to high among critical care nursing professionals. A total of 11.9% of the studied sample had a high score in the 3 dimensions of the burnout syndrome: emotional tiredness, depersonalization, and lack of personal job performance. Burnout and health levels found indicate high vulnerability in the sample studied and the need to establish prevention/intervention programs in this work context.

  20. July 2014 Critical Care Journal Club: Predicting the Future

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-08-01

    Full Text Available No abstract available. Article truncated after 150 words. Journal club was held on July 23, 2014 and six articles were reviewed. Four of the articles were on predicting mortality or complications in the ICU. We have long known that older, sicker patients are more likely to die or have complications. However, when attempts are made to go beyond this, it supports one of our favorite Yogisms, “It's tough to make predictions, especially about the future.” The last two articles were concerning the best choice for crystalloid administration in adult patients with sepsis and a review article on palliative care in the ICU. Harhay MO, Wagner J, Ratcliffe SJ, et al. Outcomes and statistical power in adult critical care randomized trials. Am J Respir Crit Care Med. 2014;189(12:1469-78. Intensive care unit (ICU-based randomized clinical trials (RCTs among adult critically ill patients commonly fail to detect treatment benefits. The authors examined 146 RCTs, 54 (37% were positive (i.e., the a ...

  1. A teamwork model to promote patient safety in critical care.

    Science.gov (United States)

    Sherwood, Gwen; Thomas, Eric; Bennett, Debora Simmons; Lewis, Patricia

    2002-12-01

    To create a safe health care system, providers must understand teamwork as a complementary relationship of interdependence. Continuing efforts to adopt the aviation model will enable health care providers to examine the role of human performance factors related to fatigue, leadership, and communication among all providers. The aviation model provides a basis for designing teamwork programs to reduce error and introduces human factor principles and key skills to be learned. Health care providers need explicit instruction in communication and teamwork rather than learning by trial and error, which can instill unintended values, attitudes, and behaviors. The growing research base continues to examine the problem of health care safety and to test the most effective team training approaches. What is the most effective pattern and timing of communication among providers? What system level changes are needed in the critical care area to improve communication through teamwork and thus create a safer health care system? What are potential points of error in the daily operation that could be alleviated through effective teamwork? Continuing to test the model will ultimately change patient safety.

  2. CE: critical care recovery center: an innovative collaborative care model for ICU survivors.

    Science.gov (United States)

    Khan, Babar A; Lasiter, Sue; Boustani, Malaz A

    2015-03-01

    Five million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed. To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center with a secondary research focus. Care is provided through a pre-CCRC patient and caregiver needs assessment, an initial diagnostic workup visit, and a follow-up visit that includes a family conference. With its sole focus on the prevention and treatment of PICS, the CCRC represents an innovative prototype aimed at modifying post-critical illness morbidities and improving the ICU survivor's quality of life.

  3. Palliative Care Communication in the ICU: Implications for an Oncology-Critical Care Nursing Partnership.

    Science.gov (United States)

    Boyle, Deborah A; Barbour, Susan; Anderson, Wendy; Noort, Janice; Grywalski, Michelle; Myer, Jeannette; Hermann, Heather

    2017-10-26

    To describe the development, launch, implementation, and outcomes of a unique multisite collaborative (ie, IMPACT-ICU [Integrating Multidisciplinary Palliative Care into the ICU]) to teach ICU nurses communication skills specific to palliative care. To identify options for collaboration between oncology and critical care nurses when integrating palliation into nursing care planning. Published literature and collective experiences of the authors in the provision of onco-critical-palliative care. While critical care nurses were the initial focus of education, oncology, telemetry, step-down, and medical-surgical nurses within five university medical centers subsequently participated in this learning collaborative. Participants reported enhanced confidence in communicating with patients, families, and physicians, offering emotional support and involvement in family meetings. Communication education is a vital yet missing element of undergraduate nursing education. Programs should be offered in the work setting to address this gap in needed nurse competency, particularly within the context of onco-critical-palliative care. Copyright © 2017. Published by Elsevier Inc.

  4. [Frequent nursing diagnoses and interventions for women under critical care].

    Science.gov (United States)

    Oliveira, Mirna Fontenele de; Freitas, Maria Célia de

    2009-01-01

    This study aimed at identifying the most frequent Nursing Diagnoses and propose interventions for women under critical care into a maternal intensive care unit in a public hospital in Fortaleza, CE, Brazil. Retrospective study conducted with women's hospital health records. Ten Nursing Diagnoses were elaborated, being four risk: risk of infection, risk of unbalance of liquids volume, risk of aspiration, risk of damaged skin integrity and six real: altered maternity, impaired physical mobility, anxiety and impaired verbal communication. For the referred Nursing Diagnoses, nursing interventions are proposed according to the link between NANDA, NIC and NOC. It was concluded that the use of ND is a necessary technology for the Nursing reality, as it makes possible the integral care.

  5. History of pulmonary critical care nursing and where we are going.

    Science.gov (United States)

    Lareau, Suzanne C; Mealer, Meredith

    2012-09-01

    Pulmonary critical care nurses have played a prominent role in the ICUs from the inception of critical care units. This article describes how the history of pulmonary critical care nursing has evolved and discusses a few of the challenges in the years to come: stress imposed by working in a critical care environment, enhancing the care of patients by altering patterns of sedation and promoting early mobilization, and dealing with increasing infection rates.

  6. Behavior observation of major noise sources in critical care wards.

    Science.gov (United States)

    Xie, Hui; Kang, Jian; Mills, Gary H

    2013-12-01

    This study aimed to investigate the behavior patterns of typical noise sources in critical care wards and relate their patterns to health care environment in which the sources adapt themselves in several different forms. An effective observation approach was designed for noise behavior in the critical care environment. Five descriptors have been identified for the behavior observations, namely, interval, frequency, duration, perceived loudness, and location. Both the single-bed and the multiple-bed wards at the selected Critical Care Department were randomly observed for 3 inconsecutive nights, from 11:30 pm to 7:00 am the following morning. The Matlab distribution fitting tool was applied afterward to plot several types of distributions and estimate the corresponding parameters. The lognormal distribution was considered the most appropriate statistical distribution for noise behaviors in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals, and the longest durations, followed by monitor alarms. The perceived loudness of talking in the nighttime wards was classified into 3 levels (raised, normal, and low). Most people engaged in verbal communication in the single-bed wards that occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. "Monitor plus ventilator alarms" was the most commonly observed combination of multiple noises. © 2013 Elsevier Inc. All rights reserved.

  7. Involvement of Pharmacists in Medical Care in Emergency and Critical Care Centers.

    Science.gov (United States)

    Imai, Toru; Yoshida, Yoshikazu

    2016-01-01

    Emergency and critical care centers provide multidisciplinary therapy for critically ill patients by centralizing the expertise and technology of many medical professionals. Because the patients' conditions vary, different drug treatments are administered along with surgery. Therefore, the role of pharmacists is important. Critically ill patients who receive high-level invasive treatment undergo physiological changes differing from their normal condition along with variable therapeutic effects and pharmacokinetics. Pharmacists are responsible for recommending the appropriate drug therapy using their knowledge of pharmacology and pharmacokinetics. Further, pharmacists need to determine the general condition of patients by understanding vital signs, blood gas analysis results, etc. It is therefore necessary to conduct consultations with physicians and nurses. The knowledge required for emergency medical treatment is not provided during systematic training in pharmaceutical education, meaning that pharmacists acquire it in the clinical setting through trial and error. To disseminate the knowledge of emergency medical care to pharmacy students, emergency care training has been started in a few facilities. I believe that medical facilities and universities need to conduct joint educational sessions on emergency medical care. Moreover, compared with other medical fields, there are fewer studies on emergency medical care. Research-oriented pharmacists must resolve this issue. This review introduces the work conducted by pharmacists for clinical student education and clinical research at the Emergency and Critical Care Center of Nihon University Itabashi Hospital and discusses future prospects.

  8. Arabic translation and adaptation of Critical Care Family Satisfaction Survey.

    Science.gov (United States)

    Brown, Alison; Hijazi, Mohammed

    2008-08-01

    To translate and adapt the Critical Care Family Satisfaction Survey (CCFSS), and test its validity and reliability for use in Saudi Arabia. Seven hundred-bed tertiary care hospital in Saudi Arabia. Seventy-six adult relatives of patients who had been cared for in an intensive care unit for 24 hrs or more. The CCFSS, a battery of 20 items divided into five subscales, was translated into Arabic. After transfer of patients to regular inpatient units, interviewers administered the survey to their next-of-kin. Respondents ranked their satisfaction with each item on a 5-point Likert scale. Subscale scores were calculated as the average of the individual item scores. The total scale score was the sum of the subscale scores. The total scale and 'Information', 'Support', 'Comfort' and 'Assurance' subscales showed acceptable internal consistency (Spearman's correlation coefficient of the total score with each of the subscale scores = 0.52-0.81, Ptranslation and adaptation of the CCFSS is a valid, reliable and feasible tool to evaluate family satisfaction in Saudi Arabian intensive care units.

  9. Communication skills training curriculum for pulmonary and critical care fellows.

    Science.gov (United States)

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

    2015-04-01

    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

  10. Better infrastructure for critical care trials: nomenclature, etymology, and informatics.

    Science.gov (United States)

    Singh, Jeffrey M; Ferguson, Niall D

    2009-01-01

    The goals of this review article are to review the importance and value of standardized definitions in clinical research, as well as to propose the necessary tools and infrastructure needed to advance nosology and medial taxonomy to improve the quality of clinical trials in the field of critical care. We searched MEDLINE for relevant articles, reviewed those selected and their reference lists, and consulted personal files for relevant information. When the pathobiology of diseases is well understood, standard disease definitions can be extremely specific and precise; however, when the pathobiology of the disease is less well understood or more complex, biological markers may not be diagnostically useful or even available. In these cases, syndromic definitions effectively classify and group illnesses with similar symptoms and clinical signs. There is no clear gold standard for the diagnosis of many clinical entities in the intensive care unit, including notably both acute respiratory distress syndrome and sepsis. There are several types of consensus methods that can be used to explicate the judgmental approach that is often needed in these cases, including interactive or consensus groups, the nominal group technique, and the Delphi technique. Ideally, the definition development process will create clear and unambiguous language in which each definition accurately reflects the current understanding of the disease state. The development, implementation, evaluation, revision, and reevaluation of standardized definitions are keys for advancing the quality of clinical trials in the critical care arena.

  11. Supporting and Empowering Nurses Undergoing Critical Care Certification.

    Science.gov (United States)

    Beaudoin, Geneviève; St-Louis, Lyne; Alderson, Marie

    2016-01-01

    Nurses working in critical care settings face multiple sources of stress, such as complex clinical situations and the use of new advanced technologies, which can affect their psychological health. Literature suggests that the promotion of educational activities, such as a certification process within a specialty, can contribute to nurses' empowerment, professional growth, and personal satisfaction. However, it is of utmost importance that the institutional organizations support nurses undergoing the certification process to optimize positive impacts of this educational activity on the nurses, on the patients, and within the institutions. In the course of a graduate studies stage, an educational program aiming at supporting and creating an empowering environment for nurses undergoing a critical care certification process was developed and implemented, in a Canadian intensive care unit, over a 7-month period. The Humanist model was used as a theoretical framework and was complemented by the problem-based learning pedagogical approach. A postintervention qualitative questionnaire revealed that the program was tailored to nurses' learning needs and that participants felt supported by their institution throughout the process. This program could help institutions support nurses in achieving higher professional and personal development levels through specialty certification.

  12. Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program.

    Science.gov (United States)

    Anderson, Wendy G; Puntillo, Kathleen; Cimino, Jenica; Noort, Janice; Pearson, Diana; Boyle, Deborah; Grywalski, Michelle; Meyer, Jeannette; O'Neil-Page, Edith; Cain, Julia; Herman, Heather; Barbour, Susan; Turner, Kathleen; Moore, Eric; Liao, Solomon; Ferrell, Bruce; Mitchell, William; Edmonds, Kyle; Fairman, Nathan; Joseph, Denah; MacMillan, John; Milic, Michelle M; Miller, Monica; Nakagawa, Laura; O'Riordan, David L; Pietras, Christopher; Thornberry, Kathryn; Pantilat, Steven Z

    2017-09-01

    Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. To implement and evaluate a palliative care professional development program for ICU bedside nurses. From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P palliative care needs and created plans to address them. Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. ©2017 American Association of Critical-Care Nurses.

  13. Veterinary Medical Genetics: A Developing Discipline.

    Science.gov (United States)

    Womack, James E.; Templeton, Joe W.

    1978-01-01

    Areas that will influence the development of veterinary medical genetics as a clinical discipline are discussed, some critical research areas of immediate concern are suggested, and misconceptions held by many practicing veterinarians which must be corrected at the level of veterinary education are identified. (JMD)

  14. Accuracy of Human and Veterinary Point-of-Care Glucometers for Use in Rhesus Macaques (Macaca mulatta), Sooty Mangabeys (Cercocebus atys), and Chimpanzees (Pan troglodytes).

    Science.gov (United States)

    Clemmons, Elizabeth A; Stovall, Melissa I; Owens, Devon C; Scott, Jessica A; Jones-Wilkes, Amelia C; Kempf, Doty J; Ethun, Kelly F

    2016-01-01

    Handheld, point-of-care glucometers are commonly used in NHP for clinical and research purposes, but whether these devices are appropriate for use in NHP is unknown. Other animal studies indicate that glucometers should be species-specific, given differences in glucose distribution between RBC and plasma; in addition, Hct and sampling site (venous compared with capillary) influence glucometer readings. Therefore, we compared the accuracy of 2 human and 2 veterinary glucometers at various Hct ranges in rhesus macaques (Macaca mulatta), sooty mangabeys (Cercocebus atys), and chimpanzees (Pan troglodytes) with that of standard laboratory glucose analysis. Subsequent analyses assessed the effect of hypoglycemia, hyperglycemia, and sampling site on glucometer accuracy. The veterinary glucometers overestimated blood glucose (BG) values in all species by 26 to 75 mg/dL. The mean difference between the human glucometers and the laboratory analyzer was 7 mg/dL or less in all species. The human glucometers overestimated BG in hypoglycemic mangabeys by 4 mg/dL and underestimated BG in hyperglycemic mangabeys by 11 mg/dL; similar patterns occurred in rhesus macaques. Hct did not affect glucometer accuracy, but all samples were within the range at which glucometers generally are accurate in humans. BG values were significantly lower in venous than capillary samples. The current findings show that veterinary glucometers intended for companion-animal species are inappropriate for use in the studied NHP species, whereas the human glucometers showed clinically acceptable accuracy in all 3 species. Finally, potential differences between venous and capillary BG values should be considered when comparing and evaluating results.

  15. Anesthesiology critical care medicine: a fellowship and faculty recruitment program.

    Science.gov (United States)

    Rose, Steven H; Long, Timothy R; Kor, Daryl J; Onigkeit, James A; Brown, Daniel R

    2011-06-01

    To review national data on anesthesiology critical care medicine (ACCM) fellowship program enrollment and to describe a program that successfully recruited ACCM fellows and faculty at a single academic medical center. An incentive program known as the Mayo Clinic Scholar program, designed to recruit ACCM fellows and faculty, was reviewed. Interviews were conducted to assess the impact of the Mayo Clinic Scholar program. Academic health center. ACCM fellowship program enrollment data were compared with similar data for critical care medicine fellowship programs in internal medicine, pulmonary medicine, pediatrics, and surgery.The results of a program to recruit ACCM fellows and faculty were reviewed. Only 89 of 147 (60.5%) ACCM fellowship positions available nationally were filled during the 2010-2011 academic year, and only 89 of the 896 (9.9%) critical care medicine fellows anticipated to graduate in 2011 were in ACCM programs. The Mayo Clinic ACCM fellowship enrolled 28 fellows from January 1, 2000 through July 1, 2010 (range 0-6 per yr). Ten of the 28 (35.7%) were United States medical graduates (USMGs) and 6 of the 10 (60.0%) USMGs who were graduates of the Mayo Clinic residency were appointed as Mayo Clinic Scholars. All 6 Mayo Clinic Scholars were retained as ACCM faculty. Only two of the 6 (33.3%) Mayo Clinic Scholars would have completed ACCM training without a Mayo Clinic Scholar appointment. All recommend ACCM training to others and plan to continue to practice ACCM. The Mayo Clinic Scholar program effectively recruited ACCM fellows and faculty in a single institution. Incentive-based programs should be considered to support the involvement of anesthesiologists in perioperative medicine. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Ethical persuasion: the rhetoric of communication in critical care.

    Science.gov (United States)

    Dubov, Alex

    2015-06-01

    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.

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

    National Research Council Canada - National Science Library

    Bara, Meredith; Joffe, Ari R

    2014-01-01

    ...) in critical care animal research published in 2012. A data-collection form and instruction manual were created based on published recommendations, and completed for all consecutive critical care animal research (using mammals...

  18. [The process of professional qualification for the critical care nurse].

    Science.gov (United States)

    Santana, Neuranides; Fernandes, Josicélia Dumêt

    2008-01-01

    Study of qualitative approach based on the dialectic historical materialism, that aimed at analizing the conformation of professional credentialing process of the critical care nurse of a hospital in Salvador, BA, Brazil. The subjects were 29 nurses. The analysis was based on the Analysis of Content, with the technique of Thematic Analysis, directed by the dialectic method. Three categories correlated to credentialing were generated: technological sophistication; individual and the collective organizational and as product and instrument of the work process. The results demonstrated that the institution estimulates the credentialing process; however the administrative politicies make it difficult the effectuation of the process of credentialing of the nurses.

  19. Dose Adjustment- An Important Issue in Critical Care

    Directory of Open Access Journals (Sweden)

    Dr. M. C. Joshi

    2006-01-01

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

  20. Blood Product Administration in the Critical Care and Perioperative Settings.

    Science.gov (United States)

    Rygård, Sofie Louise; Holst, Lars Broksø; Perner, Anders

    2018-04-01

    The critical care and perioperative settings are high consumers of blood products, with multiple units and different products often given to an individual patient. The recommendation of this review is always to consider the risks and benefits for a specific blood product for a specific patient in a specific clinical setting. Optimize patient status by treating anemia and preventing the need for red blood cell transfusion. Consider other options for correction of anemia and coagulation disorders and use an imperative non-overtransfusion policy for all blood products. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Role of central venous pressure monitoring in critical care settings.

    Science.gov (United States)

    Thomas Hill, Barry

    2018-01-31

    Central venous pressure (CVP) monitoring is used to assess the fluid status of patients in critical care settings. This article explains CVP monitoring, discussing the rationale for its use, the ways CVP can be measured, and the physiological factors that can affect the reliability and validity of CVP measurement. It also discusses the complications associated with CVP monitoring and the nursing responsibilities in relation to this activity. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  2. Respect in critical care: a foundational ethical principle.

    Science.gov (United States)

    Rushton, Cynda Hylton

    2007-01-01

    Demonstrating respect is the hallmark of excellence in caring for critically ill patients and their families. Understanding the meaning of respect and the strategies that foster it are foundational for nurses as interdisciplinary healthcare professionals. Basically, respect is the act of esteeming another. Demonstrated by word and deed, it is fostered by attending to the whole person by involving the patient and family in decision making, providing family-centered care, bearing witness, and adopting a broader perspective marked by cultural humility. By creating processes that ensure everyone's views are heard, healthcare professionals as well as patients and their families are supported. One key process, known as the "Council Process," shifts dialogue from telling to discovering, from judging to inquiring; it neutralizes conjecture, fosters the acceptance of moral conflict, and protects the integrity of healthcare professionals and their organizations. Acknowledging respect as a foundational ethical principle is the first step toward relationally rich healthcare environments for patients, families, and professionals.

  3. Perceived and actual noise levels in critical care units.

    Science.gov (United States)

    White, Brittany Lynn; Zomorodi, Meg

    2017-02-01

    To compare the noise levels perceived by critical care nurses in the Intensive Care Unit (ICU) to actual noise levels in the ICU. Following a pilot study (n=18) and revision of the survey tool, a random sample of nurses were surveyed twice in a 3-day period (n=108). Nurses perception of noise was compared to the actual sound pressure level using descriptive statistics. Nurses perceived the ICUs to be noisier than the actual values. The ICU was louder than the recommended noise level for resotrative sleep. This finding raises the question of how we can assist nurses to reduce what they perceive to be a loud environment. Future work is needed to develop interventions specifically for nurses to raise awareness of noise in the ICU and to provide them with skills to assist in noise reduction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Stress management interventions for veterinary students.

    Science.gov (United States)

    Gelberg, Susan; Gelberg, Howard

    2005-01-01

    Two-hundred-and-eighty-nine veterinary students from all four years of the University of Tennessee, College of Veterinary Medicine (UTCVM) were invited to complete the Derogatis Stress Profile (DSP)1 and an original Demographic Data Profile (DDP). The DSP assessed the students' current experiences of perceived stress, and the DDP was designed to gather information about students' academic year, their living situations, their financial situations, their interest area within the veterinary medical profession, and their current methods of coping with stress. These data were gathered as a baseline measure of veterinary medical students' perceived level of stress and quality of life. In an earlier study, data were also collected from faculty and staff about the perceived quality of the climate and culture of the veterinary college. The results of the DSP and DDP suggest that, although veterinary students at UTCVM do not experience significant levels of stress overall, they do report higher levels of subjective stress, time pressure, and depression than the general population. The more companion animals that veterinary students cared for in their personal lives, the more likely they were to report higher levels of perceived stress. Lastly, there were significant differences between genders, with female veterinary students reporting higher levels of perceived stress than their male counterparts. The preliminary results of the climate and culture data suggest that faculty and staff of the veterinary college individually feel that they are cared for in the work environment and collectively believe that the college strives for excellence.

  5. Graduating nursing students' perceived preparedness for working in critical care areas.

    Science.gov (United States)

    Halcomb, Elizabeth J; Salamonson, Yenna; Raymond, Debra; Knox, Nicole

    2012-10-01

    This article reports a study examining the relationships between undergraduate students' demographics, educational preparation and clinical experience and their self reported preparedness for employment in critical care. Increasing demand for critical care services internationally, creates a need to grow the critical care nursing workforce. Limited data are available on factors affecting new graduate nurses' career choices. Final year nursing students from a multi-campus Australian University were surveyed during 2009. Over half of the participants were interested in seeking employment in critical care following graduation. Main reasons for choosing critical care nursing were: (i) like varied and challenging work; (ii) opportunities for professional development; and (iii) like working one-on-one with patients. The main barriers identified by participants were related to the lack of knowledge and clinical skills required to work in critical care. Using the 9-item confidence and interest in critical care nursing scale, the study revealed that male participants and those who spent more than 1 week clinical placement in critical care were significantly more likely to report greater confidence and interest in seeking employment in critical care areas. The value of placing nursing students in critical care areas for more than 1 week during undergraduate clinical placements is affirmed. Whilst most final year students report feeling prepared to work in critical care areas, the next step is to explore the transition of students as new graduates in critical care to identify professional and educational issues that impact on their retention. © 2011 Blackwell Publishing Ltd.

  6. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Nigerian Veterinary Journal 37(3). 2016. Okorie-Kanu et al. 160. NIGERIAN VETERINARY JOURNAL. ISSN 0331-3026. Nig. Vet. J., September 2016. Vol. 37 (3): ... Nigeria; 3Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, Enugu state,. Nigeria. ...... (ASVCP), International Veterinary.

  7. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    1Department of Veterinary Anatomy, Faculty of Veterinary Medicine, University of Ibadan, Nigeria.. 2Department of Veterinary Anatomy, College of Veterinary Medicine, Federal University of Abeokuta, Ogun State,. Nigeria. *Corresponding Authors: .... medial and lateral canthi of each eye. Philtrum Height (PH). Measured ...

  8. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    2000-07-02

    Jul 2, 2000 ... Nigerian Veterinary Journal 36(4). 2015. Owoyemi et al. 1341. NIGERIAN VETERINARY JOURNAL. ISSN 0331-3026. Nig. Vet. J., December 2015 ... medicine, 3Department of Veterinary Anatomy, Faculty of Veterinary Medicine, University of Ibadan, Nigeria. .... in wound or burn healing, internal intake of.

  9. Rethinking critical reflection on care: late modern uncertainty and the implications for care ethics.

    Science.gov (United States)

    Vosman, Frans; Niemeijer, Alistair

    2017-12-01

    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.

  10. The last hours of living in the ICU – priorities of care for critical care ...

    African Journals Online (AJOL)

    2006-11-16

    Nov 16, 2006 ... Critical care is associated with a high mortality rate. While this varies, overall it is likely to be between. 15% and 25%.1 In some cases death occurs almost immediately after an emergency admission and there is little time to prepare either the patient or the family. In the majority of cases, however, death ...

  11. Contextualizing critical care family needs through triangulation: an Australian study.

    Science.gov (United States)

    Burr, G

    1998-08-01

    Family needs and concerns within the critical care context have been thoroughly explored from the quantitative perspective utilizing the Critical Care Family Needs Inventory (CCFNI). Nursing interventions have been designed on the basis of the findings from these studies. However, while the CCFNI would seem to encompass all the possible needs of families with a critically ill loved one, at no time were the family members themselves consulted at length in regard to the development of the instrument, or in any subsequent validation studies. Individual reality generates the variables that are measured in a needs analysis, and the family member experiences encompass dimensions that are not easily assessed by quantification. In fact the unique experiences of family members underpin their perception of need. Methodological triangulation formed the basis for this study to determine the degree of confirmation (or otherwise) between family member respondents to the CCFNI (n = 105) and those participating in an interview (n = 26) designed to explore needs and experiences. The qualitative data served the purpose of completeness by providing a more contextual representation of needs and therefore greater depth of understanding of the whole construct. The results indicate that, while there were many areas of convergence between the two samples, there were also areas of diveregence. Two major needs emerged from the interviews that are not represented on the CCFNI: the need of family members to provide reassurance and support to the patient; and their need to protect (others as well as the patient). A more complete understanding of family needs was obtained through the contextualization of their experiences.

  12. Critical Care Management of Cerebral Edema in Brain Tumors.

    Science.gov (United States)

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

    2017-01-01

    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. © The Author(s) 2015.

  13. Sound intensity and noise evaluation in a critical care unit.

    Science.gov (United States)

    Lawson, Nancy; Thompson, Kim; Saunders, Gabrielle; Saiz, Jaya; Richardson, Jeannette; Brown, Deborah; Ince, Naomi; Caldwell, Marc; Pope, Diana

    2010-11-01

    Sound levels in intensive care units can be high. Unfortunately, high levels of sound tend to result in poor sleep quality, which leads to slower healing, poorer immune response, and decreased cognitive function. To measure sound levels to which patients in intensive care units are typically exposed. Peak sound pressure levels of alarms on medical devices set at different output levels were measured. Additionally, ambient sound pressure levels for durations of 10 to 24 hours were measured on 12 occasions in patients' rooms in the intensive care unit. Peak levels of equipment alarms measured inside a patient's room were high, and increased as the setting of the alarm level increased. The levels of these alarms when measured in an adjacent room did not increase with alarm output level. Mean sound levels inside the patient's room were generally less than 45 dB(A), but peak levels were often greater than 85 dB(C). Closing the door of the adjacent room did not decrease these peak levels. Peak and mean levels did not differ systematically during 24 hours of measurement. High-intensity equipment alarms disturb patients' sleep but are critical in a medical emergency. However, nurses should not assume that raising the alarm output level will ensure that the alarm is audible from an adjacent room. Ambient noise measurements indicate high peak levels during both day and night.

  14. A critical assessment of the performance criteria in confirmatory analysis for veterinary drug residue analysis using mass spectrometric detection in selected reaction monitoring mode.

    Science.gov (United States)

    Berendsen, Bjorn J A; Meijer, Thijs; Wegh, Robin; Mol, Hans G J; Smyth, Wesley G; Armstrong Hewitt, S; van Ginkel, Leen; Nielen, Michel W F

    2016-05-01

    Besides the identification point system to assure adequate set-up of instrumentation, European Commission Decision 2002/657/EC includes performance criteria regarding relative ion abundances in mass spectrometry and chromatographic retention time. In confirmatory analysis, the relative abundance of two product ions, acquired in selected reaction monitoring mode, the ion ratio should be within certain ranges for confirmation of the identity of a substance. The acceptable tolerance of the ion ratio varies with the relative abundance of the two product ions and for retention time, CD 2002/657/EC allows a tolerance of 5%. Because of rapid technical advances in analytical instruments and new approaches applied in the field of contaminant testing in food products (multi-compound and multi-class methods) a critical assessment of these criteria is justified. In this study a large number of representative, though challenging sample extracts were prepared, including muscle, urine, milk and liver, spiked with 100 registered and banned veterinary drugs at levels ranging from 0.5 to 100 µg/kg. These extracts were analysed using SRM mode using different chromatographic conditions and mass spectrometers from different vendors. In the initial study, robust data was collected using four different instrumental set-ups. Based on a unique and highly relevant data set, consisting of over 39 000 data points, the ion ratio and retention time criteria for applicability in confirmatory analysis were assessed. The outcomes were verified based on a collaborative trial including laboratories from all over the world. It was concluded that the ion ratio deviation is not related to the value of the ion ratio, but rather to the intensity of the lowest product ion. Therefore a fixed ion ratio deviation tolerance of 50% (relative) is proposed, which also is applicable for compounds present at sub-ppb levels or having poor ionisation efficiency. Furthermore, it was observed that retention time

  15. Welfare, law and ethics in the veterinary intensive care unit: (A discussion of the different types of suffering that patients may endure in the veterinary intensive care unit, the legal limits to that suffering, and the ethics underpinning at what point that suffering becomes 'un-necessary').

    Science.gov (United States)

    Fordyce, Peter S

    2017-03-01

    In UK law, allowing an animal protected under the Animal Welfare Act 2006 (AWA 2006) (as devolved) to suffer 'unnecessarily' may render the person responsible for it to prosecution. The act does not define suffering, although 'case law' suggests that suffering encompasses more than pain. Clinicians responsible for animals under their care in the intensive care unit (ICU) are likely to also be responsible in law for the welfare of those animals, and may be called upon to justify why any suffering was necessary, or more likely, why they did not act to end any suffering when it became 'unnecessary'. As animals are considered to be 'property' in law, the legal requirement to prevent 'unnecessary suffering' may conflict with the owner's property rights. Additionally, professional conflict may arise between the clinicians whose opinion of where the border between 'heroic treatment' and 'futile treatment' lays. Different types of suffering that might be relevant to clinical and ethical decision making for patients in the ICU are discussed, with suggestions for how these might be categorised, measured and recorded, so that objective data is available on which discussions about the animal's actual and projected welfare can be held with the animal's owner, and other clinicians involved in the case. The development of 'welfare scoring systems' for the ICU may assist clarifying the point at which heroic treatment is becoming futile, and therefore suffering becoming unnecessary, and place veterinary anaesthetists in an even stronger position to act as 'advocate for the animal' in their care. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

  16. Antimicrobial stewardship in small animal veterinary practice

    DEFF Research Database (Denmark)

    Guardabassi, Luca; Prescott, John F

    2015-01-01

    Despite the increasing recognition of the critical role for antimicrobial stewardship in preventing the spread of multidrug-resistant bacteria, examples of effective antimicrobial stewardship programs are rare in small animal veterinary practice. This article highlights the basic requirements...

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

    Directory of Open Access Journals (Sweden)

    Wei-qin LI

    2017-04-01

    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

  18. The need for veterinary nursing in Nigeria

    Directory of Open Access Journals (Sweden)

    Funmilayo A. Okanlawon, RN, PhD, FWACN

    2011-06-01

    Full Text Available Traditionally, nursing care has been identified as an integral part of human medicine but is not well recognised in veterinary medicine as practised in Nigeria. In caring for human beings, a nurse is expected to have the fundamental understanding of disease aetiology, manifestations, diagnosis, manage-ment, rehabilitation, prevention and control. This is equally applicable to the care of animals. The role of veterinary nursing in veterinary medicine is significant considering the multitude of issues involved in the care of animals. The keeping of domestic animals is becoming popular and consequently the spread of infectious diseases from animals to human beings is on the increase. It is vital for human beings and animals to coexist in a healthy environment. The authors examine the importance of nursing care in veterinary medicine, the current situation in Nigeria, the role of veterinary nurses, the inter-professional approach to veterinary medicine, preparedness for the emergence of infectious diseases and career opportunities for veterinary nurses. This premise falls within the context of the ‘One Health’ concept.

  19. Critical care pharmacy services in United States hospitals.

    Science.gov (United States)

    Maclaren, Robert; Devlin, John W; Martin, Steven J; Dasta, Joseph F; Rudis, Maria I; Bond, C A

    2006-04-01

    Critical care pharmacy activities have been described as fundamental, desirable, and optimal, but actual services provided have not been evaluated. To characterize the type and level of pharmacy services provided to intensive care units (ICUs). A 38 question survey was sent in 2 consecutive mailings to all US institutions (N = 3238) with an ICU. Questions were categorized according to clinical, educational, administrative, and scholarly activities, with levels of services stratified as fundamental, desirable, or optimal. Completed surveys were received from 382 (11.8%) institutions encompassing 1034 ICUs. Direct clinical pharmacy activities were provided at 62.2% of ICUs. The pharmacists in those programs attended rounds 4.4 +/- 1.5 days/wk, mean +/- SD, and had a workweek that consisted of patient care (43% of hours worked), drug distribution (26.2%), administration (12.6%), education (10.9%), and scholarly activities (7.3%). Fundamental clinical activities performed during at least 75% of patient ICU days were providing drug information, drug therapy evaluation, drug therapy intervention, and pharmacokinetic monitoring. Conducting in-services (92.8%), a fundamental service, was the only educational activity frequently provided. Most respondents were involved with at least one multidisciplinary committee, and 45.5% conducted scholarly activities. Desirable or optimal activities were not frequently provided across all service categories. Clinical pharmacists are directly involved as caregivers in nearly two-thirds of ICUs in the US. Although they provide a range of clinical and administrative services, involvement in educational and scholarly activities is variable. The level of services provided is consistent with the criteria deemed fundamental for improving patient care. Higher-order services are far less likely to be provided.

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

    Science.gov (United States)

    Heffner, Susan; Rudy, Sally

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ilan Roy

    2012-01-01

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

  2. Health consumers' experiences in Australian critical care units: postgraduate nurse education implications.

    Science.gov (United States)

    Gill, Fenella J; Leslie, Gavin D; Grech, Carol; Latour, Jos M

    2013-01-01

    To explore critical care patients and families experiences and seek their input into nurses' postgraduate educational preparation and practice. There is an inconsistency in the expected standard of practice to 'qualify' Australian critical care nurses. There has also been a lack of health consumer input in the development of postgraduate course curriculum and content. Following institutional ethics committee approval, purposive sampling was used to select participants for focus groups and individual interviews who had experienced intensive care or coronary care. Seventeen participants provided data which created two main thematic categories; the role of the critical care nurse and; minimum practice standards for postgraduate critical care course graduates. Both physical patient care and socio-emotional support of patients and family were identified as important for the critical care nurse role. The level of socio-emotional support provided by nurses was reported to be inconsistent. Components of socio-emotional support included communication, people skills, facilitating family presence and advocacy. These components were reflected in participants' concepts of minimum practice standards for postgraduate critical care course graduates; talking and listening skills, relating to and dealing with stressed people, individualizing care and patient and family advocacy. Health consumers' views emphasize that socio-emotional skills and behaviours need to be explicitly described in postgraduate critical care nursing course curricula and instruments developed to consistently assess these core competencies. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

  3. Extracorporeal Membrane Oxygenation Applications in Cardiac Critical Care.

    Science.gov (United States)

    Raleigh, Lindsay; Ha, Rich; Hill, Charles

    2015-12-01

    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. © The Author(s) 2015.

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

    Science.gov (United States)

    Jawoniyi, Oluwafunmilayo Ololade; Gormley, Kevin

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

  5. Creating healing intensive care unit environments: physical and psychological considerations in designing critical care areas.

    Science.gov (United States)

    Bazuin, Doug; Cardon, Kerrie

    2011-01-01

    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.

  6. Diabulimia: what it is and how to recognize it in critical care.

    Science.gov (United States)

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

    2009-01-01

    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.

  7. The Mississippi State University College of Veterinary Medicine Shelter Program

    Science.gov (United States)

    Bushby, Philip; Woodruff, Kimberly; Shivley, Jake

    2015-01-01

    Simple Summary First initiated in 1995 to provide veterinary students with spay/neuter experience, the shelter program at the Mississippi State University College of Veterinary Medicine has grown to be comprehensive in nature incorporating spay/neuter, basic wellness care, diagnostics, medical management, disease control, shelter management and biosecurity. Junior veterinary students spend five days in shelters; senior veterinary students spend 2-weeks visiting shelters in mobile veterinary units. The program has three primary components: spay/neuter, shelter medical days and Animals in Focus. Student gain significant hands-on experience and evaluations of the program by students are overwhelmingly positive. Abstract The shelter program at the Mississippi State University College of Veterinary Medicine provides veterinary students with extensive experience in shelter animal care including spay/neuter, basic wellness care, diagnostics, medical management, disease control, shelter management and biosecurity. Students spend five days at shelters in the junior year of the curriculum and two weeks working on mobile veterinary units in their senior year. The program helps meet accreditation standards of the American Veterinary Medical Association’s Council on Education that require students to have hands-on experience and is in keeping with recommendations from the North American Veterinary Medical Education Consortium. The program responds, in part, to the challenge from the Pew Study on Future Directions for Veterinary Medicine that argued that veterinary students do not graduate with the level of knowledge and skills that is commensurate with the number of years of professional education. PMID:26479234

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

    Science.gov (United States)

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

    2013-01-01

    The purpose of this study was to explore the relationship between caring behavior and the disposition toward critical thinking of nursing students in clinical practice. A structural equation model was used to test the hypothesized relationship between caring behavior and critical thinking skills. Caring is the core of nursing practice, and the disposition toward critical thinking is needed for competent nursing care. In a fast-paced and complex environment, however, "caring" may be lost. Because nursing students will become professional nurses, it is essential to explore their caring behaviors and critical thinking skills and to understand how to improve their critical thinking skills based on their caring behavior. A cross-sectional study was used, with convenience sampling of students who were participating in associate degree nursing programs at 3 colleges of nursing. The following instruments were used: critical thinking disposition inventory Chinese version and caring behaviors scale. The study found that individuals with a higher frequency of caring behaviors had a higher score on critical thinking about nursing practice (β = .44, t = 5.14, P critical thinking. The findings of this study revealed the importance of caring behavior and its relationship with the disposition toward critical thinking. Thus, it is recommended that nursing education should emphasize a curriculum related to caring behavior to improve the disposition toward critical thinking of nursing students. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Kaddoura, Mahmoud A

    2010-09-01

    It is essential for nurses to develop critical thinking skills to ensure their ability to provide safe and effective care to patients with complex and variable needs in ever-changing clinical environments. To date, very few studies have been conducted to examine how nursing orientation programs develop the critical thinking skills of novice critical care nurses. Strikingly, no research studies could be found about the American Association of Critical Care Nurses Essentials of Critical Care Orientation (ECCO) program and specifically its effect on the development of nurses' critical thinking skills. This study explored the perceptions of new graduate nurses regarding factors that helped to develop their critical thinking skills throughout their 6-month orientation program in the intensive care unit. A convenient non-probability sample of eight new graduates was selected from a hospital that used the ECCO program. Data were collected with demographic questionnaires and semi-structured interviews. An exploratory qualitative research method with content analysis was used to analyze the data. The study findings showed that new graduate nurses perceived that they developed critical thinking skills that improved throughout the orientation period, although there were some challenges in the ECCO program. This study provides data that could influence the development and implementation of future nursing orientation programs. Copyright 2010, SLACK Incorporated.

  10. [End-of-life decision-making in critical care].

    Science.gov (United States)

    Trenchs Sáinz De La Maza, V; Cambra Lasaosa, F J; Palomeque Rico, A; Balcells Ramírez, J; Seriñá Ramírez, C; Hermana Tezanos Mf, M feminine T

    2002-12-01

    Introduction Termination of artificial life-support in critically-ill patients without chance of recovery or with severe damage is frequent in the intensive care unit (UCI). Patients and methodsWe studied the present situation concerning the withdrawal of life support in Spain using data collected over 10 years in referral hospitals with pediatric ICUs. Forty-nine patients were included, of which 43 had chronic diseases.ResultsThe most frequent causes of admission to the pediatric ICU in this type of patiens was respiratory failure followed by cardiovascular surgery. The family seemed to be a key element when taking a decision although in a few cases the medical team acted paternalistically. The most common ways of limiting life-support were withholding or withdrawing some treatments (mainly mechanical ventilation and vasoactive drugs) and implementing do-not-resuscitate orders. Sedation and suitable pain management were widely used in terminal care. After the decision to limit life-support was made, six patients were discharged from the pediatric ICU. ConclusionsAlthough each case should be treated individually, because of the wide variation found in the limitation of life-support, we suggest the need for common guidelines that could help the decision-making process.

  11. Developing algorithm for the critical care physician scheduling

    Science.gov (United States)

    Lee, Hyojun; Pah, Adam; Amaral, Luis; Northwestern Memorial Hospital Collaboration

    Understanding the social network has enabled us to quantitatively study social phenomena such as behaviors in adoption and propagation of information. However, most work has been focusing on networks of large heterogeneous communities, and little attention has been paid to how work-relevant information spreads within networks of small and homogeneous groups of highly trained individuals, such as physicians. Within the professionals, the behavior patterns and the transmission of information relevant to the job are dependent not only on the social network between the employees but also on the schedules and teams that work together. In order to systematically investigate the dependence of the spread of ideas and adoption of innovations on a work-environment network, we sought to construct a model for the interaction network of critical care physicians at Northwestern Memorial Hospital (NMH) based on their work schedules. We inferred patterns and hidden rules from past work schedules such as turnover rates. Using the characteristics of the work schedules of the physicians and their turnover rates, we were able to create multi-year synthetic work schedules for a generic intensive care unit. The algorithm for creating shift schedules can be applied to other schedule dependent networks ARO1.

  12. Managing diagnostic uncertainty in primary care: a systematic critical review.

    Science.gov (United States)

    Alam, Rahul; Cheraghi-Sohi, Sudeh; Panagioti, Maria; Esmail, Aneez; Campbell, Stephen; Panagopoulou, Efharis

    2017-08-07

    Diagnostic uncertainty is one of the largest contributory factors to the occurrence of diagnostic errors across most specialties in medicine and arguably uncertainty is greatest in primary care due to the undifferentiated symptoms primary care physicians are often presented with. Physicians can respond to diagnostic uncertainty in various ways through the interplay of a series of cognitive, emotional and ethical reactions. The consequences of such uncertainty however can impact negatively upon the primary care practitioner, their patients and the wider healthcare system. Understanding the nature of the existing empirical literature in relation to managing diagnostic uncertainty in primary medical care is a logical and necessary first step in order to understand what solutions are already available and/or to aid the development of any training or feedback aimed at better managing this uncertainty. This review is the first to characterize the existing empirical literature on managing diagnostic uncertainty in primary care. Sixteen databases were systematically searched from inception to present with no restrictions. Hand searches of relevant websites and reference lists of included studies were also conducted. Two authors conducted abstract/article screening and data extraction. PRISMA guidelines were adhered to. Ten studies met the inclusion criteria. A narrative and conceptual synthesis was undertaken under the premises of critical reviews. Results suggest that studies have focused on internal factors (traits, skills and strategies) associated with managing diagnostic uncertainty with only one external intervention identified. Cognitive factors ranged from the influences of epistemological viewpoints to practical approaches such as greater knowledge of the patient, utilizing resources to hand and using appropriate safety netting techniques. Emotional aspects of uncertainty management included clinicians embracing uncertainty and working with provisional diagnoses

  13. Relationship between job burnout, psychosocial factors and health care-associated infections in critical care units.

    Science.gov (United States)

    Galletta, Maura; Portoghese, Igor; D'Aloja, Ernesto; Mereu, Alessandra; Contu, Paolo; Coppola, Rosa Cristina; Finco, Gabriele; Campagna, Marcello

    2016-06-01

    Burnout is a serious problem for critical care unit workers because they are exposed to chronic psychosocial stressors, including high responsibility, advanced technology and high patient acuity. Recent evidence showed that staff burnout was directly associated with hospital infections, thus affecting quality and safety of care provided. The research aim was to investigate how burnout was associated with some psychosocial factors and with health care-associated infections in hospitalised patients. A total of 130 healthcare professionals from critical care units completed a self-reported questionnaire. The infection data were collected prospectively over a six-month period. The results showed that emotional exhaustion was related to cynicism due to high work demands. Cynicism affected team communication, which in turn was positively related to team efficacy, thus acting as a mediator. Finally, team efficacy was negatively related to infections. The study showed that emotional exhaustion and cynicism were related to psychosocial aspects, which in turn had a significant impact on healthcare-associated infections. Our findings suggest how burnout can indirectly affect healthcare-related infections as a result of the quality of teamwork. Thus, reducing burnout can be a good strategy to decrease infections, thus increasing workers' well-being while improving patient care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Critical incidents connected to nurses' leadership in Intensive Care Units.

    Science.gov (United States)

    Lima, Elaine Cantarella; Bernardes, Andrea; Baldo, Priscila Lapaz; Maziero, Vanessa Gomes; Camelo, Silvia Helena Henriques; Balsanelli, Alexandre Pazetto

    2017-01-01

    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. Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. 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. 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. Analisar a liderança do enfermeiro em Centros de Terapia Intensiva de hospitais localizados no interior do estado de São Paulo, diante de incidentes críticos positivos e negativos. Estudo exploratório, descritivo, realizado com 24 enfermeiros, que utilizou a Técnica do Incidente Crítico como referencial metodológico. Os resultados foram agrupados em 61 incidentes críticos distribuídos em categorias. Identificou-se que situações relacionadas à liderança interferem no comportamento do enfermeiro de Terapia Intensiva, dentre elas: dificuldade no processo de comunicação, conflitos existentes no dia a dia do exercício profissional, gerenciamento de pessoas e estabelecimento de metas para o alcance da assistência qualificada. Encontrou-se um modelo misto de liderança, o que permite concluir que o conhecimento e a prática dos enfermeiros acerca de teorias/estilos contemporâneos de liderança tornam-se fundamentais, pois

  15. Nurse Practitioner/Physician Assistant Staffing and Critical Care Mortality

    Science.gov (United States)

    Costa, Deena Kelly; Wallace, David J.; Barnato, Amber E.

    2014-01-01

    BACKGROUND: ICUs are increasingly staffed with nurse practitioners/physician assistants (NPs/PAs), but it is unclear how NPs/PAs influence quality of care. We examined the association between NP/PA staffing and in-hospital mortality for patients in the ICU. METHODS: We used retrospective cohort data from the 2009 to 2010 APACHE (Acute Physiology and Chronic Health Evaluation) clinical information system and an ICU-level survey. We included patients aged ≥ 17 years admitted to one of 29 adult medical and mixed medical/surgical ICUs in 22 US hospitals. Because this survey could not assign NPs/PAs to individual patients, the primary exposure was admission to an ICU where NPs/PAs participated in patient care. The primary outcome was patient-level in-hospital mortality. We used multivariable relative risk regression to examine the effect of NPs/PAs on in-hospital mortality, accounting for differences in case mix, ICU characteristics, and clustering of patients within ICUs. We also examined this relationship in the following subgroups: patients on mechanical ventilation, patients with the highest quartile of Acute Physiology Score (> 55), and ICUs with low-intensity physician staffing and with physician trainees. RESULTS: Twenty-one ICUs (72.4%) reported NP/PA participation in direct patient care. Patients in ICUs with NPs/PAs had lower mean Acute Physiology Scores (42.4 vs 46.7, P < .001) and mechanical ventilation rates (38.8% vs 44.2%, P < .001) than ICUs without NPs/PAs. Unadjusted and risk-adjusted mortality was similar between groups (adjusted relative risk, 1.10; 95% CI, 0.92-1.31). This result was consistent in all examined subgroups. CONCLUSIONS: NPs/PAs appear to be a safe adjunct to the ICU team. The findings support NP/PA management of critically ill patients. PMID:25167081

  16. Final-year veterinary students' perceptions of their communication competencies and a communication skills training program delivered in a primary care setting and based on Kolb's Experiential Learning Theory.

    Science.gov (United States)

    Meehan, Michael P; Menniti, Marie F

    2014-01-01

    Veterinary graduates require effective communication skills training to successfully transition from university into practice. Although the literature has supported the need for veterinary student communication skills training programs, there is minimal research using learning theory to design programs and explore students' perceptions of such programs. This study investigated veterinary students' perceptions of (1) their communication skills and (2) the usefulness of a communication skills training program designed with Kolb's Experiential Learning Theory (ELT) as a framework and implemented in a primary care setting. Twenty-nine final-year veterinary students from the Ontario Veterinary College attended a 3-week communication skills training rotation. Pre- and post-training surveys explored their communication objectives, confidence in their communication skills, and the usefulness of specific communication training strategies. The results indicated that both before and after training, students were most confident in building rapport, displaying empathy, recognizing how bonded a client is with his or her pet, and listening. They were least confident in managing clients who were angry or not happy with the charges and who monopolized the appointment. Emotionally laden topics, such as breaking bad news and managing euthanasia discussions, were also identified as challenging and in need of improvement. Interactive small-group discussions and review of video-recorded authentic client appointments were most valuable for their learning and informed students' self-awareness of their non-verbal communication. These findings support the use of Kolb's ELT as a theoretical framework and of video review and reflection to guide veterinary students' learning of communication skills in a primary care setting.

  17. Caring for critically ill patients outside intensive care units due to full units: a cohort study.

    Science.gov (United States)

    Urizzi, Fabiane; Tanita, Marcos T; Festti, Josiane; Cardoso, Lucienne T Q; Matsuo, Tiemi; Grion, Cintia M C

    2017-10-01

    This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

  18. Domestic violence shelter partnerships and veterinary student attitudes at North American veterinary schools and colleges.

    Science.gov (United States)

    Creevy, Kate E; Shaver, Stephanie L; Cornell, Karen K

    2013-01-01

    Animal abuse and domestic violence are linked issues, and pet ownership is reported to play a crucial role in the choice to leave an abusive situation. Although veterinarians witness the effects of abuse and violence over the course of their careers, they have limited training regarding these issues. One mechanism for educating veterinary students while providing a service for victims of domestic violence is the creation of partnerships between domestic violence shelters and veterinary schools. These extracurricular programs can provide both care for pets belonging to victims of domestic violence and an educational platform for student participants. The goals of this study were to determine the prevalence and characteristics of domestic violence shelter partnerships (DVSPs) at North American veterinary teaching hospitals and to determine whether the presence of a DVSP was associated with increased awareness among veterinary students regarding animal abuse and domestic violence. Nine of 33 veterinary schools surveyed described a DVSP program. Students at schools with DVSPs associated with their veterinary teaching hospitals were significantly more likely to indicate that their awareness of the link between animal abuse and domestic violence had increased during veterinary school. Most veterinary students reported that they felt poorly prepared to handle domestic violence and animal abuse issues in the workplace. This study indicates that extracurricular DVSPs are a viable means of educating veterinary students regarding domestic violence and animal abuse. A need for improved education on these topics in veterinary schools across North America is identified.

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

    African Journals Online (AJOL)

    The delivery of quality patient care remains a challenge in critical care services, especially where resources are stretched and the health care system fragmented. Integrating sound theory with clinical practice can benefit from the introduction of valid, reliable research findings at the bedside for the benefit of the critically ill ...

  20. Speaking Up: Veterinary Ethical Responsibilities and Animal Welfare Issues in Everyday Practice

    Science.gov (United States)

    Hernandez, Elein; Fawcett, Anne; Brouwer, Emily; Rau, Jeff

    2018-01-01

    Simple Summary Veterinarians have an ethical obligation to provide good care for the animals that they see in practice. However, at times, there may be conflicts between the interests of animal caregivers or owners, the interests of veterinarians and the interests of animals. We provide an overview of why and how veterinary ethics is taught to veterinary students, as well as providing a context for thinking about veterinary ethical challenges and animal welfare issues. We argue that veterinarians are ethically obliged to speak up and ask questions when problems arise or are seen and provide a series of clinical case examples in which there is scope for veterinarians to improve animal welfare by ‘speaking up’. Abstract Although expectations for appropriate animal care are present in most developed countries, significant animal welfare challenges continue to be seen on a regular basis in all areas of veterinary practice. Veterinary ethics is a relatively new area of educational focus but is thought to be critically important in helping veterinarians formulate their approach to clinical case management and in determining the overall acceptability of practices towards animals. An overview is provided of how veterinary ethics are taught and how common ethical frameworks and approaches are employed—along with legislation, guidelines and codes of professional conduct—to address animal welfare issues. Insufficiently mature ethical reasoning or a lack of veterinary ethical sensitivity can lead to an inability or difficulty in speaking up about concerns with clients and ultimately, failure in their duty of care to animals, leading to poor animal welfare outcomes. A number of examples are provided to illustrate this point. Ensuring that robust ethical frameworks are employed will ultimately help veterinarians to “speak up” to address animal welfare concerns and prevent future harms. PMID:29361786

  1. Thirtieth Annual Congress on Veterinary Acupuncture: IVAS Report

    Directory of Open Access Journals (Sweden)

    Krishna Kaphle

    2005-01-01

    Full Text Available More than 155 participants from 25 countries attended the 30th Annual IVAS Congress, September 8–11, 2004 in Oostende, Belgium. The focus was on veterinary acupuncture (AP and immunology, and the event was sponsored by the International Veterinary Acupuncture Society (IVAS. IVAS is a non-profit organization dedicated to promoting excellence in the practice of veterinary AP as an integral part of the total veterinary health care delivery system. The Society endeavors to establish uniformly high standards of veterinary AP through its educational programs and accreditation examination. IVAS seeks to integrate veterinary AP and the practice of Western veterinary science, while also noting that the science of veterinary AP does not overlook allied health systems, such as homeopathy, herbology, nutrition, chiropractic, kinesiology, etc. (www.ivas.org.

  2. The carbon footprint of acute care: how energy intensive is critical care?

    Science.gov (United States)

    Pollard, A S; Paddle, J J; Taylor, T J; Tillyard, A

    2014-09-01

    Climate change has the potential to threaten human health and the environment. Managers in healthcare systems face significant challenges to balance carbon mitigation targets with operational decisions about patient care. Critical care units are major users of energy and hence more evidence is needed on their carbon footprint. The authors explore a methodology which estimates electricity use and associated carbon emissions within a Critical Care Unit (CCU). A bottom-up model was developed and calibrated which predicted the electricity consumed and carbon emissions within a CCU based on the type of patients treated and working practices in a case study in Cornwall, UK. The model developed was able to predict the electricity consumed within CCU with an error of 1% when measured against actual meter readings. Just under half the electricity within CCU was used for delivering care to patients and monitoring their condition. A model was developed which accurately predicted the electricity consumed within a CCU based on patient types, medical devices used and working practice. The model could be adapted to enable it to be used within hospitals as part of their planning to meet carbon reduction targets. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  3. Veterinary Technologists and Technicians

    Science.gov (United States)

    ... State & Area Data Explore resources for employment and wages by state and area for veterinary technologists and technicians. Similar Occupations Compare the job duties, education, job growth, and pay of veterinary technologists and ...

  4. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Department of Veterinary Pathology and Microbiology; Faculty of Veterinary Medicine, Universiti Putra Malaysia, ... Parasitic diseases have a debilitating impact on human and animal health worldwide particularly in developing countries. Haemoparasitism have largely been ..... exerts a major health concern in domestic.

  5. Biomarkers in Veterinary Medicine.

    Science.gov (United States)

    Myers, Michael J; Smith, Emily R; Turfle, Phillip G

    2017-02-08

    This article summarizes the relevant definitions related to biomarkers; reviews the general processes related to biomarker discovery and ultimate acceptance and use; and finally summarizes and reviews, to the extent possible, examples of the types of biomarkers used in animal species within veterinary clinical practice and human and veterinary drug development. We highlight opportunities for collaboration and coordination of research within the veterinary community and leveraging of resources from human medicine to support biomarker discovery and validation efforts for veterinary medicine.

  6. Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program.

    Science.gov (United States)

    Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya

    2016-12-01

    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.

  7. Incorporating active-learning techniques and competency assessment into a critical care elective course.

    Science.gov (United States)

    Malcom, Daniel R; Hibbs, Jennifer L

    2012-09-10

    To design, implement, and measure the effectiveness of a critical care elective course for second-year students in a 3-year accelerated doctor of pharmacy (PharmD) program. A critical care elective course was developed that used active-learning techniques, including cooperative learning and group presentations, to deliver content on critical care topics. Group presentations had to include a disease state overview, practice guidelines, and clinical recommendations, and were evaluated by course faculty members and peers. Students' mean scores on a 20-question critical-care competency assessment administered before and after the course improved by 11% (p critical care elective course resulted in significantly improved competency in critical care and was well-received by students.

  8. Notes on critical care-review of seminal management and leadership papers in the United Kingdom.

    Science.gov (United States)

    Coombs, Maureen

    2009-06-01

    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.

  9. Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup.

    Science.gov (United States)

    Mularski, Richard A; Curtis, J Randall; Billings, J Andrew; Burt, Robert; Byock, Ira; Fuhrman, Cathy; Mosenthal, Anne C; Medina, Justine; Ray, Daniel E; Rubenfeld, Gordon D; Schneiderman, Lawrence J; Treece, Patsy D; Truog, Robert D; Levy, Mitchell M

    2006-11-01

    For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, measure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a consensus process to develop a preliminary set of quality measures to assess palliative care in the critically ill. We built on earlier and ongoing efforts of the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup to propose specific measures of the structure and process of palliative care. We used an informal iterative consensus process to identify and refine a set of candidate quality measures. These candidate measures were developed by reviewing previous literature reviews, supplementing the evidence base with recently published systematic reviews and consensus statements, identifying existing indicators and measures, and adapting indicators from related fields for our objective. Among our primary sources, we identified existing measures from the Voluntary Hospital Association's Transformation of the ICU program and a government-sponsored systematic review performed by RAND Health to identify palliative care quality measures for cancer care. Our consensus group proposes 18 quality measures to assess the quality of palliative care for the critically ill and injured. A total of 14 of the proposed measures assess processes of care at the patient level, and four measures explore structural aspects of critical care delivery. Future research is needed to assess the relationship of these measures to desired health outcomes. Subsequent measure sets should also attempt to include outcome measures, such as patient or surrogate satisfaction, as the field develops the means to rigorously measure such outcomes. The proposed measures are intended to stimulate further discussion, testing, and refinement for quality of care measurement and

  10. Nigerian Veterinary Journal

    African Journals Online (AJOL)

    The Nigerian Veterinary Journal (NVJ) has been in existence since 1971. The NVJ is published by the Nigerian Veterinary Medical Association (NVMA) as part of the association's commitment to the advancement of Veterinary Medicine in Nigeria and other parts of the world, with a general view of enhancing the livestock ...

  11. Tanzania Veterinary Journal

    African Journals Online (AJOL)

    The Tanzania Veterinary Journal (The Tropical Veterinarian) is a biannual Journal, which publishes original contribution to knowledge on Veterinary Science, Animal Science and Production, and allied sciences including new techniques and developments in Veterinary Medicine. The target readers of the Journal are the ...

  12. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Nigerian Veterinary Journal 38(3). 2017. Gberindyer et al. 250. NIGERIAN VETERINARY JOURNAL. ISSN 0331-3026. Nig. Vet. J., September 2017. Vol 38 (3): 250-259. ORIGINAL ARTICLE. Drugs Prescription Pattern in Dogs Diagnosed with Parvovirus Enteritis in Some Veterinary Clinics in Nigeria. Gberindyer, F. A.. 1.

  13. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    1Department of Veterinary Anatomy, Michael Okpara University of Agriculture, Umudike, Nigeria, 2Department of. Veterinary Anatomy ... laboratory technologists and academic staff of the departments of veterinary anatomy, pathology and public health. Design of the ... Early histology and histopathology based research was ...

  14. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Nigerian Veterinary Journal 38(2). 2017. Mustapha et al. 129 ... 1 Department of Veterinary Anatomy, College of Veterinary Medicine, Federal University of Agriculture Abeokuta,. Abeokuta, Ogun State; 2 ..... lamina 9; IB: Internal basilar nucleus; ICI: Intercalated nucleus; ICo9: Intercostal muscle motor neurons of lamina 9; ...

  15. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Nigerian Veterinary Journal 37(3). 2016. Thomas et al. 123 .... Veterinary Medicine, Federal University of. Agriculture Abeokuta and were ..... immunogenic Salmonella ghost confers protection against internal organ colonization and egg contamination. Veterinary immunology and immunopathology,. 162(1-2): 41–50. JOSHI ...

  16. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    1288. NIGERIAN VETERINARY JOURNAL. ISSN 0331-3026. Nig. Vet. J., December 2015. Vol. 36 (4): 1288-1298. ORIGINAL ARTICLE. Anatomical Studies of ... 1Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Ilorin, Ilorin, Nigeria; 2 Department of .... back, the internal organs were measured in.

  17. Persepsi Perawat Neurosurgical Critical Care Unitterhadap Perawatan Pasien Menjelang Ajal

    Directory of Open Access Journals (Sweden)

    Meilita Enggune

    2017-08-01

    Full Text Available Tingginya angka kematian yang terjadi di unit perawatan intensif, menuntut peningkatan pelayanan perawatan paliatif termasuk perawatan pasien menjelang ajal, yang melibatkan perawat perawatan kritis. Tujuan penelitian ini untuk memperoleh gambaran persepsi perawat terhadap perawatan pasien menjelang ajal di ruang Neurosurgical Critical Care Unit(NCCU. Delapan perawat pelaksana di ruang NCCU RSHS Bandung dilibatkan dalam penelitian deskriptif kualitatif ini dengan rentang usia antara 27– 43 tahun, dan bekerja selama 3–20 tahun. Teknik sampling yang digunakan adalah purposive samplingdan jumlah informan dibatasi setelah data jenuh. Pengumpulan data dengan melakukan wawancara semi terstruktur, dan analisis yang digunakan adalah content analysis. Hasil penelitian didapatkan 4 tema dan 15 subtema yaitu: (1 Pemahaman perawat tentang perawatan pasien menjelang ajal yaitu: membantu pasien meninggal dengan tenang, menghadirkan keluarga untuk memberikan dukungan, dan lebih berfokus pada bimbingan spiritual; (2 Cara menghadapi kematian yang sering terjadi yaitu: adaptasi perawat terhadap kondisi pasien menjelang ajal, kesulitan menentukan fase menjelang ajal pasien kritis, dilema dalam pengambilan keputusan, dan empati; (3 Peran perawat dalam mempersiapkan pasien menjelang ajal yaitu: pembimbing spiritual pasien, komunikator, fasilitator, dan pemberi dukungan emosional keluarga; (4 Hal-hal yang perlu diperbaiki dalam perawatan menjelang ajal yaitu: diperlukan pelatihan perawatan paliatif pada pasien kritis, diperlukan ruangan khusus pasien menjelang ajal, diperlukan pembimbing rohani khusus, dan diperlukan standar operasional prosedur (SOP perawatan pasien menjelang ajal. Perawat perlu memberikan perawatan yang membantu pasien meninggal dengan tenang, memberikan dukungan untuk keluarga, dan lebih difokuskan untuk memenuhi kebutuhan spiritual pasien.

  18. The standardization debate: A conflation trap in critical care electroencephalography.

    Science.gov (United States)

    Ng, Marcus C; Gaspard, Nicolas; Cole, Andrew J; Hoch, Daniel B; Cash, Sydney S; Bianchi, Matt; O'Rourke, Deirdre A; Rosenthal, Eric S; Chu, Catherine J; Westover, M Brandon

    2015-01-01

    Persistent uncertainty over the clinical significance of various pathological continuous electroencephalography (cEEG) findings in the intensive care unit (ICU) has prompted efforts to standardize ICU cEEG terminology and an ensuing debate. We set out to understand the reasons for, and a satisfactory resolution to, this debate. We review the positions for and against standardization, and examine their deeper philosophical basis. We find that the positions for and against standardization are not fundamentally irreconcilable. Rather, both positions stem from conflating the three cardinal steps in the classic approach to EEG, which we term "description", "interpretation", and "prescription". Using real-world examples we show how this conflation yields muddled clinical reasoning and unproductive debate among electroencephalographers that is translated into confusion among treating clinicians. We propose a middle way that judiciously uses both standardized terminology and clinical reasoning to disentangle these critical steps and apply them in proper sequence. The systematic approach to ICU cEEG findings presented herein not only resolves the standardization debate but also clarifies clinical reasoning by helping electroencephalographers assign appropriate weights to cEEG findings in the face of uncertainty. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  19. Music reduces patient anxiety during interfacility ground critical care transport.

    Science.gov (United States)

    Stuhlmiller, David F E; Lamba, Sangeeta; Rooney, Mark; Chait, Steven; Dolan, Brian

    2009-01-01

    Interfacility ground critical care transport (CCT) of patients by ambulance may be stressful. This study evaluated whether playing music during CCT reduces patient anxiety and whether objective evidence is manifested by a change in vital signs. Urban teaching hospital. In this prospective cohort study, music was played for eligible adult patients during CCT while recording vital signs. A questionnaire was subsequently mailed to patients to rate whether the ambulance transport was stressful, the impact music had on transport, whether music changed their anxiety, whether music made them comfortable and relaxed, and whether they would prefer music to be played on future transports. Vital signs were compared between respondents who perceived transport as stressful and those who did not. One hundred two patients were enrolled; 23 respondents (22.5%) constituted the study group. Four patients (17.4%) reported CCT as stressful (average response, 4.75). Nineteen (82.6%) rated CCT as not stressful (average response, 1.63). Subjectively, patients reported a positive impact of music on transport, with improved comfort and relaxation but only a minimal decrease in anxiety. No statistically significant change in vital signs was observed between cohorts; too few patients were enrolled to generate power to detect any difference. Music therapy is a simple adjunct for use during CCT that may increase patient comfort and alleviate anxiety. The small number of patients in this preliminary report limits the strength of any conclusions. Larger studies are needed.

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

    Science.gov (United States)

    Klausen, Andreas; Röhrig, Rainer; Lipprandt, Myriam

    2016-01-01

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

  1. A two phase study to revise the Australian Practice Standards for Specialist Critical Care Nurses.

    Science.gov (United States)

    Gill, Fenella J; Kendrick, Tina; Davies, Hugh; Greenwood, Melanie

    2017-05-01

    Observational work to develop the ACCCN Competency Standards was undertaken more than 20 years ago. Since then the landscape of critical care nursing as a specialty has changed and it is not known if the Competency Standards reflected contemporary practice. To revise the ACCCN Competency Standards for Specialist Critical Care Nurses to ensure they continue to meet the needs of critical care nurses and reflect current practice. A two-phased project was undertaken. In Phase I focus groups were held in all states. Thematic analysis was conducted using two techniques. The standards were revised based on the main themes. Phase II consisted of an eDelphi technique. A national panel of critical care nurses responded to three survey rounds using a 7 point likert-type scale to indicate their level of agreement with the revised standards. A 70% agreement level for each statement was determined a priori. Phase I: 12 focus groups (79 participants) were conducted. Phase II: A panel of specialist critical care nurses (research, management, clinical practice and education) responded to round 1 (n=64), round 2 (n=56), and round 3 (n=40). Fifteen practice standards with elements and performance criteria were grouped into four domains (professional practice, provision and coordination of care, critical thinking and analysis, collaboration and leadership). The revised Practice Standards for Specialist Critical Care Nurses build upon and are additional to the Nursing & Midwifery Board of Australia National Competency Standards for Registered Nurses. The standards reflect contemporary critical care nurse practices using an expanded range of technologies to care for complex critically ill patients across the lifespan in diverse settings. The national study has resulted in the 3rd edition of the Practice Standards for Specialist Critical Care Nurses. There was input from stakeholders and agreement that the revised standards capture contemporary Australian critical care nursing practice

  2. The Mississippi State University College of Veterinary Medicine Shelter Program.

    Science.gov (United States)

    Bushby, Philip; Woodruff, Kimberly; Shivley, Jake

    2015-04-24

    The shelter program at the Mississippi State University College of Veterinary Medicine provides veterinary students with extensive experience in shelter animal care including spay/neuter, basic wellness care, diagnostics, medical management, disease control, shelter management and biosecurity. Students spend five days at shelters in the junior year of the curriculum and two weeks working on mobile veterinary units in their senior year. The program helps meet accreditation standards of the American Veterinary Medical Association's Council on Education that require students to have hands-on experience and is in keeping with recommendations from the North American Veterinary Medical Education Consortium. The program responds, in part, to the challenge from the Pew Study on Future Directions for Veterinary Medicine that argued that veterinary students do not graduate with the level of knowledge and skills that is commensurate with the number of years of professional education.

  3. Anesthesia and critical-care delivery in weightlessness: A challenge for research in parabolic flight analogue space surgery studies

    Science.gov (United States)

    Ball, Chad G.; Keaney, Marilyn A.; Chun, Rosaleen; Groleau, Michelle; Tyssen, Michelle; Keyte, Jennifer; Broderick, Timothy J.; Kirkpatrick, Andrew W.

    2010-03-01

    (within multiple transport vehicles and differing gravitational environments). Standardization and pre-packaging of anesthesia, emergency pharmaceuticals, and consumables were found to facilitate the interchange of the veterinary anesthesia team members between flights. This operational process was extremely challenging. ConclusionsWith careful organization of caregivers, equipment and protocols, providing anesthesia and life support in weightlessness is theoretically possible. Unfortunately, human resource costs are extensive and likely overwhelming. Comprehensive algorithms for extended spaceflight must recognize these costs prior to making assumptions or attempting to provide critical care in space.

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

    OpenAIRE

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

    2016-01-01

    Introduction: World Health Organization and American Society of Clinical Oncology recommend early integration of specialist palliative care in patients with cancer. This paper focuses on critical review of evidence on integration of early specialist palliative care in cancer care and patient-related outcomes. Methods: The question for the literature search was - Does integration of early specialist palliative care in cancer care influences patient-related outcomes? 31 articles related to ...

  5. A framework for resolving disagreement during end of life care in the critical care unit.

    Science.gov (United States)

    Choong, Karen; Cupido, Cynthia; Nelson, Erin; Arnold, Donald M; Burns, Karen; Cook, Deborah; Meade, Maureen

    2010-08-01

    End-of-life decisions regarding the administration, withdrawal or withholding of life-sustaining therapy in the critical care setting can be challenging. Disagreements between health care providers and family members occur, especially when families believe strongly in preserving life, and physicians are resistant to providing medically "futile" care. Such disagreements can cause tension and moral distress among families and clinicians. To outline the roles and responsibilities of physicians, substitute decision makers, and the judicial system when decisions must be made on behalf of incapable persons, and to provide a framework for conflict resolution during end-of-life decision-making for physicians practicing in Canada. We used a case-based example to illustrate our objectives. We employed a comprehensive approach to understanding end-of-life decision making that included: 1) a search for relevant literature; 2) a review of provincial college policies; 3) a review of provincial legislation on consent; 4) a consultation with two bioethicists and 5) a consultation with two legal experts in health law. In Canada, laws about substitute decision-making for health care are primarily provincial or territorial. Thus, laws and policies from professional regulatory bodies on end-of-life care vary across the country. We tabulated the provincial college policies on end-of-life care and the provincial legislation on consent and advance directives, and constructed a 10-step approach to conflict resolution. Knowledge of underlying ethical principles, understanding of professional duties, and adoption of a process for mediation and conflict resolution are essential to ensuring that physicians and institutions act responsibly in maintaining a patients' best interests in the context of family-centred care.

  6. Prevalence of disorders recorded in Cavalier King Charles Spaniels attending primary-care veterinary practices in England

    OpenAIRE

    Summers, J F; O'Neill, D G; Church, D B; Thomson, P.C.; McGreevy, P D; Brodbelt, D. C.

    2015-01-01

    Background Concerns have been raised over breed-related health issues in purebred dogs, but reliable prevalence estimates for disorders within specific breeds are sparse. Electronically stored patient health records from primary-care practice are emerging as a useful source of epidemiological data in companion animals. This study used large volumes of health data from UK primary-care practices participating in the VetCompass animal health surveillance project to evaluate in detail the disorde...

  7. Death, empathy and self preservation: the emotional labour of caring for families of the critically ill in adult intensive care.

    Science.gov (United States)

    Stayt, Louise Caroline

    2009-05-01

    The purpose of this phenomenological study is to explore the emotional labour nurses' face when caring for relatives of the critically ill in intensive care unit. The admission of a critically ill patient into adult intensive care is a crisis for both patients and their families. Family members of the critically ill may experience extreme levels of stress and emotional turmoil throughout the course of the relative's illness. A central tenet of providing holistic nursing care in the intensive care unit is to care for both patients and their families, however, the emotional involvement required places considerable demands on those delivering care. The support health care providers require is frequently overlooked in these challenging environments. Heideggerian phenomenological approach was adopted. A purposive sample of 12 registered nurses working in an adult intensive care unit were interviewed. Interview transcripts were analysed using Colaizzi's framework. Data were collected in autumn 2005. Analysis of the participants' interview transcripts revealed the following themes: significance of death, establishing trust, information giving, empathy, intimacy and self preservation. Emotional work forms an important part of the critical care nurses job. The significance of death, breaking bad news and interpersonal relationships are sources of emotional stress for the critical care nurse caring for the family of the critically ill. The impact of this stress on the nurse and the care they deliver requires further investigation. Registered nurses caring for families who have relatives in adult intensive care units expand considerable emotional labour. Potentially, unless appropriately supported and managed, emotional labour may lead to occupational stress and ultimately burnout.

  8. Peritoneal dialysis in emergency and critical care medicine.

    Science.gov (United States)

    Labato, M A

    2000-08-01

    Peritoneal dialysis is a technique that has been used to treat acute renal failure in humans since 1923. Peritoneal dialysis is used in people to manage acute and chronic renal failure, as well as to remove dialyzable toxins (ethylene glycol, barbiturates, and ethanol), reduce severe metabolic disturbances, and for the treatment of peritonitis, pancreatitis, uroabdomen, hypothermia, and fluid overload. In veterinary medicine, acute renal failure is the prevailing indication for dialysis. This report will discuss the pathophysiology of peritoneal dialysis, indications, and contraindications. Catheter selection and placement will be reviewed. Types of dialysate solution will be discussed and the protocol established for instituting peritoneal dialysis. The report will conclude with a discussion of potential complications and methods to minimize them.

  9. Mechanical Ventilation Education and Transition of Critical Care Nurses into Practice.

    Science.gov (United States)

    Goldsworthy, Sandra

    2016-12-01

    A foundational skill for critical care nurses caring for mechanically ventilated patients. This paper describes challenges and opportunities in preparing nurses to transition into the intensive care environment. Hospitals invest significant funding in educational programs for new critical care nurses so that they can transition effectively into the critical care environment. Simulation has been shown to impact self-efficacy and performance. This paper describes the integration of mechanical ventilation education into a case-based simulation program and the results of a study measuring self-efficacy and transfer of learning before and after the implementation of a simulation intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Controversies surrounding critical illness-related corticosteroid insufficiency in animals.

    Science.gov (United States)

    Creedon, Jamie M Burkitt

    2015-01-01

    To describe the controversies surrounding critical illness-related corticosteroid insufficiency (CIRCI) and the use of hydrocortisone in critically ill patients, and to present published diagnostic and therapeutic strategies in companion veterinary species. Critical illness-related corticosteroid insufficiency may be due to hypothalamic-pituitary-adrenal (HPA) axis dysfunction, alterations in cortisol-plasma protein binding, target cell enzymatic changes, changes in glucocorticoid receptor (GR) function, or a combination of these or other factors present during critical illness. Appropriate tests to diagnose CIRCI are unknown. The diagnosis in people is currently based on response to treatment with hydrocortisone. There is currently no consensus on appropriate diagnostic feature(s) in veterinary species. Low-dose hydrocortisone is the treatment of choice for patients with CIRCI. If the patient survives the critical illness, prognosis for resolution of CIRCI and hydrocortisone dependence is very good. © Veterinary Emergency and Critical Care Society 2014.

  11. Critical care admission following elective surgery was not associated with survival benefit

    DEFF Research Database (Denmark)

    Kahan, Brennan C; Koulenti, Desponia; Arvaniti, Kostoula

    2017-01-01

    PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis...... of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated...... hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients...

  12. [Lung ultrasound in acute and critical care medicine].

    Science.gov (United States)

    Zechner, P M; Seibel, A; Aichinger, G; Steigerwald, M; Dorr, K; Scheiermann, P; Schellhaas, S; Cuca, C; Breitkreutz, R

    2012-07-01

    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.

  13. A CRITICAL ANALYSIS OF PATIENT SATISFACTION WITH DIABETES CARE

    Directory of Open Access Journals (Sweden)

    Cotiu Madalina-Alexandra

    2015-07-01

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

  14. Career Development Support in Pediatric Critical Care Medicine: A National Survey of Fellows and Junior Faculty.

    Science.gov (United States)

    Cifra, Christina L; Balikai, Shilpa S; Murtha, Tanya D; Hsu, Benson; Riley, Carley L

    2017-04-01

    To determine the perceptions of current pediatric critical care medicine fellows and junior faculty regarding the extent and quality of career development support received during fellowship training. Web-based cross-sectional survey open from September to November 2015. Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs. Pediatric critical care medicine fellows (second yr or higher) and junior faculty (within 5 yr of completing a pediatric critical care medicine fellowship program). None. There were 129 respondents to the survey, representing 63% of Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs. Respondents were evenly divided between fellows and junior faculty. Nearly, half (49%) of respondents reported that their pediatric critical care medicine fellowship program provided a formal career development curriculum. Ideal career tracks chosen included academic clinician educator (64%), physician-scientist (27%), community-based (nonacademic) clinician (11%), and administrator (11%). There was a disparity in focused career development support provided by programs, with a minority providing good support for those pursuing a community-based clinician track (32%) or administrator track (16%). Only 43% of fellows perceived that they have a good chance of obtaining their ideal pediatric critical care medicine position, with the most common perceived barrier being increased competition for limited job opportunities. Most respondents expressed interest in a program specific to pediatric critical care medicine career development that is sponsored by a national professional organization. Most pediatric critical care medicine fellows and junior faculty reported good to excellent career development support during fellowship. However, important gaps remain, particularly for those pursuing community-based (nonacademic) and administrative tracks

  15. Literature review of the impact of nurse practitioners in critical care services.

    Science.gov (United States)

    Fry, Margaret

    2011-01-01

    The comprehensive review sought to examine the impact of Critical Care Nurse Practitioner models, roles, activities and outcomes. The Medical Literature Analyses and Retrieval (MEDLINE), The Cumulative Index of Nursing and Allied Health Literature (CINAHL); PubMED; PROQUEST; ScienceDirect; and the Cochrane database were accessed for the review. Alternative search engines were also included. The search was conducted with the key words: critical care, intensive care, acute, adult, paediatric, trauma, disease management programs, disease management, case management, neonatal, cardiology, neurological, retrieval, transfer and combined with Nurse Practitioner. From the identified 1048 articles 47 studies were considered relevant. Internationally, Critical Care Nurse Practitioners were located in all intensive care areas and services including post intensive care discharge follow-up, intensive care patient retrieval and transfers and follow-up outpatient services. The role focussed on direct patient management, assessment, diagnosis, monitoring and procedural activities. Critical Care Nurse Practitioners improved patient flow and clinical outcomes by reducing patient complication, morbidity and mortality rates. Studies also demonstrated positive financial outcomes with reduced intensive care unit length of stay, hospital length of stay and (re)admission rates. Internationally, Critical Care Nurse Practitioners are demonstrating substantial positive patient, service and nursing outcomes. Critical Care Nurse Practitioner models were cost effective, appropriate and efficient in the delivery of critical care services. RELEVANCE TO CLINICAL PRACTISE: In Australia, there was minimal evidence of Critical Care Nurse Practitioner impact on adult, paediatric or neonatal intensive care units. The international evidence suggests that the contribution of the role needs to be strongly considered in light of future Australian service demands and workforce supply needs. In Australia

  16. Implementing Evidenced Based Oral Care for Critically Ill Patients

    Science.gov (United States)

    2016-02-28

    for oral care (defined as brushing patients’ teeth twice a day). There were no significant findings for oral care practices. Despite gains...baseline and every 2 hour OC. Implications for Military Nursing: The project is highly important to nursing because it increased nurses’ awareness and...Military Nursing: The project is highly important to nursing because it increased nurses’ awareness and knowledge of the standard of care oral care

  17. Dental Education in Veterinary Medicine

    OpenAIRE

    Diana L. Eubanks

    2011-01-01

    Periodontal disease is among the most prevalent canine dis-eases affecting over 75% of dogs. Strengthening of the human-animal bond and the increasing education of the aver-age pet owner, have fostered a heightened awareness of periodontal care in dogs and cats. Industry support has further assisted the small animal veterinarian in providing quality dental treatments and prevention. As recently as the 1990’s, veterinary curriculums contained little or no dental training. That trend is changin...

  18. Family satisfaction with patient care in critical care units in Pakistan: a descriptive cross-sectional study.

    Science.gov (United States)

    Ahtisham, Younas; Subia, Parveen; Gideon, Victor

    2016-11-23

    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.

  19. An evaluation of a critical care course for undergraduate nursing students.

    Science.gov (United States)

    Gallagher, Patrick Joseph; Rice, Billiejoan; Tierney, Paul; Page, Karen; McKinney, Aidin

    2011-01-01

    The aim of this paper was to evaluate a 2-day critical care course (CCC) delivered to a cohort of adult branch nursing students. In today's health care system there is an increase in the number of critically ill patients being cared for in a ward environment. As a result, nurses require the knowledge and skills to effectively manage this patient group. Skills such as prompt recognition of the sick patient, effective communication and performing basic management care skills are necessary. The CCC was provided to final year adult branch nursing students (n = 182) within a university in the UK. On completion of the course, participants were invited to undertake a Likert scale questionnaire. The questionnaire also contained a free response section to elicit qualitative information. Quantitative data were analysed using SPSS version 17.0 and descriptive statistics produced. Qualitative responses were analysed thematically. There was a 73.7% (n = 135) response rate. Overall, there was a positive evaluation of the course. Students (89.6%; n = 121) reported a perceived increase in confidence when caring for critically ill patients following the course and 88.2% (n = 119) felt that their knowledge and skills had improved at the end of the 2-day course. This study supports the implementation of critical care training for undergraduate nursing students. There are implications for the development of specific modules, aiming to improve undergraduate nursing students' recognition, assessment and management of the critically ill patient. There is a shortage of critical care practice placements for undergraduate nursing students. It is essential that an undergraduate curriculum incorporates critical care teaching so that critical care skills are evident at the point of registration. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care Nurses.

  20. Southern African Journal of Critical Care - Vol 26, No 2 (2010)

    African Journals Online (AJOL)

    Southern African Journal of Critical Care. ... The experiences of nurses in providing psychosocial support to families of critically ill trauma patients in intensive care units ... Psychological sequelae following ICU admission at a level 1 academic South African hospital · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  1. Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation.

    Science.gov (United States)

    McMeekin, Dawn E; Hickman, Ronald L; Douglas, Sara L; Kelley, Carol G

    2017-03-01

    Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD). To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas. A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey. Postcode stress and PTSD symptom severity were weakly associated (r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support. Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession. ©2017 American Association of Critical-Care Nurses.

  2. Predictors of mortality in a critical care unit in south western Kenya ...

    African Journals Online (AJOL)

    Background: Critical care in developing countries has been neglected in the face of high numbers of communicable and infectious diseases like malaria, tuberculosis, HIV and Critical Care Units continue to be limited to large hospitals in urban areas. There is need to know the type of patients admitted to existing units, ...

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

    NARCIS (Netherlands)

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

    2015-01-01

    Since the critical care physician will most likely be involved in a life-threatening expression of systemic mastocytosis, recognition of this disease is of utmost importance in the critical care management of these patients. Mastocytosis is a severely under-recognized disease because it typically

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

    Directory of Open Access Journals (Sweden)

    Sangeeta Jain

    2016-01-01

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

  5. Quality and safety: reflection on the implications for critical care nursing education.

    Science.gov (United States)

    Baid, Heather; Hargreaves, Jessica

    2015-07-01

    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.

  6. Perinatal regionalization: a geospatial view of perinatal critical care, United States, 2010-2013.

    Science.gov (United States)

    Brantley, Mary D; Davis, Nicole L; Goodman, David A; Callaghan, William M; Barfield, Wanda D

    2017-02-01

    Perinatal services exist today as a dyad of maternal and neonatal care. When perinatal care is fragmented or unavailable, excess morbidity and mortality may occur in pregnant women and newborns. The objective of the study was to describe spatial relationships between women of reproductive age, individual perinatal subspecialists (maternal-fetal medicine and neonatology), and obstetric and neonatal critical care facilities in the United States to identify gaps in health care access. We used geographic visualization and conducted surface interpolation, nearest neighbor, and proximity analyses. Source data included 2010 US Census, October 2013 National Provider Index, 2012 American Hospital Association, 2012 National Center for Health Statistics Natality File, and the 2011 American Academy of Pediatrics directory. In October 2013, there were 2.5 neonatologists for every maternal-fetal medicine specialist in the United States. In 2012 there were 1.4 level III or higher neonatal intensive care units for every level III obstetric unit (hereafter, obstetric critical care unit). Nationally, 87% of women of reproductive age live within 50 miles of both an obstetric critical care unit and a neonatal intensive care unit. However, 18% of obstetric critical care units had no neonatal intensive care unit, and 20% of neonatal intensive care units had no obstetric critical care unit within a 10 mile radius. Additionally, 26% of obstetric critical care units had no maternal-fetal medicine specialist practicing within 10 miles of the facility, and 4% of neonatal intensive care units had no neonatologist practicing within 10 miles. Gaps in access and discordance between the availability of level III or higher obstetric and neonatal care may affect the delivery of risk-appropriate care for high-risk maternal fetal dyads. Further study is needed to understand the importance of these gaps and discordance on maternal and neonatal outcomes. Published by Elsevier Inc.

  7. Improving Caregivers' Perceptions Regarding Patient Goals of Care/End-of-Life Issues for the Multidisciplinary Critical Care Team.

    Science.gov (United States)

    Wessman, Brian T; Sona, Carrie; Schallom, Marilyn

    2017-01-01

    With population aging and growth, use of critical care medicine at the end of life continues to rise, while many critical care providers are not adequately trained regarding goals of care/end-of-life (GOC/EOL) issues. A multidisciplinary intensive care unit (ICU) team intervention regarding GOC/EOL communication will enhance the clinical abilities of all critical care providers when discussing GOC/EOL issues and increase ICU staff comfort level while improving transitions for patients to a comfort care approach. This study was a preintervention/postintervention survey evaluation. This study was conducted at an academic tertiary surgical burn trauma ICU. The intervention was provided to nursing, ancillary staff, house staff, and attending physicians. An initial survey was circulated among the critical care staff for baseline expectations, satisfaction, and understanding of GOC/EOL care. A robust intervention was begun including the creation of a multidisciplinary GOC/EOL team, communication tools for providers, patient-family pamphlets, standardized EOL order sets, and formalized didactic sessions. Subsequently, the same survey was circulated and compared to baseline data. Preintervention/postintervention survey data were reviewed and statistically analyzed. Our survey response rate for preintervention/postintervention was 50.4% and 36.1%, respectively. The intervention generated heightened interest in improving family communication and provided focal direction to foster this growth. Based on the serial surveys regarding our intervention, statistically significant staff improvements were seen in "work stress" (P = .04), "EOL information" (P = .006), and "space allotment" (P = .001). Improved congruence of families and health care providers regarding decision over intensity of care was also noted. We created a novel unit-based multidisciplinary program for improved EOL/GOC approaches in the critical care setting. A similarly formatted program could be adapted by

  8. The American Heart Association's recent scientific statement on cardiac critical care: implications for pediatric practice.

    Science.gov (United States)

    Penny, Daniel J; Shekerdemian, Lara S

    2013-01-01

    A writing group sponsored by the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the Council on Quality of Care and Outcomes Research of The American Heart Association has recently formulated a roadmap to meet the changing needs of the patient with cardiovascular disease requiring critical care. Although this roadmap has been formulated primarily to address the care needs of the adult with critical cardiovascular disease, it contains useful lessons pertinent to the care of the patient with pediatric and congenital cardiovascular disease. In this document, we have examined The Statement and applied its framework to the evolving field of pediatric cardiac critical care. © 2012 Wiley Periodicals, Inc.

  9. Politicy of care in the criticism towards gender stereotypes.

    Science.gov (United States)

    Pires, Maria Raquel Gomes Maia; Fonseca, Rosa Maria Godoy Serpa da; Padilla, Beatriz

    2016-01-01

    analyze gender inequalities among Brazilian women in Portugal and in contemporary nursing based on care politicity in the light of gender; disclose oppression of the female produced by the stereotypes that look upon women as natural caregivers; point out politicity to deconstruct gender stereotypes. theoretical reflection with narrative review of literature to analyze classic references in the feminist epistemology combined with the care politicity thesis. the similarities between the stereotypes of the Brazilian Eves and the Portuguese Maries as either the sexualized or sanctified nurse are inserted in the Jewish-Christian moral genealogy that reaffirms the subservience of the female to the male. by attaching priority to care that needs non-care to expand the possibilities of care giving, the theoretical assumption of politicy of care can contribute to subvert the stereotypical images of Brazilian women in Portuguese lands and in contemporary nursing.

  10. Twenty-five years of critical care nursing scholarship in Australia.

    Science.gov (United States)

    McKinley, Sharon; Elliott, Doug

    2013-02-01

    Australian Critical Care has been published since 1988 and has been an important medium for the development of critical care nursing scholarship in Australia over 25 years. To review scholarship in critical care nursing in Australia since 1988 and record its progress in the context of developments in nursing education and intensive and critical care practice. Australian Critical Care issues since 1988 were reviewed, and abstracts from the Australian and New Zealand Annual Scientific Meeting on Intensive Care published in Australian Critical Care since the 1991 Meeting. Available evidence for the contribution of this body of scholarship to critical care nursing practice and patient care was considered. Original research reports and review articles have steadily increased from 1988 to 2012. The peak years for research publications were 2001, 2005 and 2012, and for reviews 2010 and 2011. Approximately 760 abstracts were presented at the Annual Scientific Meeting from 1991 to 2010; overall 24% were found lead to peer-reviewed publications, with an increase to 30% in recent years. Over 25 years, the scholarship of critical care nursing in Australia has evolved into an established area of disciplinary knowledge, based firmly in practice. Our discipline has witnessed the opportunity for PhD training, the introduction of professorial positions, a knowledge base built on original research and rigorous reviews, and sustainable dissemination. The challenges are to further strengthen this development, increase publication of research that is done, to demonstrate the influence on practice and to develop sustainable research funding. Copyright © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Health Behavior Theory for Pressure Ulcer Prevention: Root-Cause Analysis Project in Critical Care Nursing.

    Science.gov (United States)

    Choi, Kristen R; Ragnoni, Jennifer A; Bickmann, Jonathan D; Saarinen, Hannah A; Gosselin, Ann K

    2016-01-01

    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.

  12. Anxiety and Related Symptoms among Critical Care Nurses in Albaha, Kingdom of Saudi Arabia

    OpenAIRE

    Waled Amen Mohammed Ahmed

    2015-01-01

    Background/objective: Nursing is considered an Angel of Mercy profession, but it is also one of the most stressful jobs compared to other health care sectors. The aim of this study was to determine the anxiety levels and related symptoms among critical care nurses in Albaha governmental hospitals. Methods: This is a descriptive cross-sectional study. It was conducted in Albaha at four governmental hospitals in the period from January to March 2015. Sixty nurses from critical care settings (in...

  13. Pediatric Exposures to Veterinary Pharmaceuticals.

    Science.gov (United States)

    Tomasi, Suzanne; Roberts, Kristin J; Stull, Jason; Spiller, Henry A; McKenzie, Lara B

    2017-03-01

    To describe the epidemiology of veterinary pharmaceutical-related exposures to children based on calls to a regional poison control center. A retrospective analysis of pediatric (≤19 years of age) exposures to pharmaceutical products intended for animal use, managed by a regional poison control center from 1999 through 2013, was conducted. Case narratives were reviewed and coded for exposure-related circumstances and intended species. Descriptive statistics were generated. From 1999 through 2013, the Central Ohio Poison Center received 1431 calls that related to a veterinary pharmaceutical exposure for children ≤19 years of age. Most of the pediatric calls (87.6%) involved children ≤5 years of age. Exploratory behavior was the most common exposure-related circumstance (61.4%) and ingestion accounted for the exposure route in 93% of cases. Substances commonly associated with exposures included: veterinary drugs without human equivalent (17.3%), antimicrobial agents (14.8%), and antiparasitics (14.6%). Based on substance and quantity, the majority of exposures (96.9%) were not expected to result in long-term or lasting health effects and were managed at home (94.1%). A total of 80 cases (5.6%) were referred to a health care facility, and 2 cases resulted in a moderate health effect. Children ≤5 years of age are most at risk for veterinary pharmaceutical-related exposures. Although most exposures do not result in a serious medical outcome, efforts to increase public awareness, appropriate product dispensing procedures, and attention to home storage practices may reduce the risk of veterinary pharmaceutical exposures to young children. Copyright © 2017 by the American Academy of Pediatrics.

  14. Guidelines for zoo and aquarium veterinary medical programs and veterinary hospitals.

    Science.gov (United States)

    Backues, Kay; Clyde, Vickie; Denver, Mary; Fiorello, Christine; Hilsenroth, Rob; Lamberski, Nadine; Larson, Scott; Meehan, Tom; Murray, Mike; Ramer, Jan; Ramsay, Ed; Suedmeyer, Kirk; Whiteside, Doug

    2011-03-01

    These guidelines for veterinary medical care and veterinary hospitals are written to conform with the requirements of the Animal Welfare Act, which states that programs of disease prevention and parasite control, euthanasia, and adequate veterinary care shall be established and maintained under the supervision of a veterinarian. Ideally the zoo and aquarium should be providing the best possible veterinary medical care for the animals in their collections. Many of these animals are rare and endangered and the institutions should endeavor both to provide for the long term health and well being of these animals and to advance the field of non-domestic animal medicine. It is hoped that this publication will aid in this process.

  15. Critical care nurses' perception of nursing error and its causes: a qualitative study.

    Science.gov (United States)

    Valiee, Sina; Peyrovi, Hamid; Nasrabadi, Alireza Nikbakht

    2014-01-01

    Nurses' perceptions of nursing error could affect their professional practice. The aim of the study was to explore critical care nurses' perceptions of nursing error and its causes. This was a qualitative study in which 12 critical care nurses were recruited through purposive sampling. The data were collected via in-depth interviews and analyzed through qualitative content analysis method (Elo & Kyngäs, 2008). Nursing error was deemed as an unavoidable issue which consisted of the lack of congruence with standards, doing extra-nursing tasks and giving care against the agreed-upon routines. Five categories emerged as the causes of error: individual reasons, work pressure, caring blindly, the uniqueness of caring environment and the lack of coordination among health care team members. The perception of nursing error is sort of unique; hence, managers should provide support for critical care nurses and pave the way for the prevention of errors.

  16. Critical perspectives on danish early childhood education and care

    DEFF Research Database (Denmark)

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

    2010-01-01

    This paper discusses trends in contemporary Danish early childhood education and care (ECEC). Data are sourced from various policy documents, along with material from ongoing research projects in which the authors are involved. It is claimed that contemporary policy on Danish day care services ha...

  17. En Route Critical Care: Evolving, Improving & Advancing Capabilities

    Science.gov (United States)

    2011-01-26

    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

  18. ORIGINAL ARTICLES National audit of critical care resources in ...

    African Journals Online (AJOL)

    2007-11-30

    Nov 30, 2007 ... dependency' equals 'high care'. The success of the project depended on careful attention to methodology. This article describes the methodology that was followed. Methodology. A descriptive, non-interventive, observational study method was used. The study was conducted in two phases. In phase.

  19. Critical care in Malawi: The ethics of beneficence and justice

    African Journals Online (AJOL)

    2017-09-25

    Sep 25, 2017 ... alert health care providers that the patient's life is in danger, and actions ... The cost of ICU care in four European countries has been ... This work is licensed under the Creative Commons Attribution 4.0 International License.

  20. Matters of Care in Alberta's "Inspiring Education" Policy: A Critical Feminist Discourse Analysis

    Science.gov (United States)

    Bohachyk, Laura

    2016-01-01

    Using the ethics of care as a theoretical lens, alongside the techniques of discourse analysis, I critically analyze texts from Alberta's Inspiring Education policies. On the basis of this analysis, I identify two discourses: the sentimental treatment of care and the "facilitator discourse." I argue that a caring teacher-student…

  1. Predictors of Mortality in a Critical Care Unit in South Western Kenya

    African Journals Online (AJOL)

    care trained staff (critical care nurses and doctors) which may impact the quality of care. Hospitals also face the ... The ICU is currently staffed by ten nurses who work on shift basis (four during the day and two at night). Each ... cular (rheumatic heart disease, heart failure, hyper- tension), CNS(meningitis, stroke, meningitis) ...

  2. This journal is sponsored by the Critical Care Society of Southern ...

    African Journals Online (AJOL)

    1 Netcare 911, Netcare (Pty) Ltd., Midrand, South Africa. 2 Critical Care Transport Unit, Department of Health, Gauteng Provincial Government, South Africa. 3 Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa. 4 Department of Emergency Medical Care, Faculty of ...

  3. Critical incidents among intensive care unit nurses and their need for support: explorative interviews.

    Science.gov (United States)

    de Boer, Jacoba; van Rikxoort, Simone; Bakker, Arnold B; Smit, Bert J

    2014-07-01

    This article aims (a) to get insight into intensive care nurses' most critical work-related incidents, (b) their reactions and coping and (c) perceived support, in a Dutch intensive care unit. Research about the impact of critical incidents has largely been aimed at ambulance and emergency nurses; knowledge about intensive care nurses in this respect is scarce. Persistent stress reactions after critical incidents may cause symptoms of post-traumatic stress disorder, depression and anxiety. Unresolved problems may also cause poor behaviour towards patients. In response, nurses reduce work hours or even resign. Social support alleviates emotional problems, but little is known about actual support perceived. This study is a qualitative explorative study. Thematic analysis of semi-structured interviews was performed among a purposive sample of 12 intensive care nurses in a university hospital in The Netherlands. Four main themes have been identified in critical incidents: high emotional involvement in patient-related incidents (in contrast to major life-threatening events as such), avoidable incidents, sub-standard patient care and intimidation. Themes discerned in nurses' reactions after critical incidents were physical reactions, emotional reactions and cognitive/behavioural reactions. After critical incidents, nurses talked with colleagues, friends or relatives, but would have appreciated additional support. Incidents under emotionally demanding circumstances are among the most difficult situations, but may not be recognized as critical incidents by colleagues. Both adequate and inadequate coping strategies, with long-lasting problems after critical incidents, were reported. Feelings of anger, shame and powerlessness, may have hindered recovery. Talking to colleagues was perceived to be helpful, but intensive care nurses' need for support was insufficiently met. Managers should acknowledge the effects of critical incidents on intensive care nurses and take

  4. Developing a Research Agenda for Integrating Palliative Care into Critical Care and Pulmonary Practice To Improve Patient and Family Outcomes.

    Science.gov (United States)

    Aslakson, Rebecca A; Reinke, Lynn F; Cox, Christopher; Kross, Erin K; Benzo, Roberto P; Curtis, J Randall

    2017-04-01

    Palliative care is a medical specialty and philosophy of care that focuses on reducing suffering among patients with serious illness and their family members, regardless of disease diagnosis or prognosis. As critical illness or moderate to severe pulmonary disease confers significant disease-related symptom burdens, palliative care and palliative care specialists can aid in reducing symptom burden and improving quality of life among these patients and their family members. The objective of this article is to review the existing gaps in evidence for palliative care in pulmonary disease and critical illness and to use an interdisciplinary working group convened by the National Institutes of Health and the National Palliative Care Research Center to develop a research agenda to address these gaps. We completed a narrative review of the literature concerning the integration of palliative care into pulmonary and/or critical care. The review was based on recent systematic reviews on these topics as well as a summary of relevant articles identified through hand search. We used this review to identify gaps in current knowledge and develop a research agenda for the future. We identified key areas of need and knowledge gaps that should be addressed to improve palliative care for patients with pulmonary and critical illness. These areas include developing and validating patient- and family-centered outcomes, identifying the key components of palliative care that are effective and cost-effective, developing and evaluating different models of palliative care delivery, and determining the effectiveness and cost-effectiveness of palliative care interventions. The goal of this research agenda is to encourage researchers, clinicians, healthcare systems, and research funders to identify research that can address these gaps and improve the lives of patients with pulmonary and critical illness and their family members.

  5. The development of an internet-based knowledge exchange platform for pediatric critical care clinicians worldwide*.

    Science.gov (United States)

    Wolbrink, Traci A; Kissoon, Niranjan; Burns, Jeffrey P

    2014-03-01

    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

  6. [Citomegalovirus reactivation in critical ill intensive care patients].

    Science.gov (United States)

    Carrillo Esper, Raúl

    2011-01-01

    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.

  7. Elective Self-Care Course Emphasizing Critical Reasoning Principles

    OpenAIRE

    Sibbald, Debra

    2011-01-01

    Objectives. To create, implement, and assess a self-directed online course based on 3 critical reasoning principles to develop pharmacy students’ skills in literature appraisal, content, metacognition, and assessment.

  8. 'The patient is my space': hermeneutic investigation of the nurse-patient relationship in critical care.

    Science.gov (United States)

    Vouzavali, Foteini J D; Papathanassoglou, Elizabeth D E; Karanikola, Maria N K; Koutroubas, Anna; Patiraki, Elisabeth I; Papadatou, Danai

    2011-01-01

    The nurse-patient relationship has been postulated to lie at the core of nursing care. However, it is unclear how this concept applies in critical care, as a great majority of critically ill patients are unable to communicate. Through a phenomenological hermeneutical perspective, we aimed to explore intensive care nurses' perceptions and meanings regarding their interpersonal relationship with critically ill individuals. A Heideggerian hermeneutical approach was used to design the study and analyse the data, which were collected through repetitive interviews with 12 intensive care nurses. Critical care nurses report to experience deep relationships with patients, which seem to be mediated by the ongoing contact with patients' bodies. These relationships evoke intense feelings of love, empathy and care and affect how nurses perceive and make sense of their role and their world. The identified core theme of their experience is entitled 'syncytium', which describes a network of closely connected cells. According to participants' perceptions, nurse and patient affect each other reciprocally and are mutually dependent upon each other. In Heideggerian terms patients provide nurses with opportunities to experience 'authentic care' and they participate in their 'being-in-the-world', thus they are central in nurses' meanings about their role and existence. Other elicited themes that account for the perceived nurse-patient relationship include the spatiality/temporality of the relationship, nurses' perceptions and meanings attributed to their role and nurses' perceptions of death. Critical care nurses appear to experience their relationships with patients intensely. These relationships are invested with meanings and elicit powerful feelings over a shared course with patients. Patients are central in nurses' meaning-making process and role perception. These findings have implications for the educational preparation of critical care nurses and their psychological support.

  9. Critical care admission of South African (SA surgical patients: Results of the SA Surgical Outcomes Study

    Directory of Open Access Journals (Sweden)

    David Lee Skinner

    2017-05-01

    Full Text Available Background. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA. Methods. The SA Surgical Outcomes Study (SASOS was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis. Results. Of the 3 927 SASOS patients, 255 (6.5% were admitted to critical care units; of these admissions, 144 (56.5% were planned, and 111 (43.5% unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001. Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001. Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867.

  10. Working together: critical care nurses experiences of temporary staffing within Swedish health care: A qualitative study.

    Science.gov (United States)

    Berg Jansson, Anna; Engström, Åsa

    2017-08-01

    The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Powerless positions, silenced voices? - critical views on health and social care management.

    Science.gov (United States)

    Hujala, Anneli; Laulainen, Sanna; Lindberg, Kajsa

    2014-01-01

    The purpose of this paper is to provide background to this special issue and consider how critically oriented research can be applied to health and social care management. Basic principles of critical management studies are introduced briefly to frame subsequent papers in this issue. In order to identify the wicked problems and darker sides of the care field, there is a need to study things in alternative ways through critical lenses. Giving a voice to those in less powerful positions may result in redefinition and redesign of conventional roles and agency of patients, volunteers and professionals and call into question the taken-for-granted understanding of health and social care management. The special issue as a whole was designed to enhance critical approaches to the discussion in the field of health and social care. This editorial hopefully raises awareness of CMS and serves as an opening for further discussion on critical views in the research on management and organization in this field.

  12. The role of neurocritical care: a brief report on the survey results of neurosciences and critical care specialists.

    Science.gov (United States)

    Markandaya, Manjunath; Thomas, Katherine P; Jahromi, Babak; Koenig, Mathew; Lockwood, Alan H; Nyquist, Paul A; Mirski, Marek; Geocadin, Romergryko; Ziai, Wendy C

    2012-02-01

    Neurocritical care is a new subspecialty field in medicine that intersects with many of the neuroscience and critical care specialties, and continues to evolve in its scope of practice and practitioners. The objective of this study was to assess the perceived need for and roles of neurocritical care intensivists and neurointensive care units among physicians involved with intensive care and the neurosciences. An online survey of physicians practicing critical care medicine, and neurology was performed during the 2008 Leapfrog initiative to formally recognize neurocritical care training. The survey closed in July 2009 and achieved a 13% response rate (980/7524 physicians surveyed). Survey respondents (mostly from North America) included 362 (41.4%) neurologists, 164 (18.8%) internists, 104 (11.9%) pediatric intensivists, 82 (9.4%) anesthesiologists, and 162 (18.5%) from other specialties. Over 70% of respondents reported that the availability of neurocritical care units staffed with neurointensivists would improve the quality of care of critically ill neurological/neurosurgical patients. Neurologists were reported as the most appropriate specialty for training in neurointensive care by 53.3%, and 57% of respondents responded positively that neurology residency programs should offer a separate training track for those interested in neurocritical care. Broad level of support exists among the survey respondents (mostly neurologists and intensivists) for the establishment of neurological critical care units. Since neurology remains the predominant career path from which to draw neurointensivists, there may be a role for more comprehensive neurointensive care training within neurology residencies or an alternative training track for interested residents.

  13. Incontinence-associated dermatitis in the critically ill patient: an intensive care perspective.

    Science.gov (United States)

    Coyer, Fiona; Campbell, Jill

    2017-12-20

    Incontinence-associated dermatitis is a skin disorder evident as a complication of incontinence. It is characterized by perineal, buttock and groin erythema and skin breakdown. Incontinence-associated dermatitis is a ubiquitous, nosocomial condition commonly present in critically ill patients in the intensive care unit. Critically ill patients, by the nature of their critical illness and therapies used to treat their presenting condition, are commonly predisposed to faecal incontinence and are consequently at high risk of developing incontinence-associated dermatitis. However, this condition is under-explored and under-reported in the intensive care literature. The aim of this paper is to provide a review of the literature relating to incontinence-associated dermatitis from the critically ill patients in the intensive care setting. There is a paucity of literature addressing this condition in the intensive care context, with only 11 studies identified. This paper will provide an overview of the definitions, prevalence and incidence of incontinence-associated dermatitis. Furthermore, an exposition of incontinence-associated dermatitis from the critically ill patient and intensive care nursing perspectives will be presented through a review of the skin barrier function, clinical presentation, risk factors, clinical assessment and severity categorization, prevention and management of incontinence-associated dermatitis. It is imperative that critical care nurses have an appreciation of incontinence-associated dermatitis as a common, yet preventable condition, and are equipped with knowledge to appropriately prevent and manage this common complication. © 2017 British Association of Critical Care Nurses.

  14. Nurses' role transition from the clinical ward environment to the critical care environment.

    Science.gov (United States)

    Gohery, Patricia; Meaney, Teresa

    2013-12-01

    To explore the experiences of nurses moving from the ward environment to the critical care environment. Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment. A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis. Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support. The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Sound intensity and noise evaluation in a critical care unit

    National Research Council Canada - National Science Library

    Lawson, Nancy; Thompson, Kim; Saunders, Gabrielle; Saiz, Jaya; Richardson, Jeannette; Brown, Deborah; Ince, Naomi; Caldwell, Marc; Pope, Diana

    2010-01-01

    Sound levels in intensive care units can be high. Unfortunately, high levels of sound tend to result in poor sleep quality, which leads to slower healing, poorer immune response, and decreased cognitive function...

  16. Mingling of human and veterinary strains of Staphylococcus aureus: An emerging issue in health-care systems

    Directory of Open Access Journals (Sweden)

    Sara Giordana Rimoldi

    2017-11-01

    Full Text Available Aim: Methicillin-resistant Staphylococcus aureus remains a leading cause of hospital and community infections. We report a retrospective molecular characterization of S. aureus strains from different settings: hospital workers and patients, and veterinarian surgeons and pets. Materials and Methods: Eighty-nine S. aureus isolates obtained from nasal swabs of 10 patients, 17 health-care workers (HCWs, 9 pets, and 53 veterinarians were genotypically characterized by means of repetitive extragenic palindromic polymerase chain reaction (Rep PCR and whole-genome sequencing. Results: Thirteen different sequence types (STs were detected: ST398, ST22, ST8, ST30, ST15, ST5, ST121, ST45, ST10, ST6, ST34, ST97, and ST1. Two new STs differing from ST22 and ST5 for a single multilocus sequence typing gene were also identified. Rep PCR documented a genetic relationship among isolates obtained from 5 veterinarians and 10 HCWs. Conclusion: The large diversity of S. aureus strains detected may reflect a larger epidemiology within the hospital and community, in which companion animals likely act as a reservoir. We identified the circulation of ST5, ST8, ST15, ST22, ST30, ST45, and ST121 both in the hospital and veterinarian environment. Starting from the idea of a unique setting where our population lives, we consider the relationship between community- and hospital-acquired S. aureus.

  17. A 5-year retrospective audit of prescribing by a critical care outreach team.

    Science.gov (United States)

    Wilson, Mark

    2017-12-15

    UK prescribing legislation changes made in 2006 and 2012 enabled appropriately qualified nurses to prescribe any licensed medication, and all controlled drugs in schedule 2-5 of the Misuse of Drugs Regulations 2001, for any medical condition within their clinical competence. Critical Care Outreach nurses who are independent nurse prescribers are ideally placed to ensure that acutely ill patients receive treatment without delay. The perceived challenge was how Critical Care Outreach nurses would be able to safely prescribe for a diverse patient group. This study informs this developing area of nurse prescribing in critical care practice. The aims of the audit were to: identify which medications were prescribed; develop a critical care outreach formulary; identify the frequency, timing and number of prescribing decisions being made; identify if prescribing practice changed over the years and provide information for our continuing professional development. This article reports on data collected from a 5-year retrospective audit; of prescribing activity undertaken by nine independent nurse prescribers working in a 24/7 Critical Care Outreach team of a 600-bedded district general hospital in the UK. In total, 8216 medication items were prescribed, with an average of 2·6 prescribed per shift. The most commonly prescribed items were intravenous fluids and analgesia, which were mostly prescribed at night and weekends. The audit has shown that Critical Care Outreach nurse prescribing is feasible in a whole hospital patient population. The majority of prescribing occurred after 16:00 and at night. Further research would be beneficial, particularly looking at patient outcomes following reviews from prescribing critical care outreach nurses. The audit is one of the only long-term studies that describes prescribing practice in Critical Care Outreach teams in the UK. © 2017 British Association of Critical Care Nurses.

  18. Critical views on postpartum care expressed by new mothers

    Directory of Open Access Journals (Sweden)

    Waldenström Ulla

    2007-11-01

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

  19. Veterinary microbiology and microbial disease

    National Research Council Canada - National Science Library

    Quinn, P. J

    2011-01-01

    "Veterinary Microbiology is one of the core subjects for veterinary students. Fully revised and expanded, this new edition covers every aspect of veterinary microbiology for students in both paraclinical and clinical years...

  20. Sahel Journal of Veterinary Sciences

    African Journals Online (AJOL)

    The Sahel Journal of Veterinary Sciences is the official journal of the Faculty of Veterinary Medicine, University of Maiduguri, Maiduguri, Nigeria. The journal welcomes original research articles, short communications and reviews on all aspects of veterinary sciences and related disciplines.

  1. Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction.

    Science.gov (United States)

    Schram, Andrew W; Hougham, Gavin W; Meltzer, David O; Ruhnke, Gregory W

    2017-11-01

    There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.

  2. Parental involvement in neonatal critical care decision-making.

    Science.gov (United States)

    Shaw, Chloe; Stokoe, Elizabeth; Gallagher, Katie; Aladangady, Narendra; Marlow, Neil

    2016-11-01

    The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: 'making recommendations' and 'providing options'. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. 'Making recommendations' led to misalignment and reduced opportunities for questions and collaboration; 'providing options' led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance. A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/watch?v=MyuymxDNupk&feature=youtu.be. © 2016 Foundation for the Sociology of Health & Illness.

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

    Directory of Open Access Journals (Sweden)

    Velmahos George C

    2006-09-01

    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. Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest.

    Science.gov (United States)

    von Vopelius-Feldt, Johannes; Brandling, Janet; Benger, Jonathan

    2017-05-01

    Improving survival after out-of-hospital cardiac arrest (OHCA) is a priority for modern emergency medical services (EMS) and prehospital research. Advanced life support (ALS) is now the standard of care in most EMS. In some EMS, prehospital critical care providers are also dispatched to attend OHCA. This systematic review presents the evidence for prehospital critical care for OHCA, when compared to standard ALS care. We searched the following electronic databases: PubMed, EmBASE, CINAHL Plus and AMED (via EBSCO), Cochrane Database of Systematic Reviews, DARE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, NIHR Health Technology Assessment Database, Google Scholar and ClinicalTrials.gov. Search terms related to cardiac arrest and prehospital critical care. All studies that compared patient-centred outcomes between prehospital critical care and ALS for OHCA were included. The review identified six full text publications that matched the inclusion criteria, all of which are observational studies. Three studies showed no benefit from prehospital critical care but were underpowered with sample sizes of 1028-1851. The other three publications showed benefit from prehospital critical care delivered by physicians. However, an imbalance of prognostic factors and hospital treatment in these studies systematically favoured the prehospital critical care group. Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Use of decision analysis to evaluate the delivery method of veterinary health care on dairy farms as measured by correction of left displaced abomasum.

    Science.gov (United States)

    Remsburg, Darren W; Galligan, David T; Ferguson, James D

    2011-01-01

    To use decision and sensitivity analysis to examine the delivery of health care on US dairy farms as measured by correction of left displaced abomasum (LDA). 5 journal articles evaluating outcomes from veterinarian- or herd personnel-delivered correction of LDA via laparotomy or a roll-and-toggle procedure. Economic analysis. A decision tree was constructed on the basis of published outcome data for correction of LDAs performed by veterinarians and herd personnel. Sensitivity of the model to changing input assumptions was evaluated via an indifference curve and tornado graph. Decision tree analysis revealed that correction of an LDA provided by herd personnel had an expected economic advantage of $76, compared with correction provided by a veterinarian. Sensitivity of this analysis to variations in inputs indicated that changes of 2 input levels would shift the advantage to veterinarian-provided correction: a reduction (from 0.74 to 0.62) in the probability of success for correction provided by herd personnel or an increase (from 0.78 to 0.87) in the probability of success for correction provided by a veterinarian. In this model, LDA correction by herd personnel had a significant economic advantage, compared with veterinarian-provided correction. Continued absorption of traditional veterinary tasks by unlicensed herd personnel may threaten the veterinarian-client-patient relationship (VCPR), which could have profound economic and regulatory impacts. Food animal veterinarians need to evaluate their business model to ensure they continue to provide relevant, sustainable services to their clients within the context of a valid VCPR.

  6. Advanced competencies mapping of critical care nursing: a qualitative research in two Intensive Care Units.

    Science.gov (United States)

    Alfieri, Emanuela; Mori, Marina; Barbui, Valentina; Sarli, Leopoldo

    2017-07-18

    Nowadays, in Italy, the nursing profession has suffered important changes in response to the needs of citizens' health and to improve the quality of the health service in the country.  At the basis of this development there is an increase of the nurses' knowledge, competencies and responsibilities. Currently, the presence of nurses who have followed post-basic training paths, and the subsequent acquisition of advanced clinical knowledge and specializations, has made it essential for the presence of competencies mappings for each specialty, also to differentiate them from general care nurses. The objective is to get a mapping of nurse's individual competencies working in critical care, to analyze the context of the Parma Hospital and comparing it with the Lebanon Heart Hospital in Lebanon. The survey has been done through a series of interviews involving some of the hospital staff, in order to collect opinions about the ICU nurses' competencies. What emerged from the data allowed us to get a list of important abilities, competencies, character traits and  intensive care nurse activities. Italians and Lebanese nurses appear to be prepared from a technical point of view, with a desire for improvement through specializations, masters and enabling courses in advanced health maneuvers. By respondents nurses can seize a strong desire for professional improvement. At the end of our research we were able to draw a list of different individual competencies, behavioral and moral characteristics. The nurse figure has a high potential and large professional improvement prospects, if more taken into account by the health system.

  7. The emotional intelligence of professional nurses commencing critical care nursing in private hospitals in Gauteng

    OpenAIRE

    Nagel, Yvette Juanita

    2015-01-01

    M.Cur. (Nursing Science) The primary objective of this study was to determine the emotional intelligence (EI) of, and make recommendations to facilitate an improvement in the EI of professional nurses commencing work in critical care units in private hospitals in Gauteng, South Africa. The quality of nursing care directly affects patient outcomes such as morbidity, mortality, adverse events as well as the total cost of care. This places the nurse central in good, comprehensive health care,...

  8. Improving Value in Musculoskeletal Care Delivery: AOA Critical Issues.

    Science.gov (United States)

    Wei, David H; Hawker, Gillian A; Jevsevar, David S; Bozic, Kevin J

    2015-05-06

    Improving value in musculoskeletal health care has emerged as an important objective in both the United States and Canada. In order to achieve this objective, providers need to have a clear definition of value and an infrastructure for measuring outcomes of interest to patients and costs over the episode of care. Although national patient registries have been established in the United States and Canada, they nevertheless lag behind other registries worldwide in terms of collecting patient-reported outcomes and capturing data from a wide cross-section of hospitals and physicians. With the help of professional medical societies and the creation of national initiatives, patient-reported outcomes data collection on a large scale may be possible, but many challenges remain regarding implementation. Alternatives to the fee-for-service payment model, including pay-for-reporting and pay-for-performance, may help incentivize physicians and health-care providers to obtain and improve on patient-reported outcomes data collection. Other payment reforms, such as bundled payments, have been piloted in certain regions, but their sustainability and long-term success are unclear at this time. Novel health-care delivery strategies aimed at improving quality, coordinating multispecialty care, and enhancing patient participation in shared decision-making have shown promise in improving patient-centered outcomes, but delivery models continue to vary greatly throughout the United States and Canada. The current status of musculoskeletal health-care delivery requires substantial change before the goal of improving patient outcomes and lowering health-care costs can be achieved. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  9. Interventional nutrition for the critical care patient: optimal diets.

    Science.gov (United States)

    Michel, K E

    1998-11-01

    The classic goals of nutritional support have been to provide for the patient's ongoing nutritional needs and to preserve endogenous tissues from further catabolism. It is becoming increasingly clear that it also is possible to modulate metabolic and pathologic processes through the use of specific nutrients and metabolites and even the route by which nutrition is provided. This article discusses what is and is not known about the nutritional requirements of critically ill dogs and cats and some of the specific nutrients that are being used to enrich formulas for critically ill patients.

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

    Science.gov (United States)

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

    2015-01-01

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

  11. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Department of Veterinary Pathology, College of Veterinary Medicine, Michael Okpara University of Agriculture,. Umudike, P.M.B 7267 Umuahia, Abia State, Nigeria. *Corresponding author: Email: docoleji@yahoo.com; Tel. No:+234 8034509991. SUMMARY. This study investigated comparatively the genetic influence on the ...

  12. Archives: Nigerian Veterinary Journal

    African Journals Online (AJOL)

    Items 1 - 49 of 49 ... Archives: Nigerian Veterinary Journal. Journal Home > Archives: Nigerian Veterinary Journal. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 49 of 49 Items ...

  13. Nigerian Veterinary Journal (1)

    African Journals Online (AJOL)

    The importance of computers in all works of life need not to be overemphasized. However, in. Nigeria, the application of computers in veterinary medicine has not been fully utilized. Computer aided diagnosis is a process that has significantly improved the practice of veterinary medicine in other parts of the world. This paper ...

  14. Nigerian Veterinary Journal: Submissions

    African Journals Online (AJOL)

    SCOPE The Editorial Board of the Nigerian Veterinary Journal (NVJ) welcomes contributions in the form of original research papers, review articles, clinical case reports, and short communications on all aspects of Veterinary Medicine, Surgery and Animal Production. Submissions are accepted on the understanding that ...

  15. Archives: Ethiopian Veterinary Journal

    African Journals Online (AJOL)

    Items 1 - 16 of 16 ... Archives: Ethiopian Veterinary Journal. Journal Home > Archives: Ethiopian Veterinary Journal. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 16 of 16 Items ...

  16. Archives: Tanzania Veterinary Journal

    African Journals Online (AJOL)

    Items 1 - 15 of 15 ... Archives: Tanzania Veterinary Journal. Journal Home > Archives: Tanzania Veterinary Journal. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 15 of 15 Items ...

  17. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Nigerian Veterinary Journal 37(3). 2016. Meseko et al. 155. NIGERIAN VETERINARY JOURNAL. ISSN 0331-3026. Nig. Vet. J., September 2016. Vol. 37 (3): 155-159. SHORT COMMUNICATION. Detection of Haemagglutination inhibition antibody to Pandemic and. Classical Swine Influenza Virus in Commercial Piggery in ...

  18. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Nigerian Veterinary Journal 37(1). 2016. Igado et al. 54. NIGERIAN VETERINARY JOURNAL. ISSN 0331-3026. Nig. Vet. J., March 2016. Vol. 37 (1): 54-63. ORIGINAL ARTICLE. Cranio-facial and Ocular Morphometrics of the Male Greater Cane Rat. (Thryonomys swinderianus). Igado, O. O.. 1. *; Adebayo, A. O.. 2.

  19. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Nigerian Veterinary Journal 37(3). 2016. Ogunro et al. 187. NIGERIAN VETERINARY JOURNAL. ISSN 0331-3026. Nig. Vet. J., September 2016. Vol. 37 (3): 187-191. CASE REPORT. Management of Epitheliogenesis Imperfecta in a Piglet (Sus Scrofa domesticus) in Ibadan, Nigeria. Ogunro, B. N.. 1. ; Otuh, P. I.. 1.

  20. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Nigerian Veterinary Journal 38(2). 2017. Meseko et al. 124. NIGERIAN VETERINARY JOURNAL. ISSN 0331-3026. Nig. Vet. J., June 2017. Vol 38 (2): 124-128. SHORT COMMUNICATION. Fowlpox Virus from Backyard Poultry in Plateau State Nigeria: Isolation and Phylogeny of the P4b Gene Compared to a Vaccine Strain.

  1. Open Veterinary Journal

    African Journals Online (AJOL)

    Open Veterinary Journal is a peer reviewed international open access online and printed journal that publishes high-quality original research articles, reviews, short communications and case reports dedicated to all aspects of veterinary sciences and its related subjects. Other websites associated with this journal: ...

  2. Open Veterinary Journal: Contact

    African Journals Online (AJOL)

    Principal Contact. Dr. Ibrahim Eldaghayes Faculty of Veterinary Medicine, University of Tripoli Faculty of Veterinary Medicine, University of Tripoli, P. O. Box 13662, Tripoli, Libya Phone: +218 21 462 8422. Fax: +218 21 462 8421. Email: ibrahim.eldaghayes@vetmed.edu.ly ...

  3. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    variegatum (Acari: Ixodidae) Ticks from Nigeria. Ogo, N. I.. 1. ; Okubanjo, O. O.. 2. ; Inuwa, H. M.. 3 and Agbede, R. I. S.. 4. 1National Veterinary Research Institute, Vom, Plateau State. 2Department of Veterinary Parasitology and. Entomology, Ahmadu Bello University, Zaria, Nigeria. 3Department of Biochemistry, Ahmadu ...

  4. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Vet. J., December 2015. Vol. 36 (4): 1272-1282. ORIGINAL ARTICLE. Gross and Morphometric Anatomical Changes of the Thyroid Gland in the West African Dwarf ... Department of Veterinary Anatomy, Faculty of Veterinary Medicine, University of Nigeria, Nsukka, Nigeria. .... common carotid artery, internal jugular vein,.

  5. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    Vet. J., March 2016. Vol. 37 (1): 45-53. ORIGINAL ARTICLE. A Retrospective Evaluation of Intravenous Fluid Usage in Animal. Patients Treated at Veterinary Teaching Hospital Nsukka, 2005-2015 ... 2Department of Veterinary Medicine, University of Nigeria, Nsukka. ... they carried with them their own internal sea.

  6. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    SUMMARY. The prevalence and morphological pathology of renal failure in exotic breeds of dog in Lagos and Ogun States, within Southwestern Nigeria were determined from postmortem records of the. Department of Veterinary Pathology, College of Veterinary Medicine, Federal University of. Agriculture, Abeokuta ...

  7. NIGERIAN VETERINARY JOURNAL

    African Journals Online (AJOL)

    ADEYEYE

    at the Maiduguri municipal abattoir and were used for this study. Thyroid glands collected were transported in ice packs to the Department of Veterinary Pathology laboratory, University of Maiduguri, Nigeria for gross examination and thereafter, fixed and sent to Department of Veterinary. Anatomy, University of Abuja, were it ...

  8. Nurses versus physician-led interhospital critical care transport: a randomized non-inferiority trial.

    Science.gov (United States)

    van Lieshout, Erik Jan; Binnekade, Jan; Reussien, Elmer; Dongelmans, Dave; Juffermans, Nicole P; de Haan, Rob J; Schultz, Marcus J; Vroom, Margreeth B

    2016-07-01

    Regionalization and concentration of critical care increases the need for interhospital transport. However, optimal staffing of ground critical care transport has not been evaluated. In this prospective, randomized, open-label, blinded-endpoint non-inferiority trial, critically ill patients on mechanical ventilation transported by interhospital ground critical care transport were randomized between transport staffed by a dedicated team comprising a critical care nurse and paramedic (nurses group) or a dedicated team including a critical care physician (nurses + physician group). The primary outcome was the number of patients with critical events, both clinical and technical, during transport. Clinical events included decrease in blood pressure, oxygen saturation, or temperature, blood loss, new cardiac arrhythmias, or death. Non-inferiority was assumed if the upper limit of the two-sided 90 % confidence interval (CI) for the between-group difference lies below the non-inferiority margin of 3 %. Of 618 eligible transported critically ill patients, 298 could be analyzed after randomization and allocation to the nurses group (n = 147) or nurses + physician group (n = 151). The percentages of patients with critical events were 16.3 % (24 incidents in 147 transports) in the nurses group and 15.2 % (23 incidents in 151 transports) in the nurses + physician group (difference 1.1 %, two-sided 90 % CI [-5.9 to 8.1]). Critical events occurred in both groups at a higher than the expected (0-1 %) rate. In the nurses group consultations for physician assistance were requested in 8.2 % (12 in 147 transports), all of which were performed prior to transport. The number of patients with critical events did not markedly differ between critical care transports staffed by a critical care nurse and paramedic compared to a team including a critical care physician. However, as a result of an unexpected higher rate of critical events in both groups recorded by an

  9. Clinical engineering support for the critical care unit.

    Science.gov (United States)

    Wilder, D K

    1993-07-01

    A tremendous selection of choices, both for goods and services, is available in the health care industry. Unfortunately, even marginal increases in expenses are hard to rationalize in today's market. To squeeze every bit from every dollar requires very active and dynamic leadership. Regulatory requirements, with the requisite documentation, must be met efficiently to free the organization to concentrate resources on providing primary health care. Capital dollars can be spent only on the best value to meet corporate objectives. The processes of health care delivery, risk assessment and management, and technology acquisition must be integrated on a corporation-wide scope to optimize the final product. To this end, the clinical engineering department brings essential skills to this participatory, dynamic management of modern health care facilities. This process of technology management has been implemented in various hospitals since 1985. Taking lessons from industry, hospital administrators are focusing management resources to address specific concerns. Clinical engineering, with its technical expertise, practical knowledge in the delivery of health care, and accrued database, is an essential part of this process. This technology management process involves an integration of experts to find specific solutions, and the supporting policies and procedures to ensure universal use of technology management.

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

    Directory of Open Access Journals (Sweden)

    Amanda Towell

    2013-11-01

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

  11. Graduating nursing students' basic competence in intensive and critical care nursing.

    Science.gov (United States)

    Lakanmaa, Riitta-Liisa; Suominen, Tarja; Perttilä, Juha; Ritmala-Castrèn, Marita; Vahlberg, Tero; Leino-Kilpi, Helena

    2014-03-01

    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.

  12. Moral sensitivity and moral distress in Iranian critical care nurses.

    Science.gov (United States)

    Borhani, Fariba; Abbaszadeh, Abbas; Mohamadi, Elham; Ghasemi, Erfan; Hoseinabad-Farahani, Mohammad Javad

    2017-06-01

    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.

  13. Clinical effectiveness of a critical care nursing outreach service in facilitating discharge from the intensive care unit.

    Science.gov (United States)

    Williams, Teresa Ann; Leslie, Gavin; Finn, Judith; Brearley, Linda; Asthifa, Mariyam; Hay, Ben; Laurie, Karen; Leen, Tim; O'Brien, Keith; Stuart, Michael; Watt, Michelle

    2010-09-01

    Improved discharge planning and extension of care to the general care unit for patients transferring from intensive care may prevent readmission to the intensive care unit and prolonged hospital stays. Morbidity, mortality, and costs increase in readmitted intensive care patients. To evaluate the clinical effectiveness of a critical care nursing outreach service in facilitating discharge from the intensive care unit and providing follow-up in general care areas. A before-and-after study design (with historical controls and a 6-month prospective intervention) was used to ascertain differences in clinical outcomes, length of stay, and cost/benefit. Patients admitted to intensive care units in 3 adult teaching hospitals were recruited. The service centered on follow-up visits by specialist intensive care nurses who reviewed and assessed patients who were to be or had been discharged to general care areas from the intensive care unit. Those nurses also provided education and clinical support to staff in general care areas. In total, 1435 patients were discharged during the 6-month prospective period. Length of stay from the time of admission to the intensive care unit to hospital discharge (P = .85), readmissions during the same hospital admission (5.6% vs 5.4%, P = .83), and hospital survival (P = .80) did not differ from before to after the intervention. Although other studies have shown beneficial outcomes in Australia and the United Kingdom, we found no improvement in length of stay after admission to the intensive care unit, readmission rate, or hospital mortality after a critical care nursing outreach service was implemented.

  14. Defining leadership competencies for pediatric critical care fellows: Results of a national needs assessment.

    Science.gov (United States)

    Green, Michael L; Winkler, Margaret; Mink, Richard; Brannen, Melissa L; Bone, Meredith; Maa, Tensing; Arteaga, Grace M; McCabe, Megan E; Marcdante, Karen; Schneider, James; Turner, David A

    2017-05-01

    Physicians in training, including those in Pediatric Critical Care Medicine, must develop clinical leadership skills in preparation to lead multidisciplinary teams during their careers. This study seeks to identify multidisciplinary perceptions of leadership skills important for Pediatric Critical Care Medicine fellows to attain prior to fellowship completion. We performed a multi-institutional survey of Pediatric Critical Care Medicine attendings, fellows, and nurses. Subjects were asked to rate importance of 59 leadership skills, behaviors, and attitudes for Pediatric Critical Care practitioners and to identify whether these skills should be achieved before completing fellowship. Skills with the highest ratings by respondents were deemed essential. Five hundred and eighteen subjects completed the survey. Of 59 items, only one item ("displays honesty and integrity") was considered essential by all respondents. When analyzed by discipline, nurses identified 21 behaviors essential, fellows 3, and attendings 1 (p importance in 64% (38/59) of skills. Despite significant variability among Pediatric Critical Care attendings, fellows, and nurses in identifying which clinical leadership competencies are important for graduating Pediatric Critical Care fellows, they place the highest importance on skills in self-management and self-awareness. Leadership skills identified as most important may guide the development of interventions to improve trainee education and interprofessional care.

  15. Emergencies and Critical Care of Commonly Kept Fowl.

    Science.gov (United States)

    Sabater González, Mikel; Calvo Carrasco, Daniel

    2016-05-01

    Fowl are birds belonging to one of the 2 biological orders, the game fowl or land fowl (Galliformes) and the waterfowl (Anseriformes). Studies of anatomic and molecular similarities suggest these two groups are close evolutionary relatives. Multiple fowl species have a long history of domestication. Fowl are considered food-producing animals in most countries and clinicians should follow legislation regarding reportable diseases and antibiotic use, even if they are pets. This article reviews aspects of emergency care for most commonly kept fowl, including triage, patient assessment, diagnostic procedures, supportive care, short-term hospitalization, and common emergency presentations. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  17. Factors affecting mortality of critical care trauma patients | Hefny ...

    African Journals Online (AJOL)

    A direct logistic regression model has shown that factors that affected mortality were decreased GCS (p < 0.0001), mechanism of injury (p = 0.004) with burns having the highest mortality, increased age (p = 0.004), and increased ISS (p ... Key words: Intensive Care Unit, injury, epidemiology, hospitalization, registry, mortality ...

  18. Improving the Quality of Electronic Documentation in Critical Care Nursing

    Science.gov (United States)

    Stevens, Brent

    2017-01-01

    Electronic nursing documentation systems can facilitate complete, accurate, timely documentation practices, but without effective policies and procedures in place, a gap in practice exists and quality of care may be impacted. This systematic review of literature examined current evidence regarding electronic nursing documentation quality. General…

  19. Community pharmaceutical care: an 8-month critical review of two ...

    African Journals Online (AJOL)

    Background: The concept of pharmaceutical care is neither well developed nor adequately documented in Uganda. Objectives: This study is therefore an attempt to identify and quantify the various service components of community pharmacy practice in Kampala, Uganda's capital city. Setting: Two pharmacies operating ...

  20. Editorial: National audit of critical care resources. How long before ...

    African Journals Online (AJOL)

    It may be argued that it will take decades before we outlive the injustices imposed on our society by apartheid. In attempting to offer reasonable and responsible guidance to policy makers and politicians, clinicians and allied health care workers have an obligation to base decisions on objective evidence. Southern African ...

  1. Transformation: are nurse leaders in critical care ready?

    Science.gov (United States)

    Botma, Yvonne; Botha, Hanlie; Nel, Mariette

    2012-10-01

    The aim was to determine whether nursing leaders met the criteria for transformational and/or transactional leadership. Many changes have occurred in South Africa and are reflected in the health-care systems. As a result, it has become crucial to source leaders who are able to manage the change process effectively so as to ensure the success and survival of our health-care organizations. The 45-item multifactor leadership questionnaire (Rater) was completed by 41 respondents out of a population of 121. A proportional stratified simple random sampling technique was used to select the raters of seven leaders. Most nursing leaders role-modelled the culture of the organisation but did not stimulate their followers intellectually and did not demonstrate innovative motivation or individual consideration. Consequently, their followers may exhibit a lack of commitment to collective goals, with detrimental effects on the health-care organisation as a whole. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGERS: Nursing leaders should be trained to become transformational leaders so as to encourage their followers to become innovative and motivated to render high quality nursing care. © 2011 Blackwell Publishing Ltd.

  2. The conceptualization of family care during critical illness in ...

    African Journals Online (AJOL)

    Methodology: This study adopted a qualitative approach and a grounded theory research design by Strauss and Corbin (1990). Participants from two hospitals: one private and one public were selected to participate in the study. There was a total of 31 participants (family members, intensive care nurses and doctors) who ...

  3. Respiratory pharmacotherapy in emergency and critical care medicine.

    Science.gov (United States)

    Rozanski, Elizabeth A; Rondeau, Mark P

    2002-09-01

    Successful pharmacologic management of most respiratory diseases is possible. All moderately to severely affected animals benefit from rest and supplemental oxygen. Careful identification of the underlying cause as well as an understanding of the pathophysiology behind various diseases is essential to successful patient outcome.

  4. Contact precautions and hand hygiene in veterinary clinics.

    Science.gov (United States)

    Anderson, Maureen E C

    2015-03-01

    Hand hygiene, contact precautions, and other basic infection control measures are crucial in veterinary clinics, because these facilities can be community mixing pots of animals and people with a wide range of health and disease-carrier states. Veterinary staff must be knowledgeable and well trained regarding when and how to apply situation-appropriate contact precautions and to properly perform hand hygiene. The limited information on the use of contact precautions and hand hygiene practices among veterinary staff suggests that compliance is low. Improving the infection control culture in clinics and in veterinary medicine is critical to achieving better compliance with these practices. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Cognitive informatics in health and biomedicine case studies on critical care, complexity and errors

    CERN Document Server

    Patel, Vimla L; Cohen, Trevor

    2014-01-01

    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.

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

    National Research Council Canada - National Science Library

    HemmatiMaslakpak, Masumeh; Farhadi, Masumeh; Fereidoni, Javid

    2016-01-01

    .... Nero-linguistic programming (NLP) is one of the modern methods of psychotherapy. This study aimed to determine the effect of NLP on occupational stress in nurses working in critical care units of Urmia...

  7. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients

    National Research Council Canada - National Science Library

    Shehabi, Yahya; Bellomo, Rinaldo; Reade, Michael C; Bailey, Michael; Bass, Frances; Howe, Belinda; McArthur, Colin; Seppelt, Ian M; Webb, Steve; Weisbrodt, Leonie

    2012-01-01

    .... To investigate the relationships between early sedation and time to extubation, delirium, and hospital and 180-day mortality among ventilated critically ill patients in the intensive care unit (ICU). Multicenter...

  8. Optimal Management of the Critically Ill: Anaesthesia, Monitoring, Data Capture, and Point-of-Care Technological Practices in Ovine Models of Critical Care

    Directory of Open Access Journals (Sweden)

    Saul Chemonges

    2014-01-01

    Full Text Available 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.

  9. The future of critical care: renal support in 2027

    OpenAIRE

    Clark, William R.; Neri, Mauro; Garzotto, Francesco; Ricci, Zaccaria; Goldstein, Stuart L.; Ding, Xiaoqiang; Xu, Jiarui; Ronco, Claudio

    2017-01-01

    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...

  10. Defects in coagulation encountered in small animal critical care.

    Science.gov (United States)

    Brainard, Benjamin M; Brown, Andrew J

    2011-07-01

    Critically ill small animals are at risk for developing coagulation abnormalities. The processes of inflammation and coagulation are intertwined, and severe inflammation can lead to disturbances of coagulation. Severe coagulation dysfunction is associated with increased morbidity and mortality. Pathophysiology, diagnosis, and treatment of coagulation dysfunction are discussed. Defects in coagulation in small animal patients are complex and a consensus on diagnosis and treatment has yet to be reached. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Westcott Mia

    2012-03-01

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

  12. Informed Consent Documents Used in Critical Care Trials Often Do Not Implement Recommendations.

    Science.gov (United States)

    Atwere, Pearl; McIntyre, Lauralyn; Carroll, Kelly; Hayes, Tavis; Brehaut, Jamie C

    2018-02-01

    Informed consent documents are often poorly understood by research participants. In critical care, issues such as time pressure, patient capacity, and surrogate decision making complicate the consent process further. Recommendations exist for addressing critical care-specific consent issues; we examined how well existing practice implements these recommendations. We conducted a systematic search of the literature for recommendations specific to critical care informed consent and rated existing informed consent documents on their implementation of 1) 18 of these critical care recommendations and 2) 36 previously developed general informed consent recommendations. Four hundred twelve registered critical care trials were identified and a request sent to the principal investigators for an example of the informed consent document associated with the trial. Each consent document was rated on both set of recommendations. We evaluated informed consent documents for trials conducted in English or French registered with clinicaltrials.gov. Not applicable. Not applicable. Independent coders rated implementation of each recommendation on a four-point scale. Of 412 requests, 137 informed consent documents were returned, for a response rate of 34.1%. Of these, 86 met inclusion criteria and were assessed. Overall agreement between raters was 90.6% (weighted κ = 0.79; 0.77-0.81). Implementation of the 18 critical care recommendations was highly variable, ranging between 2% and 96.5%. Critical care studies often do not provide the information recommended for those providing consent for research. These clear recommendations provide testable hypotheses about how to improve the consent process for patients and family members considering trial participation in the critical care setting.

  13. Critical care clinical experience for novice students: reinforcing basic nursing skills.

    Science.gov (United States)

    Ballard, Pamela; Trowbridge, Connie

    2004-01-01

    To better match students' learning priorities with their practicum experiences and to facilitate skills learning, undergraduate faculty devised the innovative strategy of incorporating a critical care rotation into the first semester of students' clinical experience. The authors describe the basics of this previously untested critical care clinical experience and the essential planning steps prior to implementation, including faculty approval, hospital administrative and nurse manager approval, preceptor identification and education, means of evaluating and grading the students, and evaluation of the overall experience.

  14. 'Intensive care unit survivorship' - a constructivist grounded theory of surviving critical illness.

    Science.gov (United States)

    Kean, Susanne; Salisbury, Lisa G; Rattray, Janice; Walsh, Timothy S; Huby, Guro; Ramsay, Pamela

    2017-10-01

    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

  15. Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses.

    Science.gov (United States)

    Ranse, Kristen; Bloomer, Melissa; Coombs, Maureen; Endacott, Ruth

    2016-11-01

    A core component of family-centred nursing care during the provision of end-of-life care in intensive care settings is information sharing with families. Yet little is known about information provided in these circumstances. To identify information most frequently given by critical care nurses to families in preparation for and during withdrawal of life-sustaining treatment. An online cross-sectional survey. During May 2015, critical care nurses in Australia and New Zealand were invited to complete the Preparing Families for Treatment Withdrawal questionnaire. Data analysis included descriptive statistics to identify areas of information most and least frequently shared with families. Cross tabulations with demographic data were used to explore any associations in the data. From the responses of 159 critical care nurses, information related to the emotional care and support of the family was most frequently provided to families in preparation for and during withdrawal of life-sustaining treatment. Variation was noted in the frequency of provision of information across body systems and their associated physical changes during the dying process. Significant associations (pnursing experience and critical care experiences and some of the information items most and least frequently provided. The provision of information during end-of-life care reflects a family-centred care approach by critical care nurses with information pertaining to emotional care and support of the family paramount. The findings of this study provide a useful framework for the development of interventions to improve practice and support nurses in communicating with families at this time. Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  16. Pediatric Critical Care Transport as a Conduit to Terminal Extubation at Home: A Case Series.

    Science.gov (United States)

    Noje, Corina; Bernier, Meghan L; Costabile, Philomena M; Klein, Bruce L; Kudchadkar, Sapna R

    2017-01-01

    To present our single-center's experience with three palliative critical care transports home from the PICU for terminal extubation. We performed a retrospective chart review of patients transported between January 1, 2012, and December 31, 2014. All cases were identified from our institutional pediatric transport database. Patients were terminally ill children unable to separate from mechanical ventilation in the PICU, who were transported home for terminal extubation and end-of-life care according to their families' wishes. Patients underwent palliative care transport home for terminal extubation. The rate of palliative care transports home for terminal extubation during the study period was 2.6 per 100 deaths. The patients were 7 months, 6 years, and 18 years old and had complex chronic conditions. The transfer process was protocolized. The families were approached by the PICU staff during multidisciplinary goals-of-care meetings. Parental expectations were clarified, and home hospice care was arranged pretransfer. All transports were performed by our pediatric critical care transport team, and all terminal extubations were performed by physicians. All patients had unstable medical conditions and urgent needs for transport to comply with the families' wishes for withdrawal of life support and death at home. As such, all three cases presented similar logistic challenges, including establishing do-not-resuscitate status pretransport, having limited time to organize the transport, and coordinating home palliative care services with available community resources. Although a relatively infrequent practice in pediatric critical care, transport home for terminal extubation represents a feasible alternative for families seeking out-of-hospital end-of-life care for their critically ill technology-dependent children. Our single-center experience supports the need for development of formal programs for end-of-life critical care transports to include patient screening tools

  17. Implementation of a pediatric critical care focused bedside ultrasound training program in a large academic PICU.

    Science.gov (United States)

    Conlon, Thomas W; Himebauch, Adam S; Fitzgerald, Julie C; Chen, Aaron E; Dean, Anthony J; Panebianco, Nova; Darge, Kassa; Cohen, Meryl S; Greeley, William J; Berg, Robert A; Nishisaki, Akira

    2015-03-01

    To determine the feasibility and describe the process of implementing a pediatric critical care bedside ultrasound program in a large academic PICU and to evaluate the impact of bedside ultrasound on clinical management. Retrospective case series, description of program implementation. Single-center quaternary noncardiac PICU in a children's hospital. Consecutive patients from January 22, 2012, to July 22, 2012, with bedside ultrasounds performed and interpreted by pediatric critical care practitioners. A pediatric critical care bedside ultrasound program consisting of a 2-day immersive course followed by clinical performance with internal quality assurance review was implemented. Studies performed in the PICU following training were documented and reviewed against reference standards including subspecialist-performed ultrasound or clinical response. Seventeen critical care faculties and eight fellows recorded 201 bedside ultrasound studies over 6 months in defined core applications: 57 procedural (28%), 76 hemodynamic (38%), 35 thoracic (17%), and 33 abdominal (16%). A quality assurance review identified 23 studies (16% of all nonprocedural studies) as critical (affected clinical management or gave valuable information). Forty-eight percent of those studies (11/23) were within the hemodynamic core. The proportion of critical studies were not significantly different across the applications (hemodynamic, 11/76 [15%] vs thoracic and abdominal, 12/68 [18%]; p = 0.65). Examples of critical studies include evidence of tamponade secondary to pleural effusions, identification of pulmonary hypertension, hemodynamic assessment before tracheal intubation, recognition of hypovolemia and systemic vascular resistance abnormalities, determination of pneumothorax, location of chest tube and urinary catheter, and differentiation of pleural fluid from pulmonary consolidation. Implementation of a critical care bedside ultrasound program for critical care providers in a large

  18. Cultural awareness in veterinary practice: student perceptions.

    Science.gov (United States)

    Mills, Jennifer N; Volet, Simone; Fozdar, Farida

    2011-01-01

    Australian veterinary classrooms are increasingly diverse and their growing internal diversity is a result of migration and large numbers of international students. Graduates interact with other students and increasingly with clients whose attitudes, beliefs, values, and behaviors differ from their own. An understanding and respect for these differences has an impact on client communication and health care outcomes. The present study explored how students understand and are likely to deal with issues of cultural diversity in veterinary professional practice as well as the educational needs that students feel should be met in regard to preparation to engage productively with diversity in professional practice. The present study also explored the extent to which the rich diversity of the undergraduate student population constitutes an educational resource. A class of final-year veterinary students was invited to participate in a workshop exploring intercultural confidence in veterinary consultation. Twelve groups of six to eight students discussed a fictitious scenario involving a challenging clinical encounter with a client from a different culture. Students were reticent to see the scenario in terms of cultural difference, although they generally recognized that awareness of cultural issues in veterinary practice was important. They also tended to not see their own ethnicity as relevant to their practice. While some felt that veterinary practice should be culture blind, most recognized a need to orient to cultural difference and to respond sensitively. Their suggestions for curricular improvements to address these issues are also included.

  19. Critical care nurses' perceptions of and responses to moral distress.

    Science.gov (United States)

    Gutierrez, Karen M

    2005-01-01

    Nurses frequently experience conflict regarding healthcare decisions, yet are expected to implement actions which they perceive to be morally wrong. Research has described the deleterious effects of this moral incongruency, coined moral distress, on nurses' well being and has identified it as a causative agent in nursing turnover, burnout, and nurses leaving the profession. Thus, it is known that moral distress has significant consequences for nurses, but does moral distress affect nurses' provision of care, and if so, how?

  20. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    OpenAIRE

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

    2014-01-01

    Objective: Burnout is common in intensive care units (ICU) because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory) and depression (Beck Depressi...