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quality intensive care

Caroline Rouard, Nadège Bourgeois-Nicolaos, Lalaina Rahajamanana, Olivier Romain, Lydia Pouga, Véronique Derouin, Daniele De Luca, Florence Doucet-Populaire
BACKGROUND: Meticillin-susceptible and resistant Staphylococcus aureus (MSSA and MRSA) are responsible for outbreaks in intensive care units. MSSA infections have the same morbidity and mortality rate as MRSA infections but are less often studied. Whole genome sequencing (WGS) is increasingly used for outbreak monitoring but still requires specific installation and trained personnel to obtain and analyse the data. AIM: To evaluate the workflow and the benefits of the bioMerieux Episeq® (bioMerieux, France) solution in exploring an increased incidence of S...
February 13, 2019: Journal of Hospital Infection
Katharina Mattishent, Menaka Thavarajah, Ashnish Sinha, Adam Peel, Matthias Egger, Joseph Solomkin, Stijn de Jonge, Asad Latif, Sean Berenholtz, Benedetta Allegranzi, Yoon Kong Loke
BACKGROUND: Evidence-based guidelines from the World Health Organization (WHO) have recommended a high (80%) fraction of inspired oxygen (FiO2 ) to reduce surgical site infection in adult surgical patients undergoing general anaesthesia with tracheal intubation. However, there is ongoing debate over the safety of high FiO2 . We performed a systematic review to define the relative risk of clinically relevant adverse events (AE) associated with high FiO2 . METHODS: We reviewed potentially relevant articles from the WHO review supporting the recommendation, including an updated (July 2018) search of EMBASE and PubMed for randomised and non-randomised controlled studies reporting AE in surgical patients receiving 80% FiO2 compared with 30-35% FiO2 ...
March 2019: British Journal of Anaesthesia
Michael Schreiber, Clemens-Alexander Greim
The rising impact of perioperative sonography is mainly based on mobile high quality ultrasound systems. Relevant bleedings or functional limitations of the abdomen are easy to identify with sonography. The FAST-Concept can be the first access to continue proceedings in ultrasound examination of the abdomen. This paper demonstrates some important ultrasound examinations of the abdomen. The clinical main issues are traumatic and atraumatic bleedings of heart, liver and spleen with haemodynamic instability and functional limitations of abdominal organs like bile cystitis, gastrointestinal passage disability and obstructive uropathy...
February 2019: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Wolf Armbruster, Rüdiger Eichholz, Thomas Notheisen
Lung ultrasound is an underrated tool in preclinical emergency situations, intensive care units, ORs and emergency rooms. For certain clinical questions, there is a drastically higher sensitivity in comparison to chest X-ray examinations (sensitivity in pneumothorax diagnostics 86 vs. 28%, specificity 97 vs. 100%. A standardized examination improves the quality of the ultrasound examination and thus the diagnostic value. The article provides basic information on pulmonary ultrasound and aims to highlight the superiority of ultrasound over x-ray procedures for anesthesia, intensive care and emergency medicine in accordance to the international evidence-based recommendations for point of care ultrasound...
February 2019: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Anna C Sick-Samuels, Charlotte Z Woods-Hill, James C Fackler, Pranita D Tamma, Sybil A Klaus, Elizabeth E Colantuoni, Aaron M Milstone
Blood cultures are essential for the evaluation of sepsis. However, they may sometimes be obtained inappropriately, leading to high false-positive rates, largely due to contamination.1 As a quality improvement project, clinician decision-support tools for evaluating patients with fever or signs and symptoms of sepsis were implemented in April 2014 in our pediatric intensive care unit (PICU). This initiative resulted in a 46% decrease in blood culture obtainment2 and has been replicated in other institutions...
February 15, 2019: Infection Control and Hospital Epidemiology
Konan Constant N Zi, Youssouf Traoré, Médé Roger Dindji, Yapo Blaise Acho, Jean-Sylvain Bonny
Objectif: This study describes the management of medical waste at the University Hospital of Cocody, and appreciates the biological risk for care and cleaning staff. METHODS: From August 1st to 21st, 2015, a cross-sectional survey was conducted in intensive care units, gynecology-obstetrics, pediatrics-neonatology and anatomy-pathology. Care and cleaning staff filled in a standardized questionnaire. Empirical data was obtained on professional characteristics and management policy; treatment of biomedical waste and biological risk...
September 2018: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
Clare Viglione, Dylaney Bouwman, Nadera Rahman, Yixin Fang, Jeannette M Beasley, Scott Sherman, Xavier Pi-Sunyer, Judith Wylie-Rosett, Craig Tenner, Melanie Jay
Background: Goals for Eating and Moving (GEM) is a technology-assisted health coaching intervention to improve weight management in primary care at the Veterans Health Administration (VHA) that we designed through prior rigorous formative studies. GEM is integrated within the patient-centered medical home and utilizes student health coach volunteers to counsel patients and encourage participation in VHA's intensive weight management program, MOVE!. The primary aim of this study was to determine the feasibility and acceptability of GEM when compared to Enhanced Usual Care (EUC)...
2019: BMC Obesity
Alessandra Buja, Michele Rivera, Vincenzo Baldo, Marta Soattin, Ylenia Rizzolo, Giuseppe Zamengo, Sarah Boscolo, Maria Cristina Ghiotto, Gianfranco Damiani
OBJECTIVES: The aim of this study was to investigate how palliative care service structures and processes correlate with their outputs and outcomes, measuring the latter respectively in terms of intensity of care and death at home. METHODS: The Veneto Regional Health Authorities collected a set of 37 quality indicators for the year 2016, covering the following five dimensions: service integration, service structure, accessibility, professional processes and organisational processes...
February 14, 2019: BMJ Supportive & Palliative Care
Lora Walter, Meigan Robb
Preparing parents for discharge readiness starts by arming the neonatal intensive care unit registered nurses with the knowledge and understanding of family-centered care principles. Implementation of a 30-minute educational session followed by 4 weeks of mentoring increased neonatal intensive care unit registered nurses knowledge and supported a sustainable change in professional practice. Approaches used in this quality improvement project can serve as a framework for nursing professional development specialists...
February 11, 2019: Journal for Nurses in Professional Development
Juying Jin, Su Min, Qibin Chen, Dong Zhang
To determine efficacy and safety of patient-controlled intravenous analgesia (PCIA) with tramadol and lornoxicam for postoperative analgesia, and its effects on surgical outcomes in patients following thoracotomy.The records of patients who underwent thoracotomy for lung resection between January 2014 and December 2014 at our institution were reviewed. The patients were divided into 2 groups according to postoperative pain treatment modalities. Patients of the patient-controlled epidural analgesia (PCEA) group (n = 63), received PCEA with 0...
February 2019: Medicine (Baltimore)
Andrea Bruni, Eugenio Garofalo, Corrado Pelaia, Antonio Messina, Gianmaria Cammarota, Paolo Murabito, Silvia Corrado, Luigi Vetrugno, Federico Longhini, Paolo Navalesi
Patient-ventilator asynchrony is considered as a major clinical problem for mechanically ventilated patients. It occurs during partial ventilatory support, when the respiratory muscles and the ventilator interact to contribute generating the volume output. In this review article, we consider all studies published on patient-ventilator asynchrony in the last 25 years. We selected 62 studies. The different forms of asynchrony are first defined and classified. We also describe the methods used for detecting and quantifying asynchronies...
February 13, 2019: Minerva Anestesiologica
Jean Deschamps, Jordan Webber, Robin Featherstone, Meghan Sebastianski, Ben Vandermeer, Janek Senaratne, Sean M Bagshaw
INTRODUCTION: Predicting successful liberation from mechanical ventilation (MV) among critically ill patients receiving MV can be challenging. The current parameters used to predict successful extubation have shown variable predictive value. Brain natriuretic peptide (BNP) has been proposed as a novel biomarker to help guide decision-making in readiness for liberation of MV following a spontaneous breathing trial (SBT). Current evidence on the predictive ability of BNP has been uncertain, and BNP has not been integrated into clinical practice guidelines...
February 12, 2019: BMJ Open
Urs Pietsch, Giacomo Strapazzon, Dimitri Ambühl, Volker Lischke, Simon Rauch, Jürgen Knapp
BACKGROUND: Human external cargo (HEC) extrication during helicopter rescue missions is commonly used in mountain emergency medical services. Furthermore, longline or winch operations offer the opportunity to deliver professional medical care onsite. As the safety and quality of emergency medical care depends on training and experience, we aimed to investigate characteristics of mountain rescue missions with HEC. METHODS: We retrospectively reviewed all rescue missions conducted by Air Zermatt (a commercial rescue service in the high-alpine region of Switzerland) from January 2010 to September 2016...
February 13, 2019: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Lorenz Weidhase, Daniel Wellhöfer, Gero Schulze, Thorsten Kaiser, Tim Drogies, Ulrike Wurst, Sirak Petros
BACKGROUND: The aim of this study was to evaluate whether Interleukin-6 (IL-6) could be a faster indicator of treatment success in adults with severe sepsis and septic shock compared to procalcitonin (PCT) and C-reactive protein (CRP). METHODS: Data from adult patients with severe sepsis and septic shock managed at the medical intensive care unit (ICU) of the University Hospital Leipzig between September 2009 and January 2012 were analyzed retrospectively. Values for CRP, PCT and IL-6 on admission as well as after 24 and 48-72 h were collected...
February 13, 2019: BMC Infectious Diseases
M K Ahsan, N Zaman, J Islam
Spine injuries, a common component in Polytrauma are usually affects the young people and is a major cause of morbidity and poses a significant health care expenditure and considerable threats to survival and quality of life. We retrospectively assess the demographics, incidence, mode of trauma, associated spine injuries, complications, neurological improvement and mortality. Records of total 1695 admitted patients, spinal injuries were 262 patients. Among them 30(11.45%) patients were associated with Polytrauma victims...
January 2019: Mymensingh Medical Journal: MMJ
Kelly Thompson, Balasubramanian Venkatesh, Simon Finfer
Sepsis, defined as life-threatening organ dysfunction due to a dysregulated host response to infection, is recognised by the World Health Organization as a global health priority. Each year, 5000 of the 18 000 adults with sepsis treated in Australian intensive care units die, with survivors suffering long-term physical, cognitive and psychological dysfunction, which is poorly recognised and frequently untreated. There are currently no effective pharmacological treatments for sepsis, making early recognition, resuscitation and immediate treatment with appropriate antibiotics the key to reducing the burden of resulting disease...
February 2019: Internal Medicine Journal
Anne Frawley, John Hickey, Christine Weaver, James P Williams, Tamas Szakmany
BACKGROUND: The management of pain, agitation and sedation for ventilated patients who are admitted to intensive care is an essential part of their care. The introduction of sedation protocols is associated with improved patient outcomes. METHODS: We conducted an observational cohort study among mechanically ventilated patients in a 16-bed ICU over a two-year period. We retrospectively examined data from two patient populations, namely those before and after the introduction of a new sedation protocol in July 2015...
February 12, 2019: Anaesthesiology Intensive Therapy
Feng-Huang Yang, Feng-Yu Lin, Yueh-Juen Hwu
BACKGROUND: Evidence-based studies propose that the aspirate pH test may be easily and reliably conducted to verify the proper placement of nasogastric tubes (NGTs). Nurses rarely implement this procedure because of the lack of related knowledge. PURPOSE: The purpose of this study was to explore the feasibility of implementing a revised standard care procedure to enhance nurses' ability to verify placement of the NGT. METHODS: This study used a quasi-experimental, longitudinal research design...
February 8, 2019: Journal of Nursing Research: JNR
Azizeh Khaled Sowan, Meghan Leibas, Albert Tarriela, Charles Reed
BACKGROUND: The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. OBJECTIVE: This study aimed to evaluate nurses' perceptions of the usability of a nursing care plan solution that includes 234 CPGs. METHODS: A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses' perceptions of system usability...
February 12, 2019: JMIR Human Factors
Emily M Tompkins, David J Anderson
Under life-history theories of ageing, increased senescence should follow relatively high reproductive effort. This expectation has rarely been tested against senescence varying between and within the two sexes, although such an approach may clarify the origins of sex-specific ageing in the context of a given mating system. Nazca boobies (Sula granti; a seabird) practise serial monogamy and biparental care. A male-biased population sex ratio results in earlier and more frequent breeding by females. Based on sex-specific reproductive schedules, females were expected to show faster age-related decline for survival and reproduction...
February 12, 2019: Journal of Animal Ecology
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