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https://www.readbyqxmd.com/read/29351145/recent-evidence-on-early-mobilization-in-critical-ill-patients
#1
Kristina Fuest, Stefan J Schaller
PURPOSE OF REVIEW: To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field. RECENT FINDINGS: Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients...
January 17, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29347952/the-german-quality-network-sepsis-study-protocol-for-the-evaluation-of-a-quality-collaborative-on-decreasing-sepsis-related-mortality-in-a-quasi-experimental-difference-in-differences-design
#2
Daniel Schwarzkopf, Hendrik Rüddel, Matthias Gründling, Christian Putensen, Konrad Reinhart
BACKGROUND: While sepsis-related mortality decreased substantially in other developed countries, mortality of severe sepsis remained as high as 44% in Germany. A recent German cluster randomized trial was not able to improve guideline adherence and decrease sepsis-related mortality within the participating hospitals, partly based on lacking support by hospital management and lacking resources for documentation of prospective data. Thus, more pragmatic approaches are needed to improve quality of sepsis care in Germany...
January 18, 2018: Implementation Science: IS
https://www.readbyqxmd.com/read/29347908/management-and-outcomes-of-patients-presenting-with-sepsis-and-septic-shock-to-the-emergency-department-during-nursing-handover-a-retrospective-cohort-study
#3
Sami Alsolamy, Atheer Al-Sabhan, Najla Alassim, Musharaf Sadat, Eman Al Qasim, Hani Tamim, Yaseen M Arabi
BACKGROUND: Clinical handover is an important process for the transition of patient-care responsibility to the next healthcare provider, but it may divert the attention of the team away from active patients. This is challenging in the Emergency Department (ED) because of highly dynamic patient conditions and is likely relevant in conditions that requires time-sensitive therapies, such as sepsis. We aimed to examine the management and outcomes of patients presenting with sepsis and septic shock to the ED during nursing handover...
January 18, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29344622/barriers-to-and-facilitators-of-implementing-enhanced-recovery-pathways-using-an-implementation-framework-a-systematic-review
#4
Alexander B Stone, Christina T Yuan, Michael A Rosen, Michael C Grant, Lauren E Benishek, Elizabeth Hanahan, Lisa H Lubomski, Clifford Ko, Elizabeth C Wick
Importance: Enhanced recovery pathways (ERPs) have the potential to reduce length of hospital stay, costs, and complications following surgery but can be challenging to implement. Objective: To examine the body of literature on ERPs to assess how authors describe barriers and facilitators of ERP implementation and identify, in aggregate, the best practices that should be considered utilizing the Consolidated Framework for Implementation Research (CFIR) to extract these elements and summarize common barriers and facilitators according to its 5 major domains: (1) intervention characteristics, (2) inner setting, (3) outer setting, (4) characteristics of the individuals, and (5) the process of implementation...
January 17, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29344355/impact-of-an-antifungal-stewardship-intervention-on-optimization-of-candidemia-management
#5
Hana Rac, Jamie L Wagner, S Travis King, Katie E Barber, Kayla R Stover
Background: Candidemia represents a leading cause of healthcare-associated bloodstream infections with significant morbidity and mortality. Previous studies have demonstrated that comprehensive care bundles improve candidemia management but are time-consuming. Objective: To determine the impact of a one-time targeted candidemia intervention on time to initiation of adequate therapy compared to standard of care. Methods: This Institutional Review Board (IRB)-approved, quasi-experiment evaluated a targeted candidemia intervention involving a single phone call to the primary team providing recommendations for care...
January 2018: Therapeutic Advances in Infectious Disease
https://www.readbyqxmd.com/read/29344102/should-preoperative-showering-or-cleansing-with-chlorhexidine-gluconate-chg-be-part-of-the-surgical-care-bundle-to-prevent-surgical-site-infection
#6
Charles E Edmiston, David Leaper
Showering preoperatively with chlorhexidine gluconate is an issue that continues to promote debate; however, many studies demonstrate evidence of surgical site infection risk reduction. Methodological issues have been present in many of the studies used to compile guidelines and there has been a lack of standardisation of processes for application of the active agents in papers pre-2009. This review and commentary paper highlights the potential for enhancing compliance with this low-risk and low-cost intervention and provides some guidance for enhancing implementation of preoperative showering with both chlorhexidine in solution and impregnated wipes...
November 2017: Journal of Infection Prevention
https://www.readbyqxmd.com/read/29337126/rigid-plate-fixation-vs-wire-cerclage-patient-reported-and-economic-outcomes-from-a-randomized-trial
#7
Keith B Allen, Vinod H Thourani, Yoshifumi Naka, Kendra J Grubb, John Grehan, Nirav Patel, T Sloane Guy, Kevin Landolfo, Marc Gerdisch, Mark Bonnell, David J Cohen
BACKGROUND: In a multicenter randomized trial, sternal closure following cardiac surgery using rigid plate fixation (RPF) compared with wire cerclage (WC) resulted in improved sternal healing, reduced sternal complications and was cost neutral at 6 months. Additional secondary endpoints are presented from this trial. METHODS: Twelve US centers randomized 236 patients to RPF (n=116) or WC (n=120). Patient reported outcomes measures (PROMs) including pain, function, and quality-of-life (QOL) scores were assessed through 6-months and correlated to computed tomographic derived sternal healing scores using logistic regression...
January 11, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29329916/impact-of-the-international-nosocomial-infection-control-consortium-s-multidimensional-approach-on-rates-of-ventilator-associated-pneumonia-in-14-intensive-care-units-in-11-hospitals-of-5-cities-within-argentina
#8
Victor Daniel Rosenthal, Javier Desse, Diego Marcelo Maurizi, Gustavo Jorge Chaparro, Pablo Wenceslao Orellano, Viviana Chediack, Rafael Cabrera, Daniel Golschmid, Cristina Graciela Silva, Julio Cesar Vimercati, Juan Pablo Stagnaro, Ivanna Perez, María Laura Spadaro, Adriana Miriam Montanini, Dina Pedersen, Teresa Laura Paniccia, Ana María Ríos Aguilera, Raul Cermesoni, Juan Ignacio Mele, Ernesto Alda, Analía Edith Paldoro, Agustín Román Ortta, Bettina Cooke, María Cecilia García, Mora Nair Obed, Cecilia Verónica Domínguez, Pablo Alejandro Saúl, María Cecilia Rodríguez Del Valle, Alberto Claudio Bianchi, Gustavo Alvarez, Ricardo Pérez, Carolina Oyola
BACKGROUND: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. METHODS: A multicenter, prospective, before-after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network...
January 9, 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29329118/ce-managing-sepsis-and-septic-shock-current-guidelines-and-definitions
#9
Mary Beth Flynn Makic, Elizabeth Bridges
Recent updates emphasize early recognition and prompt intervention. ABSTRACT: Sepsis is a leading cause of critical illness and hospital mortality. Early recognition and intervention are essential for the survival of patients with this syndrome. In 2002, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) launched the Surviving Sepsis Campaign (SSC) to reduce overall patient morbidity and mortality from sepsis and septic shock by driving practice initiatives based on current best evidence...
January 11, 2018: American Journal of Nursing
https://www.readbyqxmd.com/read/29325725/who-goes-to-inpatient-rehabilitation-or-skilled-nursing-facilities-unexpectedly-following-total-knee-arthroplasty
#10
Alexander J Rondon, Timothy L Tan, Max R Greenky, Karan Goswami, Noam Shohat, Jessica L Phillips, James J Purtill
BACKGROUND: Inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) represent a significant portion of post-operative expenses of bundled payments for total knee arthroplasty (TKA). Although many surgeons no longer routinely send patients to IRFs or SNFs, some patients are unable to be discharged directly home. This study identified patient factors for discharge to post-acute care facilities with an institutional protocol of discharging TKA patients home. METHODS: A retrospective review of patients undergoing primary unilateral TKA at a single institution from 2012 to 2017 was performed...
December 21, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29323987/care-bundles-in-the-management-of-a-copd-exacerbation
#11
Charlotte Lloyd, Joanne Garside
Chronic obstructive pulmonary disease (COPD), the umbrella term used to describe chronic lung diseases that cause limitations in lung airflow, is predicted to be the third leading cause of death by 2030. COPD is said to affect 3 million people in the UK, resulting in approximately 30 000 deaths each year. Related healthcare costs continue to escalate, not least because of increasing readmission rates associated with COPD emergencies. The use of care bundles to streamline care is becoming more popular in an attempt to tackle this issue...
January 11, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29323761/chronic-critical-illness-application-of-what-we-know
#12
REVIEW
Martin D Rosenthal, Amir Y Kamel, Cameron M Rosenthal, Scott Brakenridge, Chasen A Croft, Frederick A Moore
Over the last decade, chronic critical illness (CCI) has emerged as an epidemic in intensive care unit (ICU) survivors worldwide. Advances in ICU technology and implementation of evidence-based care bundles have significantly decreased early deaths and have allowed patients to survive previously lethal multiple organ failure (MOF). Many MOF survivors, however, experience a persistent dysregulated immune response that is causing an increasingly predominant clinical phenotype called the persistent inflammation, immunosuppression, and catabolism syndrome (PICS)...
January 11, 2018: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/29319533/flax-stems-from-a-specific-architecture-to-an-instructive-model-for-bioinspired-composite-structures
#13
Christophe Baley, Camille Goudenhooft, Marianne Gibaud, Alain Bourmaud
The present paper proposes to carefully study and describe the reinforcement mechanisms within a flax stem, which is an exceptional natural model of composite structure. Thanks to accurate microscopic investigations, with both optical and SEM method, we finely depicted the flax stem architecture, which can be view as a composite structure with an outer protection, a unidirectional ply on the periphery and a porous core; each component has a specific function, such as mechanical reinforcement for the unidirectional ply and the porous core...
January 10, 2018: Bioinspiration & Biomimetics
https://www.readbyqxmd.com/read/29318267/participation-and-dropout-in-the-bundled-payments-for-care-improvement-initiative
#14
Karen E Joynt Maddox, E John Orav, Jie Zheng, Arnold M Epstein
No abstract text is available yet for this article.
January 9, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29317914/a-high-impact-intervention-for-a-high-impact-intervention-improving-documentation-of-peripheral-venous-access-insertion-in-theatre
#15
Kavita Upadhyaya, Heidy Hendra, Nick Wilson
The Department of Health's 'High Impact Intervention (HII) - Peripheral intravenous cannula care bundle' lists six actions to be performed at the time of peripheral intravenous cannulation. Audit of compliance to these requires documentation. We assessed documentation on the anaesthetic charts of 50 surgical patients. Purpose-made stickers were then placed on all anaesthetic charts. Re-assessment of a further 50 patients' charts demonstrated a significant improvement in documentation of the bundle post intervention (Fisher's exact test P < 0...
January 2018: Journal of Infection Prevention
https://www.readbyqxmd.com/read/29316825/on-surmounting-the-barriers-to-hpv-vaccination-we-can-do-better
#16
Aria C Attia, Judith Wolf, Ana Nuñez
The major impediment to increased HPV vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention's (CDC) Healthy People 2020 target of 80% coverage. Parents' willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic...
January 10, 2018: Annals of Medicine
https://www.readbyqxmd.com/read/29313072/-antibiotic-stewardship-measures-for-optimizing-prescription-of-anti-infective-agents
#17
REVIEW
C Lanckohr, H Bracht
Antibiotic stewardship (ABS) comprises a bundle of different interventions to improve anti-infective treatment in a hospital setting. An important component of ABS interventions is the interdisciplinary approach to infection management. Besides improving infrastructural aspects on a hospital level, including surveillance of the use of anti-infective agents and nosocomial infections, collation and interpretation of statistics on resistance and formulation of local treatment guidelines, ABS teams go to the wards and advise treating physicians on antibiotic therapy...
January 8, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29310974/sepsis-in-tropical-regions-report-from-the-task-force-on-tropical-diseases-by-the-world-federation-of-societies-of-intensive-and-critical-care-medicine
#18
Steven McGloughlin, Guy A Richards, Mohd Basri Mat Nor, Shirish Prayag, Tim Baker, Pravin Amin
Sepsis and septic shock in the tropics are caused by a wide array of organisms. These infections are encountered mainly in low and middle-income countries (LMIC) where a lack of infrastructure and medical facilities contribute to the high morbidity and mortality. Published sepsis guidelines are based on studies primarily performed in high income countries and as such recommendations may or may not be relevant to practice in the tropics. Failure to adhere to guidelines, particularly among non-intensive care specialists even in high-income countries, is an area of concern for sepsis management...
December 30, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29306875/serum-lactate-cut-offs-as-a-risk-stratification-tool-for-in-hospital-adverse-outcomes-in-emergency-department-patients-screened-for-suspected-sepsis
#19
Amith L Shetty, Kelly Thompson, Karen Byth, Petra Macaskill, Malcolm Green, Mary Fullick, Harvey Lander, Jonathan Iredell
OBJECTIVES: We investigated specific lactate thresholds for adverse outcomes in patients presenting to emergency departments (EDs) with suspected sepsis identified based on the performance of a sepsis screening algorithm. DESIGN AND SETTING: A standardised sepsis bundle was implemented across public hospitals in New South Wales, Australia, as a quality improvement initiative. A register of all adult ED presentations (≥18 years) meeting predefined criteria for sepsis was created, using a combination of data linkage and direct reporting from 97 participating sites...
January 5, 2018: BMJ Open
https://www.readbyqxmd.com/read/29300217/development-of-an-rn-champion-model-to-improve-the-outcomes-of-ventilator-associated-pneumonia-patients-in-the-intensive-care-unit
#20
Carol Robinson, Marci Hoze, Stacy Hevener, Amy A Nichols
Healthcare-associated infections are costly. Methods to prevent infections must be effective and provide a return on investment to be sustainable. A funded project supported the design and implementation of a unique quality and safety model, using unit-based quality and safety RN champions. The goal was to create and sustain a hospital-wide safety culture focused on preventing ventilator-associated pneumonia (VAP) by adopting the Institute for Healthcare Improvement's VAP bundle. The program began with a pilot in 7 ICUs...
January 4, 2018: Journal of Nursing Administration
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