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Monitoring critical care

Michelle Hadjiconstantinou, Jo Byrne, Danielle H Bodicoat, Noelle Robertson, Helen Eborall, Kamlesh Khunti, Melanie J Davies
BACKGROUND: Poor diabetes self-care can have a negative impact on psychological well-being and quality of life. Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs, Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions. However, there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes...
October 21, 2016: Journal of Medical Internet Research
James Raftery, Steve Hanney, Trish Greenhalgh, Matthew Glover, Amanda Blatch-Jones
BACKGROUND: This report reviews approaches and tools for measuring the impact of research programmes, building on, and extending, a 2007 review. OBJECTIVES: (1) To identify the range of theoretical models and empirical approaches for measuring the impact of health research programmes; (2) to develop a taxonomy of models and approaches; (3) to summarise the evidence on the application and use of these models; and (4) to evaluate the different options for the Health Technology Assessment (HTA) programme...
October 2016: Health Technology Assessment: HTA
Joseph M Blankush, Robbie Freeman, Joy McIlvaine, Trung Tran, Stephen Nassani, I Michael Leitman
Modified Early Warning Scores (MEWS) provide real-time vital sign (VS) trending and reduce ICU admissions in post-operative patients. These early warning calculations classically incorporate oxygen saturation, heart rate, respiratory rate, systolic blood pressure, and temperature but have not previously included end-tidal CO2 (EtCO2), more recently identified as an independent predictor of critical illness. These systems may be subject to failure when physiologic data is incorrectly measured, leading to false alarms and increased workload...
October 20, 2016: Journal of Clinical Monitoring and Computing
Alistair E W Johnson, Mohammad M Ghassemi, Shamim Nemati, Katherine E Niehaus, David A Clifton, Gari D Clifford
Clinical data management systems typically provide caregiver teams with useful information, derived from large, sometimes highly heterogeneous, data sources that are often changing dynamically. Over the last decade there has been a significant surge in interest in using these data sources, from simply re-using the standard clinical databases for event prediction or decision support, to including dynamic and patient-specific information into clinical monitoring and prediction problems. However, in most cases, commercial clinical databases have been designed to document clinical activity for reporting, liability and billing reasons, rather than for developing new algorithms...
February 2016: Proceedings of the IEEE
Zaheed Damani, Gail MacKean, Eric Bohm, Brie DeMone, Brock Wright, Tom Noseworthy, Jayna Holroyd-Leduc, Deborah A Marshall
BACKGROUND: Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba...
October 18, 2016: Health Research Policy and Systems
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
Ann M Mayo, Melodee Harris, Bill Buron
Specific changes to the national clinical nurse specialist (CNS) certification are necessitating a move away the psychiatric/mental health (P/MH) CNS population focus. However, a rapidly increasing older adult population with P/MH comorbidities such as depression and anxiety means that the adult-gerontology CNS (AGCNS) will likely be coordinating much of the complex care needs of this vulnerable population. Therefore, strategies are needed to ensure AGCNSs are competent in advanced practice P/MH nursing. In addition, at this critical time in the redesign of healthcare, the Institute of Medicine has made interprofessional practice center stage for healthcare professional education...
November 2016: Clinical Nurse Specialist CNS
Hussein Walijee, Alexandria Morgan, Bethan Gibson, Sandeep Berry, Ali Jaffery
Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015...
2016: International Journal of Otolaryngology
Steven L Clark, Emily Hamilton, Thomas J Garite, Audra Timmins, Philip A Warrick, Samuel Smith
BACKGROUND: Despite intensive efforts directed at initial training in fetal heart rate interpretation, continuing medical education, board certification/recertification, team training and the development of specific protocols for the management of abnormal fetal heart rate patterns, the goals of consistently preventing hypoxia-induced fetal metabolic acidemia and neurologic injury remain elusive. OBJECTIVE: To validate a recently published algorithm for the management of category II fetal heart rate tracings , examine reasons for the birth of infants with significant metabolic acidemia despite the use of electronic fetal heart rate monitoring and critically examine the limits of EFHRM in the prevention of neonatal metabolic acidemia...
October 14, 2016: American Journal of Obstetrics and Gynecology
Şule Özbilgin, Volkan Hanc, Dilek Ömür, Mücahit Özbilgin, Mine Tosun, Serhan Yurtlu, Semih Küçükgüçlü, Atalay Arkan
The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count...
October 2016: Medicine (Baltimore)
Floriana Pinto, Gianni Biancofiore
BACKGROUND: The ABCDE (Awakening and Breathing coordination of daily sedation and ventilator removal trials; Choice of sedative or analgesic exposure; Delirium monitoring and management; and Early mobility and exercise) bundle is a multidisciplinary set of evidence-based practices for improving patient outcomes in the intensive care unit. Nurses are critical to all the bundle's requirements. Therefore, understanding their knowledge, attitudes, and perception of the different bundle's components might help for an easier implementation into everyday clinical practice...
November 2016: Dimensions of Critical Care Nursing: DCCN
Alladi Mohan, G Sivaram Naik, J Harikrishna, D Prabath Kumar, M H Rao, Kvs Sarma, K K Guntupalli
BACKGROUND & OBJECTIVES: Ingestion of Cleistanthus collinus causes hypokalemia and cardiac arrhythmias leading to mortality in most cases. We undertook this retrospective study to evaluate the clinical presentation and predictors of outcome in critically ill patients admitted with C. collinus poisoning. METHODS: The case records of 56 patients admitted to the medical intensive care unit (MICU) of a tertiary care teaching hospital in south India (2000-2014) with C...
June 2016: Indian Journal of Medical Research
Laurence Ducharme-Crevier, Michele G Mills, Priya M Mehta, Craig M Smith, Mark S Wainwright
BACKGROUND: The primary objective of this study was to characterize changes in cerebral blood flow measured using transcranial Doppler in children with central nervous system infections. We hypothesized that children with central nervous system infections have abnormal cerebral blood flow, associated with a greater frequency of complications and poor neurological outcome. METHODS: We conducted a single-center, retrospective study of children admitted to the neonatal or pediatric intensive care unit with central nervous system infection and undergoing transcranial Doppler as part of routine care between March 2011 and July 2015...
September 4, 2016: Pediatric Neurology
Seher Erdoğan, Arzu Oto, Mehmet Boşnak
Mean platelet volume (MPV) is a simple and economical test that is easy to interpret and is routinely measured with automatic cell counters. It indicates platelet volume and platelet function and activation. Variations in platelet volume may occur more as a result of varying differentiation of megakaryocytes in association with production agents in bone marrow rather than of ageing of platelets in circulation. The purpose of this study was to evaluate the relation between mortality and changes in MPV values in patients hospitalized in the pediatric intensive care unit...
November 2015: Turkish Journal of Pediatrics
Michael Osthoff, Martin Siegemund, Gianmarco Balestra, Mohd Hafiz Abdul-Aziz, Jason A Roberts
Prolonged infusion of β-lactam antibiotics as either extended (over at least 2 hours) or continuous infusion is increasingly applied in intensive care units around the world in an attempt to optimise treatment with this most commonly used class of antibiotics, whose effectiveness is challenged by increasing resistance rates. The pharmacokinetics of β-lactam antibiotics in critically ill patients is profoundly altered secondary to an increased volume of distribution and the presence of altered renal function, including augmented renal clearance...
2016: Swiss Medical Weekly
Brent I Fox, Bill G Felkey
Some things really never change. For example, medication adherence remains a critical factor that influences the effectiveness of our modern health care system. Is there a magic bullet to solve the problem of nonadherence? We don't think there is. We do believe, however, that tools to monitor adherence continue to improve in their utility.
November 2015: Hospital Pharmacy
Marine Desarmenien, Anne Laure Blanchard-Courtois, Bara Ricou
Advances in intensive care medicine have created a new disease called the chronic critical illness. While a significant proportion of severely ill patients who twenty years ago would have died survive the acute phase, they remain heavily dependent on intensive care for a prolonged period of time. These patients, who can be called "Patient Long Séjour" in French (PLS) or Prolonged Length of Stay patients in English, develop specific health issues that are still poorly recognised. They require special care, which differs from treatments that are given during the acute phase of their illness...
2016: Swiss Medical Weekly
Gerardo Bosco, Giacomo Garetto, Alessandro Rubini, Antonio Paoli, Prachiti Dalvi, Devanand Mangar, Enrico M Camporesi
INTRODUCTION: Some patients admitted to the intensive care unit (ICU) might require repetitive hyperbaric oxygen treatment (HBOT) while receiving critical care. In such cases, the presence of a hyperbaric chamber located inside or near an ICU is preferable; however, this set-up is not always possible. In Padua, the "Associazione Tecnici IPerbarici" hyperbaric centre is a stand-alone facility outside of a hospital. Despite this, selected ICU patients receive HBOT at this facility. METHODS: We retrospectively reviewed the medical records from 2003 to 2013 of 75 consecutive, critically-ill patients, 28 of whom were initially intubated and mechanically ventilated whilst undergoing HBOT...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Anton Krige, Martin Bland, Thomas Fanshawe
BACKGROUND: Passive leg raising (PLR) is a so called self-volume challenge used to test for fluid responsiveness. Changes in cardiac output (CO) or stroke volume (SV) measured during PLR are used to predict the need for subsequent fluid loading. This requires a device that can measure CO changes rapidly. The Vigileo™ monitor, using third-generation software, allows continuous CO monitoring. The aim of this study was to compare changes in CO (measured with the Vigileo device) during a PLR manoeuvre to calculate the accuracy for predicting fluid responsiveness...
2016: Journal of Intensive Care
Jennifer G Jetton, Mark Sorenson
Both acute kidney injury (AKI) and chronic kidney disease (CKD) are seen more frequently in the neonatal intensive care unit (NICU) as advances in supportive care improve the survival of critically ill infants as well as those with severe, congenital kidney and urinary tract anomalies. Many aspects of the infant's care, including fluid balance, electrolyte and mineral homeostasis, acid-base balance, and growth and nutrition require close monitoring by and collaboration among neonatologists, nephrologists, dieticians, and pharmacologists...
October 6, 2016: Seminars in Fetal & Neonatal Medicine
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