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quality intensive care

Juliana L Torres, Silvia L A da Silva, Fabiane R Ferreira, Liliane P S Mendes, Luciana A Machado
Background: Chronic pain is known to increase health care use in high-income countries, but in Brazil, little is known. Objective: To investigate the association between chronic pain and health care use among Brazilian older adults and explore the relationship between pain severity and health care use. Methods: This cross-sectional study was derived from the population-based study Frailty in Brazilian Older People-FIBRA. Chronic pain, pain intensity and pain-related disability were assessed through additional telephone interviews...
December 5, 2018: Family Practice
John Chung-Han Wu, Hsin-Yu Chen, Chien-Hung Liao, Shang-Yu Wang, Chih-Yuan Fu, Chih-Hao Chen, Chien-Tzung Chen
OBJECTIVE: Maxillofacial fractures with concomitant laryngeal injuries put both the quality and maintenance of life in jeopardy. Because of its low incidence, it is often overlooked in the clinical setting. The purpose of this study is to review the incidence, clinical presentations, managements, and outcomes of these patients. METHODS: A retrospective analysis of medical records from 2008 to 2015 was conducted at a single institute. A case series (n = 12, which contributed 22...
December 3, 2018: Annals of Plastic Surgery
Laurelie R Wall, Sanjeewa Kularatna, Elizabeth C Ward, Bena Cartmill, Anne J Hill, Elizabeth Isenring, Joshua Byrnes, Sandro V Porceddu
Research advocates for the use of intensive, prophylactic swallowing therapy to help reduce the severity of dysphagia in patients receiving (chemo)radiotherapy ([C]RT) for head/neck cancer (HNC). Unfortunately, the intensity of this therapy, coupled with growing patient numbers and limited clinical resources, provides challenges to many international cancer facilities. Telepractice has been proposed as a potential method to provide patients with greater support in home-practice, whilst minimising burden to the health service...
December 4, 2018: Dysphagia
Mairi Mascarenhas, Michelle Beattie, Michelle Roxburgh, John MacKintosh, Noreen Clarke, Devjit Srivastava
Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments...
2018: BMJ Open Quality
Robert Knoerl, Edie Weller, Barbara Halpenny, Donna Berry
BACKGROUND: Impaired physical function due to chemotherapy-induced peripheral neuropathy (CIPN) symptoms may lead to diminished quality of life. However, even with the knowledge of the effects of CIPN on physical function, clinicians infrequently assess and manage CIPN. Interventions that prioritize the early identification of CIPN to provide prompt treatment may reduce the impact of CIPN on physical function. The purpose of this paper is to compare self-reported physical function in individuals receiving neurotoxic chemotherapy between Electronic Symptom Assessment-Cancer (ESRA-C) intervention group (e...
December 4, 2018: BMC Cancer
Yoshiaki Iwashita, Kazuto Yamashita, Hiroshi Ikai, Masamitsu Sanui, Hiroshi Imai, Yuichi Imanaka
BACKGROUND: In most countries, patients receiving mechanical ventilation (MV) are treated in intensive care units (ICUs). However, in some countries, including Japan, many patients on MV are not treated in ICUs. There are insufficient epidemiological data on these patients. Here, we sought to describe the epidemiology of patients on MV in Japan by comparing and contrasting patients on MV treated in ICUs and in non-ICU settings. A preliminary comparison of patient outcomes between ICU and non-ICU patients was a secondary objective...
December 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
Zacariah K Shannon, Stacie A Salsbury, Donna Gosselin, Robert D Vining
BACKGROUND: Few studies have investigated patient and provider expectations of chiropractic care, particularly in multidisciplinary settings. This qualitative study explored stakeholder expectations of adding a chiropractor to the healthcare team at a rehabilitation specialty hospital. METHODS: The research methodology was an organizational case study with an inpatient facility for persons recovering from complex neurological conditions serving as the setting. Sixty stakeholders, including patients, families, hospital staff, and administrators, were interviewed or participated in focus groups in June 2015...
December 4, 2018: BMC Complementary and Alternative Medicine
Alison Avenell, Clare Robertson, Zoë Skea, Elisabet Jacobsen, Dwayne Boyers, David Cooper, Magaly Aceves-Martins, Lise Retat, Cynthia Fraser, Paul Aveyard, Fiona Stewart, Graeme MacLennan, Laura Webber, Emily Corbould, Benshuai Xu, Abbygail Jaccard, Bonnie Boyle, Eilidh Duncan, Michal Shimonovich, Marijn de Bruin
BACKGROUND: Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2 ] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES: Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES: Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017)...
November 2018: Health Technology Assessment: HTA
C Margarido, J Ferns, V Chin, T Ribeiro, B Nascimento, J Barrett, E Herer, S Halpern, L Andrews, G Ballatyne, M Chapmam, J Gomes, J Callum
BACKGROUND: A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team. METHODS: A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review...
November 3, 2018: International Journal of Obstetric Anesthesia
Oriol Yuguero, Ana Vena, Carles Forné, Jose Daniel Lacasta, Cecilia Llobet, Maria José Abadías
There are lack of indicators of quality of care in resuscitation units of emergency departments. With the aim of proposing a series of indicators to evaluate the quality of care delivered in hospital resuscitation areas, we conducted a descriptive study of 7579 admissions to the resuscitation unit of an emergency department at a Spanish hospital between 2012 and 2016. The proposed indicators were the percentage of patients attending to the emergency department admitted to the resuscitation area by level of triage, the length of stay, the percentage of patients moved to intensive care and surgery at disposition, the mortality in the area or in the emergency department within 24 hours of disposition, and the data completeness...
November 2018: Medicine (Baltimore)
Shan Zhang, Xiaoke Dai, Chunbao Guo
Intravenous fluid prescription plays an important role in sepsis management, which may be associated with patient prognosis. The objective of the present study was to determine if the administration of crystalloid fluids is associated with clinical outcome for patients with severe sepsis and septic shock.The medical records of 79 patients with severe sepsis or septic shock at an academic tertiary care hospital between 2011 and 2016 were reviewed retrospectively. The patients were dichotomized based on the median 3-day amount of corrected crystalloid fluids as low (<193 mL/kg) versus high (>193 mL/kg)...
November 2018: Medicine (Baltimore)
Thomas Higel, Anna Alaoui, Céline Bouton, Jean-Pascal Fournier
OBJECTIVES: To comprehensively assess the effect of a living will on end-of-life care. DESIGN: Systematic review with narrative analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. PARTICIPANTS: All interventional and observational studies were included, excepting those with fictive cases. Included studies were conducted in adults with and without living wills, excluding individuals with specific psychiatric living wills...
December 3, 2018: Journal of the American Geriatrics Society
Kim Gibson, Anne Hofmeyer, Jane Warland
BACKGROUND: Nurses working in the neonatal intensive care unit (NICU) who care for dying infants and their families say they do not necessarily have the expertise or the specific training to provide quality end-of-life-care (EOLC). PURPOSE: The purpose of this review was to critically appraise the existing qualitative literature regarding nurses' experiences when caring for infants during end of life in the NICU and to identify barriers and enablers to provide quality EOLC...
December 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Jeffrey J Kiernan, Cynthia A Ellison, Kathryn J Tinckam
PURPOSE OF REVIEW: This review is intended to describe both the usefulness and limitations of mean fluorescence intensity (MFI) as a semiquantitative measure for assessing the presence, relative strength, and clinical impact of human leukocyte antigen (HLA) alloantibodies, as well as the other qualitative features of antibodies that are important considerations in assessing patient risk. RECENT FINDINGS: Using MFI as a quantitative measure is complicated by procedural variation between HLA laboratories...
November 30, 2018: Current Opinion in Organ Transplantation
Dong-Liang Mu, Dong-Xin Wang, Lingzhong Meng
PURPOSE OF THE REVIEW: There is increasing interest in the use of noncerebral somatic tissue oxygen saturation (SstO2) monitoring on the basis of near-infrared spectroscopy in patients undergoing surgery or residing in intensive care unit. The relevant question is whether SstO2 monitoring can improve the quality of care. In this article, we reviewed the clinical application of SstO2 monitoring in acute care, focusing on its use in patients undergoing surgery. RECENT FINDINGS: Multiple small cohort studies conducted on pediatric patients reported close associations of SstO2 measurements over different regions such as the splanchnic and renal tissue beds with systemic oxygenation, transfusion, hemodynamic indices, morbidity, and mortality...
November 29, 2018: Current Opinion in Anaesthesiology
Mohammad Bani Younis, Feryal Hayajneh, Abdu-Monim Batiha
The general goal of this review is to summarize, clarify, and evaluate what is known about patients' sleep in the intensive care units (ICUs) in terms of sleep measurement and management. In addition, this review focuses on the gap in knowledge in this field. A review of online databases for relevant articles in the period between 2000 and 2017 was conducted. The results of this study indicate that there are several methods to measure patients' quality of sleep. Polysomnography and actigraphy are the most common standard objective and valid methods used to measure sleep disorders in the ICU...
January 2019: Critical Care Nursing Quarterly
Robert Howard, Elizabeth Cort, Rosie Bradley, Emma Harper, Linda Kelly, Peter Bentham, Craig Ritchie, Suzanne Reeves, Waleed Fawzi, Gill Livingston, Andrew Sommerlad, Sabu Oomman, Ejaz Nazir, Ramin Nilforooshan, Robert Barber, Chris Fox, Ajay Macharouthu, Pranathi Ramachandra, Vivek Pattan, John Sykes, Valerie Curran, Cornelius Katona, Tom Dening, Martin Knapp, Renee Romeo, Richard Gray
BACKGROUND: Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment. OBJECTIVES: The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter...
November 2018: Health Technology Assessment: HTA
Oliver Burdall, Liam Willgress, Nina Goad
BACKGROUND: Understanding the importance of the barrier function of the skin of preterm and term neonates is crucial in effective neonatal skin and diaper care. This literature search aimed to review the development of different practices in neonatal care to maintain skin barrier function, in turn preventing diaper dermatitis. METHODS: We performed two quantitative literature searches of English language studies: an initial literature search of studies published in the last 5 years was conducted using Cinahl, Medline, Embase, British Nursing Index, and DelphiS, followed by a second search of publications from 1990 to 2017 using the National Institute of Clinical Excellence Health Databases Advanced Search using key words, synonyms, and Boolean phrasing...
December 2, 2018: Pediatric Dermatology
Prashant Parulekar, Ed Neil-Gallacher, Alex Harrison
Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine...
November 2018: Journal of the Intensive Care Society
Hanne Birgit Alfheim, Milada Cvancarova Småstuen, Kristin Hofsø, Kirsti Tøien, Leiv Arne Rosseland, Tone Rustøen
BACKGROUND: Family caregivers of patients in the intensive care unit (ICU) experience impairments in the quality of life. Previous studies report that psychological quality of life improves over time, but there has been limited longitudinal research, and measurement points have differed. Factors such as age, gender, and posttraumatic stress symptoms have been found to be associated with the quality of life, but level of hope and its associations with the quality of life have not been investigated...
November 29, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
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