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Elizabeth Fiske
BACKGROUND: Working in a neonatal intensive care unit (NICU) can be both rewarding and stressful. Stressors can outweigh satisfiers, leading to job dissatisfaction and turnover. Nurse retention remains a problem, particularly for nurses within the first year of employment. PURPOSE: The purpose of this study was to examine current nurse stressors, satisfiers, and coping processes in the NICU. METHODS: Seventy-two neonatal nurses from 3 Magnet facilities in North Carolina completed the ICU Stressors Survey, the Ways of Coping Scale, demographic data questions, and free-text questions in Qualtrics, a secure online survey system...
June 21, 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Eniko Szakmar, Colin J Morley, Gusztav Belteki
OBJECTIVES: To investigate how compensating for endotracheal tube leaks by targeting the leak-compensated tidal volume affects measured physiologic and ventilator variables during neonatal mechanical ventilation. DESIGN: Retrospective observational study. SETTING: A level III Neonatal ICU. PATIENTS: We enrolled 30 neonates who were ventilated using synchronized intermittent positive pressure mode with volume guarantee and had at least 12 hours of continuous detailed recording of ventilation variables...
June 21, 2018: Pediatric Critical Care Medicine
Jessica Keim-Malpass, Kyle B Enfield, James Forrest Calland, Douglas E Lake, Matthew T Clark
Predictive analytics monitoring that informs clinicians of the risk for failed extubation would help minimize both the duration of mechanical ventilation and the risk of emergency re-intubation in ICU patients. We hypothesized that dynamic monitoring of cardiorespiratory data, vital signs, and lab test results would add information to standard clinical risk factors. To develop predictive analytic models for patients who failed extubation in critical care settings in an academic medical center using standard and novel risk factors...
June 22, 2018: Physiological Measurement
Aliae Ar Mohamed-Hussein, Hoda A Makhlouf, Zahraa I Selim, Waleed Gamaleldin Saleh
BACKGROUND: In COPD weight loss and muscle wasting contribute significantly to morbidity, disability and handicap. Dominant-handgrip strength for evaluation of muscle strength has not been tested as a parameter to predict outcome of weaning from mechanical ventilation (MV). OBJECTIVES: to evaluate the association between handgrip strength and the duration and success of weaning and extubation outcome. PATIENTS AND METHODS: This prospective study included 34 COPD patients requiring MV for at least 48 hours...
June 22, 2018: Clinical Respiratory Journal
Felix Berlth, Patrick S Plum, Seung-Hun Chon, Christian A Gutschow, Elfriede Bollschweiler, Arnulf H Hölscher
BACKGROUND: The impact of total minimally invasive esophagectomy (MIE) on early postoperative outcome and patient's survival is a matter of recent discussion. METHODS: We performed a 1:2 propensity score-matched comparison of 20 patients who underwent 3D-MIE and high intrathoracic esophagogastrostomy with 40 patients who underwent hybrid esophagectomy (HYBRID) with laparoscopic gastric mobilization and open transthoracic esophagectomy and the same anastomosis for esophageal adenocarcinoma in 2014 and 2015...
June 21, 2018: Surgical Endoscopy
Rachel M Nygaard, Frederick W Endorf
Frostbite is a form of thermal injury that can have devastating consequences for patients, including digit amputations and sometimes more proximal amputations. To the best of the authors' knowledge, no one has determined national characteristics of frostbite patients, nor the prevalence of these diagnostic and therapeutic modalities. This is the first look at nationwide trends in the treatment of frostbite in the United States. Patients with frostbite injury were identified in the National Trauma Data Bank (NTDB) and National Burn Repository (NBR)...
December 6, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
Christine M McDonald, Sarah West, David Dushenski, Stephen E Lapinsky, Christine Soong, Kate van den Broek, Melanie Ashby, Gillian Wilde-Friel, Carrie Kan, Mark McIntyre, Andrew Morris
Objective: To develop a triage-based screening algorithm and treatment order-sets aimed at improving the quality of care of all patients with sepsis presenting to our emergency department (ED). Design: Retrospective cohort study conducted during a pre-intervention period from 1 April 2010 to 31 March 2011 and a post-intervention period from 1 September 2014 to 30 April 2015. Setting: A large teaching hospital located in Toronto, Ontario, Canada with a 35-bed ED...
June 20, 2018: International Journal for Quality in Health Care
Malcolm S Ross, Mary E Burriss, Daniel G Winger, Robert P Edwards, Madeleine Courtney-Brooks, Michelle M Boisen
OBJECTIVES: Previous studies have identified age, nutritional status, and hematocrit as risk factors for unplanned ICU admission in gynecologic oncology patients. We sought to identify additional perioperative factors that can be predictive of unplanned ICU admission and its impact on outcomes in women with ovarian cancer undergoing ovarian cancer cytoreductive procedures. METHODS: This was a case-control study of patients with unplanned ICU admission after primary surgery for ovarian cancer from January 2007 to December 2013...
June 18, 2018: Gynecologic Oncology
Allan E Stolarski, Claire P Miller, Ashar Ata, Kimberly Owens, Lauren Evans, Carl Rosati, Steven C Stain, Marcel Tafen
BACKGROUND: Anticoagulant and antiplatelet agents (ACAP) have been shown to negatively affect trauma patients. METHODS: Outcomes in adults with rib fractures were reviewed. Pearson chi-square test was used for analysis. Multivariate logistic regression was used to adjust for potential confounders. RESULTS: Of the 1448 included patients, 149 (10.3%) took preinjury ACAP; these patients were significantly older than non-anticoagulated patients (72 vs...
June 18, 2018: American Journal of Surgery
Mahnaz Yadollahi, Ali Kashkooe, Monireh Feyzi, Saman Bornapour
PURPOSE: Trauma-related injuries are the leading cause of death worldwide. Some risk factors make traumatic patients susceptible to infection. Furthermore, some mortality risk factors, including length of hospitalization and increasing age, were detected in non-traumatic infected patients. This study aimed to assess mortality risk factors among nosocomial infected traumatic patients in Rajaee trauma center, Shiraz, Iran. METHODS: This prospective cohort study was conducted during a period of 2 years since April 2015 to March 2017 in Rajaee hospital, which is the center of emergency medical services for traumatic injuries in Shiraz, Iran...
May 19, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
Philip Ashley, Shawn R Gilbert
Obese children with high-energy injuries present with more severe injuries, more extremity injuries, and higher Injury Severity Scores. They are at increased risk for complications, prolonged ventilation, and ICU stay and have increased mortality. Obesity is associated with altered bone mass accrual and higher fracture rates. Obese patients have a higher risk of loss of reduction of forearm fractures, more severe supracondylar fractures, and a higher likelihood of lateral condyle fractures. Obese patients are more likely to have complications with femur fractures and have higher rates of foot and ankle fracture...
July 2018: Orthopedic Clinics of North America
Carla M Sevin, Sarah L Bloom, James C Jackson, Li Wang, E Wesley Ely, Joanna L Stollings
PURPOSE: To describe the design and initial implementation of an Intensive Care Unit Recovery Center (ICU-RC) in the United States. MATERIALS AND METHODS: A prospective, observational feasibility study was undertaken at an academic hospital between July 2012 and December 2015. Clinical criteria were used to develop the ICU-RC, identify patients at high risk for post intensive care syndrome (PICS), and offer them post-ICU care. RESULTS: 218/307 referred patients (71%) survived to hospital discharge; 62 (28% of survivors) were seen in clinic...
August 2018: Journal of Critical Care
Yuan-Yuan Wang, Shuang-Fei Hu, Hui-Min Ying, Long Chen, Hui-Li Li, Fang Tian, Zhen-Feng Zhou
BACKGROUND: The benefit results of postoperative tight glycemic control (TGC) were controversial and there was a lack of well-powered studies that support current guideline recommendations. METHODS: The EMBASE, MEDLINE, and the Cochrane Library databases were searched utilizing the key words "Blood Glucose", "insulin" and "Postoperative Period" to retrieve all randomized controlled trials evaluating the benefits of postoperative TGC as compared to conventional glycemic control (CGC) in patients undergoing surgery...
June 22, 2018: BMC Endocrine Disorders
Puja Shankar, Ariel Mueller, Senthil Packiasabapathy, Doris Gasangwa, Melissa Patxot, Brian O'Gara, Shahzad Shaefi, Edward R Marcantonio, Balachundhar Subramaniam
BACKGROUND: Postoperative delirium is common in elderly cardiac surgery patients. It is multifactorial and is influenced by the patient's baseline status and the nature of the medical and surgical interventions that the patient receives. Some of these factors are potentially modifiable, including postoperative sedation and analgesia protocols. This study has been designed to evaluate the effectiveness of postoperative intravenous acetaminophen in conjunction with either dexmedetomidine or propofol in decreasing the incidence of delirium...
June 22, 2018: Trials
Sunyoung Park, Se Hee Na, Jooyoung Oh, Jong Seok Lee, Seung-Taek Oh, Jae-Jin Kim, Jin Young Park
PURPOSE: Pain and anxiety are understudied despite their importance to the general medical condition. The aim of the present study was to examine the effects of pain and anxiety and their relationship to the doses of opioids and anxiolytics administered in intensive care unit (ICU) patients. METHODS: The subjects included 1349 conscious, critically ill patients admitted to an ICU. Psychiatrists evaluated the patients daily for pain and anxiety. Data regarding the doses of opioids and benzodiazepines administered were gathered...
June 2, 2018: Journal of Critical Care
Patrick Saunders-Hastings, Bryson Quinn Hayes, Robert Smith, Daniel Krewski
Background: Influenza pandemics emerge at irregular and unpredictable intervals to cause substantial health, economic and social burdens. Optimizing health-system response is vital to mitigating the consequences of future pandemics. Methods: We developed a mathematical model to assess the preparedness of Canadian health systems to accommodate pandemic-related increases in patient demand. We identify vulnerable areas, assess the potential of inter-wave vaccination to mitigate impacts and evaluate the association between demographic and health-system characteristics in order to identify predictors of pandemic consequences...
August 2017: Infectious Disease Modelling
Rhodri Saunders, Dimitris Geogopoulos
Background: Mechanical ventilation is an integral, but expensive, part of the intensive care unit (ICU). Optimal use of mechanical ventilation could save costs and improve patient outcomes. Here, the cost effectiveness of proportional assist ventilation (PAV™ ventilation by Medtronic) is estimated relative to pressure support ventilation (PSV). Methods: A cohort-level, clinical model was built using data from clinical trials. The model estimates patient-ventilator asynchrony >10%, tracheostomy, ventilator-associated pneumonia, other nosocomial infections, spontaneous breathing trial success, hypoxemia, and death...
2018: Frontiers in Public Health
Reem Akel, Ghina Fakhri, Rana Salem, Fouad Boulos, Khaled Habib, Arafat Tfayli
Background: Follicular dendritic cell sarcoma (FDCS) is an extremely rare malignant tumor caused by proliferation of antigen-presenting follicular dendritic cells. The tumor most commonly arises in lymph nodes, with fewer than 30% of cases originating in extranodal sites. Case Presentation: We report the case of a 39-year-old previously healthy male patient who presented with paraneoplastic pemphigus in the setting of a large intraperitoneal mass with no associated lymphadenopathy...
May 2018: Case Reports in Oncology
Gabrielė Linkaitė, Mantas Riauka, Ignė Bunevičiūtė, Saulius Vosylius
Introduction: Delirium not only compromises patient care, but is also associated with poorer outcomes: increased duration of mechanical ventilation, higher mortality, and greater long-term cognitive dysfunction. The PRE-DELIRIC model is a tool used to calculate the risk of the development of delirium. The classification of the patients into groups by risk allows efficient initiation of preventive measures. The goal of this study was to validate the PRE-DELIRIC model using the CAM-ICU (The Confusion Assessment Method for the Intensive Care Unit) method for the diagnosis of delirium...
2018: Acta Medica Lituanica
Andrew Numa, Himanshu Aneja, John Awad, Hari Ravindranathan, Puneet Singh, Kevin Swil, Gary Williams
OBJECTIVES: To determine whether the association between hyperoxia and increased risk-adjusted mortality in adult intensive care patients is also observed in a pediatric intensive care population. DESIGN: Single-center retrospective analysis of admissions to ICU over a 5-year period commencing January 1, 2012, examining the relationship between PaO2 measured within the first hour of admission and risk-adjusted mortality. Standardized mortality rates were calculated using the Pediatric Index of Mortality-3, and patients were grouped into 50 mm Hg (6...
June 20, 2018: Pediatric Critical Care Medicine
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