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https://www.readbyqxmd.com/read/27936423/optimising-the-community-based-approach-to-healthcare-improvement-comparative-case-studies-of-the-clinical-community-model-in-practice
#1
Emma-Louise Aveling, Graham Martin, Georgia Herbert, Natalie Armstrong
Community-based approaches to healthcare improvement are receiving increasing attention. Such approaches could offer an infrastructure for efficient knowledge-sharing and a potent means of influencing behaviours, but their potential is yet to be optimised. After briefly reviewing challenges to community-based approaches, we describe in detail the clinical community model. Through exploring clinical communities in practice, we seek to identify practical lessons for optimising this community-based approach to healthcare improvement...
November 22, 2016: Social Science & Medicine
https://www.readbyqxmd.com/read/27936199/circulating-microvesicles-are-elevated-acutely-following-major-burns-injury-and-associated-with-clinical-severity
#2
Kieran P O'Dea, John R Porter, Nikhil Tirlapur, Umar Katbeh, Suveer Singh, Jonathan M Handy, Masao Takata
Microvesicles are cell-derived signaling particles emerging as important mediators and biomarkers of systemic inflammation, but their production in severe burn injury patients has not been described. In this pilot investigation, we measured circulating microvesicle levels following severe burns, with severe sepsis patients as a comparator group. We hypothesized that levels of circulating vascular cell-derived microvesicles are elevated acutely following burns injury, mirroring clinical severity due to the early onset and prevalence of systemic inflammatory response syndrome (SIRS) in these patients...
2016: PloS One
https://www.readbyqxmd.com/read/27936153/impact-of-transient-and-persistent-acute-kidney-injury-on-chronic-kidney-disease-progression-and-mortality-after-gastric-surgery-for-gastric-cancer
#3
Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Sun-Seog Kweon, Soo Wan Kim
Acute kidney injury (AKI) is common after gastric surgery for gastric cancer and associated with adverse outcomes. However, the impact of transient or persistent AKI on clinical outcomes after gastric surgery for gastric cancer has not been described. We performed a retrospective study of 4,886 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2012. AKI patients were classified as transient and persistent AKI based on the return of serum creatinine to the level indicating no AKI within 7 days...
2016: PloS One
https://www.readbyqxmd.com/read/27935773/lung-protective-ventilation
#4
Rex A Marley, Kaycee Simon
Historically, mechanical ventilation of the lungs utilizing relatively large tidal volumes was common practice in the operating room and intensive care unit (ICU). The rationale behind this treatment strategy was to yield better patient outcomes, that is, fewer pulmonary complications, and a reduction in morbidity and mortality. As evidence-based practice has evolved, potential harmful effects of traditional, nonphysiological mechanical ventilation (ventilation with larger tidal volumes and the tolerance of high airway pressures) even in shortterm treatment have been shown to correlate with systemic inflammation and the development of ventilator-associated lung injury...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27934808/presence-of-metallo-beta-lactamases-mbl-extended-spectrum-beta-lactamase-esbl-ampc-positive-non-fermenting-gram-negative-bacilli-among-intensive-care-unit-patients-with-special-reference-to-molecular-detection-of-blactx-m-blaampc-genes
#5
Richa Gupta, Abida Malik, Meher Rizvi, Moied Ahmed
BACKGROUND & OBJECTIVES: Non-fermenting Gram-negative bacilli (NFGNB) including Pseudomonas aeruginosa and Acinetobacter baumannii have been implicated in a variety of infections, particularly in the Intensive Care Units (ICUs). This study was aimed to overview the burden of multidrug-resistant NFGNB causing infections in ICU and also to assess the occurrence of extended-spectrum beta-lactamases (ESBLs), AmpC and metallo-beta-lactamases (MBLs) among these isolates. METHODS: Bacterial culture, identification and antibiotic susceptibility were carried out...
August 2016: Indian Journal of Medical Research
https://www.readbyqxmd.com/read/27933180/serum-levels-of-immunoglobulins-and-severity-of-community-acquired-pneumonia
#6
Mari C de la Torre, Pere Torán, Mateu Serra-Prat, Elisabet Palomera, Estel Güell, Ester Vendrell, Joan Carles Yébenes, Antoni Torres, Jordi Almirall
INSTRUCTION: There is evidence of a relationship between severity of infection and inflammatory response of the immune system. The objective is to assess serum levels of immunoglobulins and to establish its relationship with severity of community-acquired pneumonia (CAP) and clinical outcome. METHODS: This was an observational and cross-sectional study in which 3 groups of patients diagnosed with CAP were compared: patients treated in the outpatient setting (n=54), patients requiring in-patient care (hospital ward) (n=173), and patients requiring admission to the intensive care unit (ICU) (n=191)...
2016: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/27932670/annals-express-red-blood-cell-distribution-width-and-neutrophil-to-lymphocyte-ratio-are-associated-with-outcomes-of-adult-subarachnoid-hemorrhage-patients-admitted-to-intensive-care-unit
#7
Yuan-Lan Huang, Zhi-Jun Han, Zhi-De Hu
BACKGROUND: Red blood cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) have been reported to be associated with outcomes of acute cerebral infarction. However, their prognostic value in patients with subarachnoid hemorrhage (SAH) remains largely unknown. The aim of this study was to investigate the prognostic value of RDW and NLR in SAH patients. METHODS: Medical records of adult SAH patients admitted to intensive care unit (ICU) were extracted from Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II, version 2...
December 8, 2016: Annals of Clinical Biochemistry
https://www.readbyqxmd.com/read/27932050/icu-telemedicine-program-financial-outcomes
#8
Craig M Lilly, Christine Motzkus, Teresa Rincon, Shawn E Cody, Karen Landry, Richard S Irwin
BACKGROUND: Intensive care unit (ICU) telemedicine improves access to high quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following tele-ICU implementation and after the addition of logistic center function has not been published. METHODS: Primary data were collected for consecutive adult patients of a single academic medical center. We compared clinical and financial outcomes across 3 groups that differed with regard to telemedicine support: a group without tele-ICU support (Pre-ICU intervention group), a group with tele-ICU support (ICU Telemedicine group) and a tele-ICU group with added logistical center functions and support for quality care standardization (Logistic Center Group)...
December 5, 2016: Chest
https://www.readbyqxmd.com/read/27931564/taking-care-of-relationships-in-the-intensive-care-unit-positive-impact-on-family-consent-for-organ-donation
#9
M G Bocci, C D'Alò, R Barelli, S Inguscio, A Prestifilippo, S Di Paolo, S Lochi, M Fanfarillo, D L Grieco, R Maviglia, A Caricato, G Mistraletti, S Pulitanò, M Antonelli, C Sandroni
BACKGROUND: Organ donation refusal from relatives of potential donors with brain death significantly reduces organ availability. The need for organ donation has increased over time, but the shortage of available donors is the major limiting factor in transplantation. We analyzed the impact of a new systematic communication approach between medical staff and patients' relatives on the rate of consent to organ donation. METHODS: The study was conducted as a single-center, non-randomized, controlled, before-and-after study at an 18-bed intensive care unit (ICU) of a university hospital...
December 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27931294/long-term-outcome-after-pediatric-intensive-care-unit-asthma-admissions
#10
Ibrahim Abu-Kishk, Sharon Polakow-Farkash, Arnon Elizur
BACKGROUND: Patients with asthma admitted to the pediatric intensive care unit (PICU) are often found to have had previous severe asthma exacerbations. OBJECTIVE: To prospectively evaluate the outcome of children after PICU admission. METHODS: Patients, ages 218 years, admitted to the PICU at Assaf Harofeh Medical Center over a 10-year period were assessed at a mean of 10 years after their admission and compared with matched patients admitted to the pediatric ward...
November 2016: Allergy and Asthma Proceedings:
https://www.readbyqxmd.com/read/27930995/predictors-of-clinicians-underuse-of-daily-sedation-interruption-and-sedation-scales
#11
B Sneyers, S Henrard, P F Laterre, M M Perreault, C Beguin, D Wouters, N Speybroeck, A Spinewine
PURPOSE: The purpose of the study is to identify predictors of underuse of sedation scales and daily sedation interruption (DSI). METHODS: We surveyed all physicians and seven nurses in every Belgian intensive care unit (ICU), addressing practices and perceptions on guideline recommendations. Underuse was defined for sedation scales as use less than 3× per day and for DSI as never using it. Classification trees and logistic regressions identified predictors of underuse...
August 11, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27930821/assessment-of-asymmetrical-dimethylarginine-metabolism-in-patients-with-critical-illness
#12
Rawia A Ghashut, Scott Blackwell, Sylvia Ryan, Laura Willox, Donald C McMillan, John Kinsella, Dinesh Talwar
BACKGROUND: Critically ill patients experience metabolic disorders including hypercatabolic state and hyperglycaemia and these are associated with poor outcome. Hyperglycaemia and asymmetric dimethylarginine (ADMA) are reported to have significant influences on endothelial dysfunction. The aim of the present study was to examine the relationship between plasma asymmetric dimethylarginine (ADMA) and related arginine metabolism in patients with critical illness. MATERIALS AND METHODS: Two venous blood samples (EDTA) (104 patients), on admission and follow up sample in the last day in ICU (died or discharge sample median 7, IQR 6-8, range 5-15)...
December 8, 2016: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/27929925/evaluation-of-factors-associated-with-death-in-patients-with-necrotizing-fasciitis-of-the-abdominal-wall
#13
Christian W Ertl, Nicole C Carpp, Jeffrey Johnson, Leandra Burke
BACKGROUND: Necrotizing fasciitis (NF) is a rapidly progressing, life-threatening soft tissue infection. The prognostic factors associated with death from abdominal wall NF are not well understood. METHODS: The medical records of 61 patients with abdominal wall NF were reviewed retrospectively. Demographic, co-morbidity, laboratory, and clinical data were collected and compared for patients who survived and who did not. RESULTS: Sixty-one patients met the inclusion criteria, with eight deaths (13...
December 8, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27928779/how-antibiotics-should-be-prescribed-to-hospitalized-elderly-patients-with-community-acquired-pneumonia
#14
Forest W Arnold
Elderly patients hospitalized with community-acquired pneumonia (CAP) should be administered antimicrobials in the emergency department prior to transfer to the ward or intensive care unit (ICU). For ward patients, a β-lactam with a macrolide or a respiratory fluoroquinolone alone should be given to cover typical and atypical pathogens. For ICU patients, a β-lactam with either a macrolide or a fluoroquinolone should be given. Other regimens are indicated if methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa is a concern...
December 7, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27928649/the-diagnostic-value-of-1%C3%A2-%C3%A2-%C3%A2-3-beta-d-glucans-and-galactomannan-assays-in-children-suffering-from-bacteremia-in-pediatric-intensive-care-unit
#15
Fang Zheng, Yelian Gu, Hui Zha, Jun Deng, Zhiquan Zhang
The value of (1 → 3)-beta-D-glucans (BG) and galactomannan (GM) assays on diagnostic invasive fungal infections (IFIs) has been observed in adult ICU and in children with hematological malignancies. Only scant data evaluated non-hematological in pediatric intensive care unit (PICU). Here, we retrospectively analyzed the role of bacterial infection to the reactivity of BG and GM assays in PICU. The results showed that the overall prevalence of bacteremia was 13.8% (65/470). The most common underlying disease was pneumonia (81...
December 7, 2016: Mycopathologia
https://www.readbyqxmd.com/read/27928193/developing-a-business-plan-for-critical-care-pharmacy-services
#16
Brian L Erstad, Henry J Mann, Robert J Weber
Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service...
November 2016: Hospital Pharmacy
https://www.readbyqxmd.com/read/27927814/non-invasive-ventilation-in-acute-respiratory-failure-a-meta-analysis
#17
Yu-Jing Liu, Jing Zhao, Hui Tang
Non-invasive positive-pressure ventilation (NPPV) has assumed an important role in the management of respiratory failure because it provides ventilatory support without the need for an invasive airway. However, its effectiveness remains unclear. We performed this meta-analysis to investigate the utility of NPPV intervention in patients with acute respiratory failure (ARF). A comprehensive literature search identified 12 studies enrolling a total of 963 patients from Medline, PubMed, Cochrane and EMBASE databases that assessed the effectiveness of NPPV versus conventional mechanical ventilation and/or non-ventilation therapy in patients with ARF, irrespective of the underlying aetiology, as well as mortality rate and the length of intensive care unit (ICU) or hospital stay...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27927497/acute-renal-infarction-after-lateral-lumbar-interbody-spinal-fusion-for%C3%A2-kyphoscoliosis
#18
Sanjeev J Suratwala, MaryAnne Cronin, Katelyn Kondra, Vincent Leone
STUDY DESIGN: Case report. OBJECTIVES: Case report of acute renal infarction following lateral interbody fusion with posterior instrumentation for adult lumbar kyphoscoliosis. SUMMARY OF BACKGROUND DATA: This is the first reported renal infarction following minimally invasive lateral interbody fusion and posterior spinal instrumentation. METHODS: We report a case of acute renal infarction in a 72-year-old woman following direct lateral interbody fusion (DLIF) with percutaneous pedicle screw and rod fixation from L1 to L5 for correction of kyphoscoliosis...
September 2016: Spine Deformity
https://www.readbyqxmd.com/read/27927246/minimally-invasive-oesophagectomy-versus-open-esophagectomy-for-resectable-esophageal-cancer-a-meta-analysis
#19
REVIEW
Waresijiang Yibulayin, Sikandaer Abulizi, Hongbo Lv, Wei Sun
BACKGROUND: Open esophagectomy (OE) is associated with significant morbidity and mortality. Minimally invasive oesophagectomy (MIO) reduces complications in resectable esophageal cancer. The aim of this study is to explore the superiority of MIO in reducing complications and in-hospital mortality than OE. METHODS: MEDLINE, Embase, Science Citation Index, Wanfang, and Wiley Online Library were thoroughly searched. Odds ratio (OR)/weighted mean difference (WMD) with a 95% confidence interval (CI) was used to assess the strength of association...
December 8, 2016: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27925855/costs-associated-with-influenza-related-hospitalization-in-the-elderly
#20
Núria Torner, Encarna Navas, Núria Soldevila, Diana Toledo, Gemma Navarro, Aurea Morillo, Maria José Pérez, Angela Domínguez
Seasonal influenza epidemics remain a considerable burden in adults, especially in those at higher risk of complications. The aim of this study was to determine the costs associated with influenza-related hospitalization in patients aged ≥65 years admitted to 20 hospitals from seven Spanish regions during the 2013-14 and 2014-15 influenza seasons. Bivariate analysis was used to compare costs in vaccinated and unvaccinated cases. Costs were calculated according to the Spanish National Health System diagnosis-related group tables for influenza and other respiratory system conditions (GRD 89 and GRD 101)...
December 7, 2016: Human Vaccines & Immunotherapeutics
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