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https://www.readbyqxmd.com/read/28537773/a-new-generation-of-comfort-care-order-sets-aligning-protocols-with-current-principles
#1
Melissa A Bender, Caroline Hurd, Nicole Solvang, Kathy Colagrossi, Diane Matsuwaka, J Randall Curtis
BACKGROUND: There are few published comfort care order sets for end-of-life symptom management, contributing to variability in treatment of common symptoms. At our academic medical centers, we have observed that rapid titration of opioid infusions using our original comfort care order set's titration algorithm causes increased discomfort from opioid toxicity. OBJECTIVE: The aim of this study was to describe the process and outcomes of a multiyear revision of a standardized comfort care order set for clinicians to treat end-of-life symptoms in hospitalized patients...
May 24, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28522914/one-year-experience-with-computer-assisted-propofol-sedation-for-colonoscopy
#2
Otto S Lin, Danielle La Selva, Richard A Kozarek, Deborah Tombs, Wade Weigel, Ryan Beecher, Johannes Koch, Susan McCormick, Michael Chiorean, Fred Drennan, Michael Gluck, Nanda Venu, Michael Larsen, Andrew Ross
AIM: To report our one-year experience with computer assisted propofol sedation (CAPS) for colonoscopy as the first United States Medical Center to adopt CAPS technology for routine clinical use. METHODS: Between September 2014 and August 2015, 2677 patients underwent elective outpatient colonoscopy with CAPS at our center. All colonoscopies were performed by 1 of 17 gastroenterologists certified in the use of the CAPS system, with the assistance of a specially trained nurse...
April 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28498636/study-protocol-evaluating-the-use-of-bowel-stimulation-before-loop-ileostomy-closure-to-reduce-postoperative-ileus-a-multicenter-randomized-controlled-trial
#3
Richard Garfinkle, Nora Trabulsi, Nancy Morin, Terry Phang, Sender Liberman, Liane Feldman, Gerald Fried, Marylise Boutros
AIM: Postoperative ileus is the most commonly observed morbidity following ileostomy closure. Studies have demonstrated that the defunctionalized bowel of a loop ileostomy undergoes a series of functional and structural changes, such as atrophy of the intestinal villi and muscular layers, which may contribute to ileus. A single-center study in Spain demonstrated that preoperative bowel stimulation via the distal limb of the loop ileostomy decreased postoperative ileus, length of stay, and time to gastrointestinal function...
May 12, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28494173/suicide-attempt-with-acetonitrile-ingestion-in-a-nursing-mother
#4
Eduardo Mello De Capitani, Carla Fernanda Borrasca-Fernandes, Maíra Branco Pimenta, Camila Carbone Prado, Paula Christiane Soubhia, Rafael Lanaro, Sueli Mello Moreira, Rafael Linden, Helena Valle Nóbrega, Fábio Bucaretchi, José Luiz Costa
CONTEXT: Acetonitrile (ACN) is a solvent rapidly absorbed through lungs and intestinal tract, and is slowly metabolized to cyanide (CN) by enzymatic processes mediated by CYP2E1. OBJECTIVE: To describe the clinical and laboratory evolution, ACN elimination half-life, and its presence in breast milk in a nursing mother who attempted suicide. CASE DETAILS: A 25-year-old 2-month nursing mother ingested an estimated dose of 2.1 g/kg of ACN. Blood and urine samples were collected 24 h later for ACN, CN and thiocyanate analysis, and 12...
May 11, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28488361/clonidine-for-sedation-and-analgesia-for-neonates-receiving-mechanical-ventilation
#5
REVIEW
Olga Romantsik, Maria Grazia Calevo, Elisabeth Norman, Matteo Bruschettini
BACKGROUND: Although routine administration of pharmacologic sedation or analgesia during mechanical ventilation in preterm neonates is not recommended, its use in clinical practice remains common. Alpha-2 agonists, mainly clonidine and dexmedetomidine, are used as adjunctive (or alternative) sedative agents alongside opioids and benzodiazepines. Clonidine has not been systematically assessed for use in neonatal sedation during ventilation. OBJECTIVES: To assess whether clonidine administered to term and preterm newborn infants receiving mechanical ventilation reduces morbidity and mortality rates...
May 10, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28471928/complication-rates-of-3-hypertonic-saline-infusion-through-peripheral-intravenous-access
#6
Claudia Andira Perez, Stephen A Figueroa
INTRODUCTION: Hyperosmolar therapy with hypertonic saline (HTS) is a cornerstone in the management of intracranial hypertension and hyponatremia in the neurological intensive care unit. Theoretical safety concerns remain for infiltration, thrombophlebitis, tissue ischemia, and venous thrombosis associated with continuous 3% HTS administered via peripheral intravenous (pIV) catheters. It is common practice at many institutions to allow only central venous catheter infusion of 3% HTS. METHODS: Hospital policy was changed to allow the administration of 3% HTS via 16- to 20-gauge pIVs to a maximum infusion rate of 50 mL/h in patients without central venous access...
June 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28469890/hypokalaemia-addressing-human-factors-and-improving-education-around-prescription-and-administration-of-intravenous-iv-potassium-infusion-in-trauma-and-orthopaedics
#7
Vanushia Thirumal, Gavin Love
A high incidence of hypokalaemia was noted in Trauma and Orthopaedics of Ninewells Hospital. We sought to establish the reason behind this and implemented three PDSA cycles via questionnaires to 30 ward staff, both doctors and nurses over a 1 week period in December, February and July 2016. Key baseline measures include availability of IV fluids with 40mmol potassium on the wards, confidence prescribing or administering IV fluids with 40mmol potassium, necessity for cardiac monitoring during slow IV potassium replacement and recognition of confusion and learning need in this area...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28460699/case-study-of-high-dose-ketamine-for-treatment-of-complex-regional-pain-syndrome-in-the-pediatric-intensive-care-unit
#8
REVIEW
Tracy Ann Pasek, Kelli Crowley, Catherine Campese, Rachel Lauer, Charles Yang
Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient...
June 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28445171/identification-of-depressive-signs-in-patients-and-their-family-members-during-ipad-based-audiovisual-sessions
#9
Carol E Smith, Marilyn Werkowitch, Donna Macan Yadrich, Noreen Thompson, Eve-Lynn Nelson
Home parenteral nutrition requires a daily life-sustaining intravenous infusion over 12 hours. The daily intravenous infusion home care procedures are stringent, time-consuming tasks for patients and family caregivers who often experience depression. The purposes of this study were (1) to assess home parenteral nutrition patients and caregivers for depression and (2) to assess whether depressive signs can be seen during audiovisual discussion sessions using an Apple iPad Mini. In a clinical trial (N = 126), a subsample of 21 participants (16...
April 25, 2017: Computers, Informatics, Nursing: CIN
https://www.readbyqxmd.com/read/28402925/time-delays-associated-with-vasoactive-medication-preparation-and-delivery-in-simulated-patients-at-risk-of-cardiac-arrest
#10
P G Brindley, D O'Dochartaigh, C Volney, S Ryan, M J Douma
PURPOSE: To compare, quantify, and describe the time-delays associated with four common methods of adrenaline administration in the simulated setting of impending cardiac arrest. METHODS: Using sham medication and a high-fidelity simulator, experienced Nurses prepared, then delivered, adrenaline by: i) bolus, ii) lower-concentration infusion iii) higher-concentration infusion, and iv) higher-concentration infusion plus carrier-line. We recorded medication preparation and delivery time, plus administration errors and self-reported competence...
April 7, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28387946/three-sides-to-a-story-child-parent-and-nurse-perspectives-on-the-child-s-experience-during-hematopoietic-stem-cell-transplantation
#11
Christina K Ullrich, Angie Mae Rodday, Kristin M Bingen, Mary Jo Kupst, Sunita K Patel, Karen L Syrjala, Lynnette L Harris, Christopher J Recklitis, Grace Chang, Eva C Guinan, Norma Terrin, Hocine Tighiouart, Sean Phipps, Susan K Parsons
BACKGROUND: The experience of children undergoing hematopoietic stem cell transplantation (HSCT), including the ways in which different participants (ie, children, parents, and nurses) contribute to the overall picture of a child's experience, is poorly characterized. This study evaluated parent, child, and nurse perspectives on the experience of children during HSCT and factors contributing to interrater differences. METHODS: Participants were enrolled in a multicenter, prospective study evaluating child and parent health-related quality of life over the year after HSCT...
April 7, 2017: Cancer
https://www.readbyqxmd.com/read/28375083/the-curative-effect-analysis-and-nursing-measures-of-the-transvaginal-myomectomy-and-transabdominal-myomectomy
#12
Lingping Meng, Wanxia Li
To analyze the curative effects of the transvaginal myomectomy (TVM) and the traditional transabdominal myomectomy (TAM). The group with traditional TAM received routine preoperative nursing guidance and postoperative care. While the group with TVM received preoperative strengthened psychological care, vaginal preparation and postoperative strengthened vagina nursing, paying attention to the prevention and treatment of complications, and maintaining effective pelvic draining and other nursing measures. After that, the statistical processing and analysis were used to compared the intraoperative blood loss, operating time, postoperative infusion time, hospitalization time, postoperative eating, postoperative ambulation, the usage rate of postoperative analgesic, postoperative morbidity and postoperative complications between the two groups Comparison between TVM group and TAM group showed that the difference of the operating time, postoperative infusion time, hospitalization time, postoperative eating, postoperative ambulation, the usage rate of postoperative analgesic, postoperative morbidity and postoperative complications between the two groups were statistically significant (P<0...
November 2016: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28345825/comparison-of-hypersensitivity-reactions-to-carboplatin-retreatment-in-gynecologic-cancer-patients-between-one-and-two-hour-infusions-a-randomized-trial-study
#13
Weerawich Pornwattanakrilert, Prapaporn Suprasert
Objective: To compare the incidence rate of carboplatin hypersensitivity reactions (HSRs) in gynecologic cancer patients receiving one-hour or two-hour carboplatin retreatment infusions. Setting: A Prospective Randomized Controlled Trial. Methods: Recurrent gynecologic cancer patients 25 to 80-years of age who were scheduled to receive carboplatin retreatment after previously receiving at least six cycles of carboplatin without a history of platinum allergy were invited to enroll. They were randomized to receive either a one-hour or two-hour carboplatin infusion in each cycle...
February 1, 2017: Asian Pacific Journal of Cancer Prevention: APJCP
https://www.readbyqxmd.com/read/28345437/clinical-profile-dosing-and-quality-of-life-outcomes-in-primary-immune-deficiency-patients-treated-at-home-with-immunoglobulin-g-data-from-the-ideal-patient-registry
#14
Sean Kearns, Loretta Kristofek, William Bolgar, Luqman Seidu, Samantha Kile
BACKGROUND: Patients with primary immune deficiency (PID) often require immunoglobulin G (IgG, commonly referred to as Ig) replacement therapy to prevent infections and associated comorbidities. Ig therapy can be given either through intravenous or subcutaneous routes, and both can be done in the home setting. There is limited information available on the real-world diagnosis, management, and outcomes of this patient population, given the variable disease presentation and treatment options...
April 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28338517/improving-nutritional-support-of-burn-service-patients-by-increasing-the-number-of-days-when-100-of-prescribed-formula-is-given
#15
Peggie F Conrad, Julie Liberio, Razia Aleem, Marcia M Halerz, Michael J Mosier, Arthur P Sanford, Richard L Gamelli
The authors sought to increase the number of days when burn service patients receive 100% of prescribed enteral nutrition. The authors first performed a retrospective review of 37 patients (group 1) receiving enteral nutrition. The authors then created and implemented a nurse-directed feeding algorithm, placing patients into three age groups addressing maximum hourly infusion rates, high residual limits, initiating feeding, refeeding residuals, and replacing formula. The authors then performed a prospective review of 37 patients (group 2) fed utilizing the new algorithm...
March 21, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28333819/practice-bulletin-no-177-obstetric-analgesia-and-anesthesia
#16
(no author information available yet)
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28333811/practice-bulletin-no-177-summary-obstetric-analgesia-and-anesthesia
#17
(no author information available yet)
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28333787/building-research-infrastructure-in-magnet%C3%A2-hospitals-current-status-and-future-directions
#18
Meg Johantgen, Marianne Weiss, Vicki Lundmark, Robin Newhouse, Karen Haller, Lynn Unruh, Maria Shirey
OBJECTIVE: The aim of this study was to describe the infrastructures supporting research in Magnet® hospitals. BACKGROUND: Hospitals undertaking the journey toward Magnet designation must build research and evidence-based practice (EBP) infrastructures that support the infusion of research and EBP into clinical practice. METHODS: An electronic survey was developed and distributed to the chief nursing officer or Magnet coordinator of all Magnet hospitals between June 10, 2015, and July 8, 2015...
April 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/28321140/y-site-incompatibility-between-premix-concentrations-of-vancomycin-and-piperacillin-tazobactam-do-current-compatibility-testing-methodologies-tell-the-whole-story
#19
Wesley D Kufel, Christopher D Miller, Paul R Johnson, Kaleigh Reid, James J Zahra, Robert W Seabury
Background: Published literature has demonstrated commercially available premix vancomycin (5 mg/mL) and piperacillin-tazobactam (67.5 mg/mL) as physically compatible via simulated Y-site methodology. Compatibility via actual Y-site infusion has yet to be established. Objective: To assess and compare the compatibility of commercially available premix concentrations of vancomycin and piperacillin-tazobactam via simulated and actual Y-site evaluation. Methods: Vancomycin and piperacillin-tazobactam were tested using simulated and actual Y-site infusion methodologies...
February 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28270721/the-hospital-at-home-program-no-place-like-home
#20
M Lippert, S Semmens, L Tacey, T Rent, K Defoe, M Bucsis, T Shykula, J Crysdale, V Lewis, D Strother, L Lafay-Cousin
BACKGROUND: The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. METHODS: Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching...
February 2017: Current Oncology
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