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https://www.readbyqxmd.com/read/29788245/implementation-science-in-low-resource-settings-using-the-interactive-systems-framework-to-improve-hand-hygiene-in-a-tertiary-hospital-in-ghana
#1
Brianne Kallam, Christie Pettitt-Schieber, Medge Owen, Rebecca Agyare Asante, Elizabeth Darko, Rohit Ramaswamy
Quality issue: Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Initial assessment: Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections...
May 19, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29784518/impact-of-blood-donor-sex-on-transfusion-related-outcomes-in-preterm-infants
#2
Thomas Murphy, Anju Chawla, Richard Tucker, Betty Vohr
OBJECTIVE: Explore the role of red blood cell donor sex on preterm infant neonatal outcomes. STUDY DESIGN: In a retrospective, exploratory, cohort study, the hospital blood bank database was queried for units of blood released to neonatal intensive care unit patients in 2009-2010. The state blood center provided donor sex, and a department database provided neonatal characteristics and morbidities. Comparisons were made for 2 groups: those who ever received female blood and those who did not...
May 18, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29749505/identification-of-genes-and-pathways-associated-with-multiple-organ-dysfunction-syndrome-by-microarray-analysis
#3
Changwei Gu, Wanhai Qiao, Lina Wang, Minmin Li, Kang Song
Multiple organ dysfunction syndrome (MODS) is characterized by the development of progressive physiological dysfunction of ≥2 organs or organ systems and is responsible for the majority of the morbidity and mortality among patients in intensive care units. The aim of the present study was to investigate the potential genes and pathways associated with MODS. The microarray dataset GSE60088 was downloaded from the Gene Expression Omnibus and used to identify differentially expressed genes (DEGs) between organ tissues (lung, liver and kidney) obtained from a murine model of MODS and healthy controls...
May 4, 2018: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29748956/neurobehavioral-evaluation-of-neonates-with-congenital-heart-disease-a-cohort-study
#4
Whitnee J Hogan, Sarah Winter, Nelangi M Pinto, Cindy Weng, Xiaoming Sheng, Elisabeth Conradt, Janine Wood, Michael D Puchalski, Lloyd Y Tani, Thomas A Miller
AIM: To describe neurobehavioral patterns in neonates with congenital heart disease (CHD). METHOD: A cohort study describing neurobehavioral performance of neonates with CHD requiring cardiac surgery. The neonates were evaluated preoperatively and postoperatively with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) and scores were compared with published normative values. Clinical factors were obtained by chart review to assess their association with behavior...
May 10, 2018: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/29747939/factors-related-to-limitation-of-life-support-within-48h-of-intensive-care-unit-admission-a-multicenter-study
#5
V Blazquez, A Rodríguez, A Sandiumenge, E Oliver, B Cancio, M Ibañez, G Miró, E Navas, M Badía, M D Bosque, M T Jurado, M López, M Llauradó, N Masnou, T Pont, M Bodí
OBJECTIVE: To determine factors related to limitations on life support within 48h of intensive care unit (ICU) admission. STUDY DESIGN: Prospective multicenter study. SETTING: Eleven ICUs. PATIENTS: All patients who died and/or had limitations on life support after ICU admission during a four-month period. VARIABLES: Patient characteristics, hospital characteristics, characteristics of limitations on life support...
May 7, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29739825/safety-ii-behavior-in-a-pediatric-intensive-care-unit
#6
Jenna Merandi, Kathryn Vannatta, J Terrance Davis, Richard E McClead, Richard Brilli, Thomas Bartman
: media-1vid110.1542/5763093009001PEDS-VA_2018-0018 Video Abstract BACKGROUND AND OBJECTIVE: Safety I error elimination concepts are focused on retrospectively investigating what went wrong and redesigning system processes and individual behaviors to prevent similar future occurrences. The Safety II approach recognizes complex systems and unpredictable circumstances, mandating flexibility and resilience within systems and among individuals to avoid errors. We hypothesized that in our high-complexity and high-risk PICU, Safety II concepts contribute to its remarkably low adverse drug event rate...
May 8, 2018: Pediatrics
https://www.readbyqxmd.com/read/29738784/m-grabowski-et-al-characterizations-of-handwashing-sink-activities-in-a-single-hospital-medical-intensive-care-unit
#7
M Grabowski, J M Lobo, B Gunnell, K Enfield, R Carpenter, L Barnes, A Mathers
BACKGROUND: Handwashing sink drains are increasingly implicated as a potential reservoir of antibiotic-resistant bacteria in hospital outbreaks; however, usage patterns that may promote this source remain unknown. AIM: To understand behaviours in the intensive care unit (ICU) that may facilitate establishment and nosocomial transmission of multidrug-resistant Gram negatives from a sink-trap reservoir to a patient. METHODS: Motion-sensitive cameras captured anonymized activity paired with periodic in-person observations during a quality investigation from four ICU sinks (two patient rooms and two patient bathrooms) in a university hospital...
May 5, 2018: Journal of Hospital Infection
https://www.readbyqxmd.com/read/29736044/improving-the-clinical-pharmacist-handover-process-in-the-intensive-care-unit-with-a-pharmacotherapy-specific-tool-the-i-happy-study
#8
Emma Attfield, Matthew P Swankhuizen, Nicole Bruchet, Richard Slavik, Sean K Gorman
Background: Pharmacists in the intensive care unit (ICU) provide pharmaceutical care to critically ill patients. Identification and resolution of drug therapy problems improves outcomes for these patients. To maintain continuity of care, pharmacotherapy plans should be transferred to a receiving pharmacist upon discharge of patients from the ICU. No previous studies have addressed the development or evaluation of a systematic, standardized clinical handover tool and process for pharmacists...
March 2018: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/29729037/using-focused-ethnography-to-explore-and-describe-the-process-of-nurses-shift-reports-in-a-psychiatric-intensive-care-unit
#9
Martin Salzmann-Erikson
AIMS AND OBJECTIVES: To explore and describe the cultural routine of shift reports among nursing staff in a psychiatric intensive care unit, and further to develop a taxonomic, thematic and theoretical understanding of the process. BACKGROUND: Lack of communication among healthcare staff is associated with risks for medical errors. Thus, handovers and shift reports are an essential and integral routine among nurses in order to pass on information about the patients' health status...
May 5, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29727522/development-of-a-short-course-on-management-of-critically-ill-patients-with-acute-respiratory-infection-and-impact-on-clinician-knowledge-in-resource-limited-icus
#10
Janet V Diaz, Justin R Ortiz, Paula Lister, Nahoko Shindo, Neill K J Adhikari
BACKGROUND: The 2009 influenza A (H1N1) pandemic caused surges of patients in intensive care units (ICUs) in resource-limited settings. Several Ministries of Health requested clinical management guidance from the World Health Organization (WHO), which had not previously developed guidance regarding critically ill patients. OBJECTIVE: To assess the acceptability and impact on knowledge of a short course about the management of critically ill patients with acute respiratory infections complicated by sepsis or acute respiratory distress syndrome delivered to clinicians in resource-limited ICUs...
May 4, 2018: Influenza and Other Respiratory Viruses
https://www.readbyqxmd.com/read/29724444/work-system-barriers-and-strategies-reported-by-tele-intensive-care-unit-nurses-a-case-study
#11
REVIEW
Peter L T Hoonakker, Pascale Carayon
Tele-intensive care units (ICUs) are an innovation to handle issues such as personnel shortage and improving care. In tele-ICUs, clinical teams monitor ICU patients remotely and support clinicians in multiple ICUs. The tele-ICU and ICU clinicians function as virtual teams. Little is known how these teams function and what challenges they encounter. We examined the challenges from the perspective of nurses in a tele-ICU. We used a case study design and conducted interviews with 10 tele-ICU nurses. The nurses encounter challenges in interacting with the multiple ICUs that they monitor remotely and have developed strategies to cope with these challenges...
June 2018: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/29724439/nurse-technology-interactions-and-patient-safety
#12
REVIEW
Halley Ruppel, Marjorie Funk
Nurses are the end-users of most technology in intensive care units, and the ways in which they interact with technology affect quality of care and patient safety. Nurses' interactions include the processes of ensuring proper input of data into the technology as well as extracting and interpreting the output (clinical data, technical data, alarms). Current challenges in nurse-technology interactions for physiologic monitoring include issues regarding alarm management, workflow interruptions, and monitor surveillance...
June 2018: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/29724363/african-americans-are-less-likely-to-receive-care-by-a-cardiologist-during-an-intensive-care-unit-admission-for-heart-failure
#13
Khadijah Breathett, Wenhui G Liu, Larry A Allen, Stacie L Daugherty, Irene V Blair, Jacqueline Jones, Gary K Grunwald, Marc Moss, Tyree H Kiser, Ellen Burnham, R William Vandivier, Brendan J Clark, Eldrin F Lewis, Sula Mazimba, Catherine Battaglia, P Michael Ho, Pamela N Peterson
OBJECTIVES: This study sought to determine whether the likelihood of receiving primary intensive care unit (ICU) care by a cardiologist versus a noncardiologist was greater for Caucasians than for African Americans admitted to an ICU for heart failure (HF). The authors further evaluated whether primary ICU care by a cardiologist is associated with higher in-hospital survival, irrespective of race. BACKGROUND: Increasing data demonstrate an association between better HF outcomes and care by a cardiologist...
May 2018: JACC. Heart Failure
https://www.readbyqxmd.com/read/29723925/neonatologists-can-impede-or-support-parents-participation-in-decision-making-during-medical-rounds-in-neonatal-intensive-care-units
#14
Anna Axelin, Jyri Outinen, Kirsi Lainema, Liisa Lehtonen, Linda S Franck
AIM: We explored the dynamics of neonatologist-parent communication and decision-making during medical rounds in a level three neonatal intensive care unit. METHODS: This was a qualitative study, with an ethnographic approach, that was conducted at Turku University Hospital, Finland, from 2013-2014. We recruited eight mothers and seven couples, their 11 singletons and four sets of twins and two neonatologists and observed and video recorded 15 medical rounds. The infants were born at 23+5 to 40+1 weeks and the parents were aged 24-47...
May 3, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29721645/midazolam-increases-preload-dependency-during-endotoxic-shock-in-rabbits-by-affecting-venous-vascular-tone
#15
Jianxiao Chen, Tao Yu, Federico Longhini, Xiwen Zhang, Songqiao Liu, Ling Liu, Yi Yang, Haibo Qiu
BACKGROUND: Septic patients often require sedation in intensive care unit, and midazolam is one of the most frequently used sedatives among them. But the interaction between midazolam and septic shock is not known. The aim of this study is to investigate the effects of midazolam on preload dependency in an endotoxic shock model by evaluating systemic vascular tone and cardiac function. METHODS: Eighteen rabbits were randomly divided into three groups: Control group, MID1 group and MID2 group...
May 2, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29720570/ripk3-mediates-pathogenesis-of-experimental-ventilator-induced-lung-injury
#16
Ilias I Siempos, Kevin C Ma, Mitsuru Imamura, Rebecca M Baron, Laura E Fredenburgh, Jin-Won Huh, Jong-Seok Moon, Eli J Finkelsztein, Daniel S Jones, Michael Torres Lizardi, Edward J Schenck, Stefan W Ryter, Kiichi Nakahira, Augustine Mk Choi
In patients requiring ventilator support, mechanical ventilation (MV) may induce acute lung injury (ventilator-induced lung injury [VILI]). VILI is associated with substantial morbidity and mortality in mechanically ventilated patients with and without acute respiratory distress syndrome. At the cellular level, VILI induces necrotic cell death. However, the contribution of necroptosis, a programmed form of necrotic cell death regulated by receptor-interacting protein-3 kinase (RIPK3) and mixed-lineage kinase domain-like pseudokinase (MLKL), to the development of VILI remains unexplored...
May 3, 2018: JCI Insight
https://www.readbyqxmd.com/read/29706412/handover-from-operating-theatre-to-the-intensive-care-unit-a-quality-improvement-study
#17
Andrea P Marshall, Georgia Tobiano, Niki Murphy, Greg Comadira, Nicola Willis, Therese Gardiner, Lucy Hervey, Wendy Simpson, Brigid M Gillespie
BACKGROUND: Transitioning a patient from the operating theatre (OT) to the intensive care unit (ICU) is a dynamic and complex process. Handover of the critically ill postoperative patient can contribute to procedural and communication errors. Standardised protocols are means for structuring and improving handover content. Both have been shown to be effective in reducing information omission and improve communication during this transition period. OBJECTIVES: The aim of this uncontrolled before and after study was to improve handover processes and communication about the care for critically ill patients transferred from OT to ICU...
April 26, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29705093/no-firm-evidence-that-lack-of-blinding-affects-estimates-of-mortality-in-randomised-clinical-trials-of-intensive-care-interventions-a-systematic-review-and-meta-analysis
#18
REVIEW
Carl Thomas Anthon, Anders Granholm, Anders Perner, Jon Henrik Laake, Morten Hylander Møller
OBJECTIVE: To evaluate the effect of blinding on mortality effect estimates in randomised clinical trials (RCTs) in adult intensive care unit (ICU) patients. STUDY DESIGN AND SETTINGS: A systematic review and meta-analysis of RCTs reporting mortality effect estimates of ICU interventions in adult ICU patients. We assessed differences in summarised risk ratios (RRs) with 95% confidence intervals (CIs) between blinded and unblinded RCTs. P <0.10 was considered statistically significant (test-of-interaction)...
April 26, 2018: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29695013/determining-inappropriate-medication-alerts-from-inaccurate-warning-overrides-in-the-intensive-care-unit
#19
Christine A Rehr, Adrian Wong, Diane L Seger, David W Bates
OBJECTIVE:  This article aims to understand provider behavior around the use of the override reason "Inaccurate warning," specifically whether it is an effective way of identifying unhelpful medication alerts. MATERIALS AND METHODS:  We analyzed alert overrides that occurred in the intensive care units (ICUs) of a major academic medical center between June and November 2016, focused on the following high-significance alert types: dose, drug-allergy alerts, and drug-drug interactions (DDI)...
April 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/29689120/acute-on-chronic-liver-failure-getting-ready-for-prime-time
#20
Jasmohan S Bajaj, Richard Moreau, Patrick S Kamath, Hugo E Vargas, Vicente Arroyo, K Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C Lai, Florence Wong
Acute on chronic liver failure (ACLF) is a culmination of chronic liver disease and extra-hepatic organ failures, which is associated with a high short-term mortality and immense healthcare expenditure. There are varying definitions for organ failures and ACLF in Europe, North America and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multi-factorial and related to interactions between the immuno-inflammatory system, microbiota and the precipitating factors...
April 24, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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