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https://www.readbyqxmd.com/read/28316887/comparison-of-methods-of-alert-acknowledgement-by-critical-care-clinicians-in-the-icu-setting
#1
Andrew M Harrison, Charat Thongprayoon, Christopher A Aakre, Jack Y Jeng, Mikhail A Dziadzko, Ognjen Gajic, Brian W Pickering, Vitaly Herasevich
BACKGROUND: Electronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored. OBJECTIVE: To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system...
2017: PeerJ
https://www.readbyqxmd.com/read/28283014/-fungemia-and-septic-arthritis-caused-by-saprochaete-capitata-in-a-patient-with-fanconi-aplastic-anemia-a-case-report
#2
Ömür Mustafa Parkan, Mustafa Altay Atalay, Ayşe Nedret Koç, Çiğdem Pala, Gonca Aydemir, Leylagül Kaynar
Saprochaete capitata (formerly known as Blastoschizomyces capitatus, Trichosporon capitatum, Geotrichum capitatum) is a rare but emerging yeast-like fungus. It is commonly found in environmental sources and can be isolated from skin, gastrointestinal system and respiratory tract of healthy individuals as well. It mainly infects patients with hematological malignancies such as acute myeloid leukemia (AML), especially in the presence of neutropenia; and mortality rates are high in those patients. Although the data about the in vitro antifungal susceptibility are limited, it is being reported that amphotericin B and voriconazole are more effective on S...
January 2017: Mikrobiyoloji Bülteni
https://www.readbyqxmd.com/read/28276800/sepsis-alert-a-triage-model-that-reduces-time-to-antibiotics-and-length-of-hospital-stay
#3
Mari Rosenqvist, Emma Fagerstrand, Peter Lanbeck, Olle Melander, Per Åkesson
OBJECTIVE: To study if a modified triage system at an Emergency Department (ED) combined with educational efforts resulted in reduced time to antibiotics and decreased length of hospital stay (LOS) for patients with severe infection. METHODS: A retrospective, observational study comparing patients before and after the start of a new triage model at the ED of a University Hospital. After the implementation of the model, patients with fever and abnormal vital signs were triaged into a designated sepsis line (Sepsis Alert) for rapid evaluation by the attending physician supported by a infectious diseases (IDs) specialist...
February 28, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28275488/early-management-of-sepsis-with-emphasis-on-early-goal-directed-therapy-ame-evidence-series-002
#4
REVIEW
Zhongheng Zhang, Yucai Hong, Nathan J Smischney, Han-Pin Kuo, Panagiotis Tsirigotis, Jordi Rello, Win Sen Kuan, Christian Jung, Chiara Robba, Fabio Silvio Taccone, Marc Leone, Herbert Spapen, David Grimaldi, Sven Van Poucke, Steven Q Simpson, Patrick M Honore, Stefan Hofer, Pietro Caironi
Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials...
February 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28149888/scoring-systems-for-the-characterization-of-sepsis-and-associated-outcomes
#5
COMMENT
Natalie McLymont, Guy W Glover
Sepsis is responsible for the utilisation of a significant proportion of healthcare resources and has high mortality rates. Early diagnosis and prompt interventions are associated with better outcomes but is impeded by a lack of diagnostic tools and the heterogeneous and enigmatic nature of sepsis. The recently updated definitions of sepsis have moved away from the centrality of inflammation and the systemic inflammatory response syndrome (SIRS) criteria which have been shown to be non-specific. Sepsis is now defined as a "life-threatening organ dysfunction caused by a dysregulated host response to infection"...
December 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28097288/secondary-analysis-of-an-electronic-surveillance-system-combined-with-multi-focal-interventions-for-early-detection-of-sepsis
#6
Bonnie L Westra, Sean Landman, Pranjul Yadav, Michael Steinbach
To conduct an independent secondary analysis of a multi-focal intervention for early detection of sepsis that included implementation of change management strategies, electronic surveillance for sepsis, and evidence based point of care alerting using the POC AdvisorTM application. METHODS: Propensity score matching was used to select subsets of the cohorts with balanced covariates. Bootstrapping was performed to build distributions of the measured difference in rates/means. The effect of the sepsis intervention was evaluated for all patients, and High and Low Risk subgroups for illness severity...
January 18, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27938401/testing-modes-of-computerized-sepsis-alert-notification-delivery-systems
#7
Mikhail A Dziadzko, Andrew M Harrison, Ing C Tiong, Brian W Pickering, Pablo Moreno Franco, Vitaly Herasevich
BACKGROUND: The number of electronic health record (EHR)-based notifications continues to rise. One common method to deliver urgent and emergent notifications (alerts) is paging. Despite of wide presence of smartphones, the use of these devices for secure alerting remains a relatively new phenomenon. METHODS: We compared three methods of alert delivery (pagers, EHR-based notifications, and smartphones) to determine the best method of urgent alerting in the intensive care unit (ICU) setting...
December 9, 2016: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/27918869/paramedic-initiated-cms-sepsis-core-measure-bundle-prior-to-hospital-arrival-a-stepwise-approach
#8
Jason G Walchok, Ronald G Pirrallo, Douglas Furmanek, Martin Lutz, Colt Shope, Brandi Giles, Greta Gue, Aaron Dix
BACKGROUND: To improve patient outcomes, the Center for Medicare and Medicaid Services (CMS) implemented core measures that outline the initial treatment of the septic patient. These measures include initial blood culture collection prior to antibiotics, adequate intravenous fluid resuscitation, and early administration of broad spectrum antibiotics. We sought to determine if Paramedics can initiate the CMS sepsis core measure bundle in the prehospital field reliably. METHODS: This is a retrospective, case series from a 3rd service EMS system model in Greenville, South Carolina between November 17, 2014 and February 20, 2016...
December 5, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27851113/1477-sofa-scores-in-patients-triggering-an-emr-based-sepsis-alert
#9
Julie Graham, Bunny Krall, Asaf Presente, Jacqueline Saucier, Ian Butler
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27850914/1278-design-of-an-electronic-medical-record-based-alert-system-to-detect-the-onset-of-severe-sepsis
#10
Stephanie Fountain, James Perry, Brenda Stoffer, Robert Raschke
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27752318/a-collaborative-improvement-project-by-an-nhs-emergency-department-and-scottish-ambulance-paramedics-to-improve-the-identification-and-delivery-of-sepsis-6
#11
Martin Carberry, John Harden
Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38)...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27631709/automated-detection-of-sepsis-using-electronic-medical-record-data-a-systematic-review
#12
Laurel A Despins
Severe sepsis and septic shock are global issues with high mortality rates. Early recognition and intervention are essential to optimize patient outcomes. Automated detection using electronic medical record (EMR) data can assist this process. This review describes automated sepsis detection using EMR data. PubMed retrieved publications between January 1, 2005 and January 31, 2015. Thirteen studies met study criteria: described an automated detection approach with the potential to detect sepsis or sepsis-related deterioration in real or near-real time; focused on emergency department and hospitalized neonatal, pediatric, or adult patients; and provided performance measures or results indicating the impact of automated sepsis detection...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27628652/nosocomial-sepsis-evaluation-of-the-efficacy-of-preventive-measures-in-a-level-iii-neonatal-intensive-care-unit
#13
Catarina Cardoso de Almeida, Susana Maria Saraiva Pissarra da Silva, Filipa Silveira Dias Flor de Lima Caldas de Oliveira, Maria Hercília Ferreira Guimarães Pereira Areias
OBJECTIVE: To evaluate nosocomial infections preventive bundle, implemented in April 2010 in Centro Hospitalar de São João (CHSJ) Neonatal Intensive Care Unit (NICU) effectiveness. METHODS: Newborns admitted to level-III NICU of CHSJ, between 1 April 2007 and 31 March 2013, with sepsis as discharge diagnosis, were selected and divided into two periods (Period 1 and 2, before and after new preventive bundle introduction). Data from the two periods were compared...
October 3, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27549755/prospective-evaluation-of-an-automated-method-to-identify-patients-with-severe-sepsis-or-septic-shock-in-the-emergency-department
#14
Samuel M Brown, Jason Jones, Kathryn Gibb Kuttler, Roger K Keddington, Todd L Allen, Peter Haug
BACKGROUND: Sepsis is an often-fatal syndrome resulting from severe infection. Rapid identification and treatment are critical for septic patients. We therefore developed a probabilistic model to identify septic patients in the emergency department (ED). We aimed to produce a model that identifies 80 % of sepsis patients, with no more than 15 false positive alerts per day, within one hour of ED admission, using routine clinical data. METHODS: We developed the model using retrospective data for 132,748 ED encounters (549 septic), with manual chart review to confirm cases of severe sepsis or septic shock from January 2006 through December 2008...
August 22, 2016: BMC Emergency Medicine
https://www.readbyqxmd.com/read/27477368/a-proposed-primary-health-early-warning-score-phews-with-emphasis-on-early-detection-of-sepsis-in-the-elderly
#15
Ian Anderson
There are several secondary care early warning scores which alert for severe illness including sepsis. None are specifically adjusted for primary care. A Primary Health Early Warning Score (PHEWS) is proposed which incorporates practical parameters from both secondary and primary care.
March 2016: Journal of Primary Health Care
https://www.readbyqxmd.com/read/27441272/telemedicine-resuscitation-and-arrest-trial-treat-a-feasibility-study-of-real-time-provider-to-provider-telemedicine-for-the-care-of-critically-ill-patients
#16
Anish K Agarwal, David F Gaieski, Sarah M Perman, Marion Leary, Gail Delfin, Benjamin S Abella, Brendan G Carr
BACKGROUND: Protocol-based resuscitation strategies in the Emergency Department (ED) improve survival for out-of-hospital cardiac arrest (OHCA) and severe sepsis but implementation has been inconsistent. OBJECTIVE: To determine the feasibility of a real-time provider-to-provider telemedical intervention for the treatment of OHCA and severe sepsis. MATERIALS AND METHODS: A three-center pilot study utilizing a "hub-spoke model" with an academic medical center acting both as the hub for teleconsultation as well as a spoke hospital enrolling patients...
April 2016: Heliyon
https://www.readbyqxmd.com/read/27437061/validation-of-test-performance-and-clinical-time-zero-for-an-electronic-health-record-embedded-severe-sepsis-alert
#17
Joshua Rolnick, N Lance Downing, John Shepard, Weihan Chu, Julia Tam, Alexander Wessels, Ron Li, Brian Dietrich, Michael Rudy, Leon Castaneda, Lisa Shieh
BACHGROUND: Increasing use of EHRs has generated interest in the potential of computerized clinical decision support to improve treatment of sepsis. Electronic sepsis alerts have had mixed results due to poor test characteristics, the inability to detect sepsis in a timely fashion and the use of outside software limiting widespread adoption. We describe the development, evaluation and validation of an accurate and timely severe sepsis alert with the potential to impact sepsis management...
2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27404288/the-nature-and-variability-of-automated-practice-alerts-derived-from-electronic-health-records-in-a-u-s-nationwide-critical-care-research-network
#18
Cody Benthin, Sonal Pannu, Akram Khan, Michelle Gong
RATIONALE: The nature, variability, and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently used in acute care settings for clinical care or research is unknown. OBJECTIVES: To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network. METHODS: We surveyed investigators at 38 institutions involved in the National Institutes of Health-funded Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL) for quantitative and qualitative analysis...
October 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27374948/identifying-patients-with-sepsis-on-the-hospital-wards
#19
REVIEW
Poushali Bhattacharjee, Dana P Edelson, Matthew M Churpek
Sepsis contributes to up to half of all deaths in hospitalized patients, and early interventions, such as appropriate antibiotics, have been shown to improve outcomes. Most research has focused on early identification and treatment of septic patients in the emergency department and the intensive care unit; however, many patients develop sepsis on the general wards. The goal of this review is to discuss recent advances in sepsis detection in patients on the hospital wards. It will discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening septic patients, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick Sepsis-related Organ Failure Assessment (qSOFA) score...
June 30, 2016: Chest
https://www.readbyqxmd.com/read/27328580/idiopathic-pneumatosis-intestinalis-requiring-decompressive-laparotomy
#20
Andrew McGregor, Khaldoun Bekdache, Laura Choi
INTRODUCTION: Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are radiographic signs of questionable bowel ischemia. Pneumatosis intestinalis can be associated with possible benign conditions such as obstructive airway disease. We present a patient who demonstrated clinical signs of overt sepsis with corresponding radiological findings of PI and HPVG concering for possible small or large bowel ischemia. However at exploration, no sign of small or large bowel injury or ischemia could be detected...
May 2016: Connecticut Medicine
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