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https://www.readbyqxmd.com/read/29025194/procalcitonin-to-initiate-or-discontinue-antibiotics-in-acute-respiratory-tract-infections
#1
REVIEW
Philipp Schuetz, Yannick Wirz, Ramon Sager, Mirjam Christ-Crain, Daiana Stolz, Michael Tamm, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Kristina B Kristoffersen, Olaf Burkhardt, Tobias Welte, Stefan Schroeder, Vandack Nobre, Long Wei, Heiner C Bucher, Neera Bhatnagar, Djillali Annane, Konrad Reinhart, Angela Branche, Pierre Damas, Maarten Nijsten, Dylan W de Lange, Rodrigo O Deliberato, Stella Ss Lima, Vera Maravić-Stojković, Alessia Verduri, Bin Cao, Yahya Shehabi, Albertus Beishuizen, Jens-Ulrik S Jensen, Caspar Corti, Jos A Van Oers, Ann R Falsey, Evelien de Jong, Carolina F Oliveira, Bianca Beghe, Matthias Briel, Beat Mueller
BACKGROUND: Acute respiratory infections (ARIs) comprise of a large and heterogeneous group of infections including bacterial, viral, and other aetiologies. In recent years, procalcitonin (PCT), a blood marker for bacterial infections, has emerged as a promising tool to improve decisions about antibiotic therapy (PCT-guided antibiotic therapy). Several randomised controlled trials (RCTs) have demonstrated the feasibility of using procalcitonin for starting and stopping antibiotics in different patient populations with ARIs and different settings ranging from primary care settings to emergency departments, hospital wards, and intensive care units...
October 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29025070/interdisciplinary-family-conferences-to-improve-patient-experience-in-the-neonatal-intensive-care-unit
#2
Jennifer A Trujillo, Yesenia Fernandez, Lyla Ghafoori, Kristina Lok, Arwin Valencia
Parents play a significant role in the development of their neonate. They can affect the length of stay in a neonatal intensive care unit (NICU) and are seen as an integral part of the team. Parents are often put in positions where difficult decision making is required of them in the care of their critically ill child. Studies suggest that one way to improve the family's experience and to encourage their involvement is by establishing a formal and focused family conference. Therefore, the NICU social workers and the interdisciplinary team collaborated to formulate strategies to improve communication that would enhance current practice...
September 15, 2017: Health & Social Work
https://www.readbyqxmd.com/read/29018070/hypothermic-oxygenated-machine-perfusion-hope-for-orthotopic-liver-transplantation-of-human-liver-allografts-from-extended-criteria-donors-ecd-in-donation-after-brain-death-dbd-a-prospective-multicentre-randomised-controlled-trial-hope-ecd-dbd
#3
Zoltan Czigany, Wenzel Schöning, Tom Florian Ulmer, Jan Bednarsch, Iakovos Amygdalos, Thorsten Cramer, Xavier Rogiers, Irinel Popescu, Florin Botea, Jiří Froněk, Daniela Kroy, Alexander Koch, Frank Tacke, Christian Trautwein, Rene H Tolba, Marc Hein, Ger H Koek, Cornelis H C Dejong, Ulf Peter Neumann, Georg Lurje
INTRODUCTION: Orthotopic liver transplantation (OLT) has emerged as the mainstay of treatment for end-stage liver disease. In an attempt to improve the availability of donor allografts and reduce waiting list mortality, graft acceptance criteria were extended increasingly over the decades. The use of extended criteria donor (ECD) allografts is associated with a higher incidence of primary graft non-function and/or delayed graft function. As such, several strategies have been developed aiming at reconditioning poor quality ECD liver allografts...
October 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/29016462/the-medical-futility-experience-of-nurses-in-caring-for-critically-ill-patients
#4
Ming-Yi Hsu, Shu-Fen Su, Lien-Ying Chiang, Sou-Jen Shih, Yu-Chen Chen
BACKGROUND: Medical futility is a key bioethical concern. In Taiwan, policymakers tend to provide care standards and evaluation guidelines for critically ill and terminal patients whose treatment is medically futile. However, the current status of medical futility for critically ill patients is inadequate, and no consensus currently exists on the definition of medical futility. PURPOSE: The aim of this study was to understand the medical futility experiences of intensive care nurses...
October 10, 2017: Journal of Nursing Research: JNR
https://www.readbyqxmd.com/read/28991944/sound-and-light-levels-are-similarly-disruptive-in-icu-and-non-icu-wards
#5
Stuti J Jaiswal, Solana Garcia, Robert L Owens
OBJECTIVE: To compare ambient sound and light levels, including SLCs, in ICU and non-ICU environments. DESIGN: Observational study. SETTING: Tertiary-care hospital. MEASUREMENTS: Sound measurements of 0.5 Hz were analyzed to provide average hourly sound levels, sound peaks, and SLCs =17.5 decibels (dB). For light data, measurements taken at 2-minute intervals provided average and maximum light levels. RESULTS: The ICU rooms were louder than non-ICU wards; hourly averages ranged from 56...
October 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28987397/duration-of-postoperative-mechanical-ventilation-as-a-quality-metric-for-pediatric-cardiac-surgical-programs
#6
Michael Gaies, David K Werho, Wenying Zhang, Janet E Donohue, Sarah Tabbutt, Nancy S Ghanayem, Mark A Scheurer, John M Costello, J William Gaynor, Sara K Pasquali, Justin B Dimick, Mousumi Banerjee, Steven M Schwartz
BACKGROUND: Few metrics exist to assess quality of care at pediatric cardiac surgical programs, limiting opportunities for benchmarking and quality improvement. Postoperative duration of mechanical ventilation (POMV) may be an important quality metric because of its association with complications and resource utilization. In this study we modelled case-mix-adjusted POMV duration and explored hospital performance across POMV metrics. METHODS: This study used the Pediatric Cardiac Critical Care Consortium clinical registry to analyze 4,739 hospitalizations from 15 hospitals (October 2013 to August 2015)...
October 4, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28982305/advanced-modes-of-mechanical-ventilation-introduction-for-the-critical-care-pharmacist
#7
Michael J Cawley
Mechanical ventilation continues to be an evolving modality in the critical care environment. Technological advances in microprocessor-controlled ventilation integrated with the complexity of new ventilator modes has provided the multidisciplinary team opportunities to further improve the care of the critically ill ventilator patients. As members of the critical care multidisciplinary team, pharmacists require a basic understanding of both conventional and advanced modes of mechanical ventilation in order to assist in optimizing medication use and ultimately patient health-care outcomes...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28980410/the-pediatric-echocardiography-boot-camp-four-year-experience-and-impact-on-clinical-performance
#8
Shiraz A Maskatia, Antonio G Cabrera, Shaine A Morris, Carolyn A Altman
BACKGROUND: We previously reported on the short-term impact of an echocardiography "Boot Camp" on a single class of cardiology fellows (CF). The impact of the Boot Camp on performance throughout fellowship is unknown. METHODS: We enrolled four classes of CFs and two classes of cardiac ICU fellows (CVs) prospectively into the Boot Camp and compared CFs to a historical cohort. Experience with echocardiography was surveyed. Outcome measures included written pre- and post-Camp exams, a performance based test (PBT), self-efficacy assessments, numbers of echocardiograms performed, and echocardiogram quality during the last 3 months of fellowship...
October 2017: Echocardiography
https://www.readbyqxmd.com/read/28979532/introduction-of-the-identification-situation-background-assessment-recommendations-tool-to-improve-the-quality-of-information-transfer-during-medical-handover-in-intensive-care
#9
Benjamin Ramasubbu, Emma Stewart, Rosalba Spiritoso
OBJECTIVE: To audit the quality and safety of the current doctor-to-doctor handover of patient information in our Cardiothoracic Intensive Care Unit. If deficient, to implement a validated handover tool to improve the quality of the handover process. METHODS: In Cycle 1 we observed the verbal handover and reviewed the written handover information transferred for 50 consecutive patients in St George's Hospital Cardiothoracic Intensive Care Unit. For each patient's handover, we assessed whether each section of the Identification, Situation, Background, Assessment, Recommendations tool was used on a scale of 0-2...
February 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28977205/methodological-quality-of-randomized-clinical-trials-of-respiratory-physiotherapy-in-coronary-artery-bypass-grafting-patients-in-the-intensive-care-unit-a-systematic-review
#10
Jaqueline Lorscheitter, Cinara Stein, Rodrigo Della Méa Plentz
OBJECTIVE: To assess methodological quality of the randomized controlled trials of physiotherapy in patients undergoing coronary artery bypass grafting in the intensive care unit. METHODS: The studies published until May 2015, in MEDLINE, Cochrane and PEDro were included. The primary outcome extracted was proper filling of the Cochrane Collaboration's tool's items and the secondary was suitability to the requirements of the CONSORT Statement and its extension. RESULTS: From 807 studies identified, 39 were included...
July 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28976485/incongruence-in-perceptions-identifying-barriers-to-patient-satisfaction-in-the-intensive-care-unit
#11
Sarah Thomas, Lindsay Quirk, Cheri Blevins, Beth Quatrara, Lisa Letzkus
BACKGROUND: Patient satisfaction is at the forefront of quality care and patient outcomes. The literature identifies the discrepancy between nurse and patient perceptions in a variety of care settings; few studies have investigated the perceptions of care in a critical care unit. Understanding the perceptions in a critical care unit is necessary to optimize organizational performance related to quality, safety, patient-centered care, and efficiency. OBJECTIVE: The purpose of the study was to determine whether a discrepancy exists between what patients and families perceive as satisfaction with their care as compared with the nurses' perception of what constitutes positive patient satisfaction in a medical critical care unit...
November 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28976482/it-s-in-your-hands-an-educational-initiative-to-improve-parent-family-hand-hygiene-compliance
#12
Celeste J Chandonnet, Kristan M Boutwell, Nadine Spigel, Judith Carter, Michele DeGrazia, Al Ozonoff, Kathleen Flaherty
BACKGROUND: Health care-associated infections contribute to increased morbidity and mortality, increased resource use, higher costs, and extended hospitalizations. Proper hand hygiene (HH) is essential to health care-associated infection prevention. Low compliance among parents in our neonatal intensive care unit (NICU) was identified and prompted development of an HH initiative. OBJECTIVE: The objective of this quality improvement project was to improve parent HH practices with the ultimate goal of achieving 100% compliance with parent HH...
November 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28974647/a-quality-improvement-project-to-improve-evidence-based-inhaled-nitric-oxide-use
#13
Colleen A Hughes Driscoll, Natalie L Davis, Megan Miles, Dina El-Metwally
BACKGROUND: Inhaled nitric oxide (INO) reduces extracorporeal membrane oxygenation (ECMO) use in term and near-term neonates with persistent pulmonary hypertension of the newborn; however, its overutilization is increasing. We hypothesized that implementing a shared baseline protocol would safely improve evidence-based INO use in a Level IV neonatal ICU. METHODS: Through several plan-do-study-act cycles, a shared baseline protocol for initiation and weaning of INO was developed and implemented starting in August 2014...
October 3, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28974644/respiratory-therapist-managed-arterial-catheter-insertion-and-maintenance-program-experience-in-a-non-teaching-community-hospital
#14
Sasheen Pack, Peter Y Hahn, James K Stoller, Srinivas R Mummadi
BACKGROUND: Usual practice in community health-care settings indicates that arterial catheters are inserted by physicians. In the context of a respiratory therapist (RT)-managed arterial catheter placement protocol being implemented in our community hospital, the current study describes the implementation and outcomes of this RT-managed arterial catheter insertion and maintenance program. METHODS: Tuality Healthcare is a 215-bed community health-care system (10-bed ICU) in Hillsboro, Oregon...
October 3, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28974595/acute-respiratory-distress-syndrome%C3%A2
#15
Christopher Mason, Nessa Dooley, Mark Griffiths
Acute respiratory distress syndrome is a common cause of acute respiratory failure that is underdiagnosed both inside and outside of intensive care units. Progression to the most severe forms of the syndrome confers a mortality rate greater than 40% and is associated with often severe functional disability and psychological sequelae in survivors. While there are no disease-modifying pharmacotherapies for the syndrome, this progression may be prevented through the institution of quality improvement measures that minimise iatrogenic injury associated with acute severe illness...
October 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28973626/delirium-in-older-persons-advances-in-diagnosis-and-treatment
#16
Esther S Oh, Tamara G Fong, Tammy T Hshieh, Sharon K Inouye
Importance: Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effects with substantial health care costs. Objective: To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field...
September 26, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28971637/an-intervention-to-reduce-the-time-interval-between-hospital-entry-and-emergency-coronary-angiography-in-patients-with-st-elevation-myocardial-infarction
#17
Basheer Karkabi, Ronen Jaffe, David A Halon, Amnon Merdler, Nader Khader, Ronen Rubinshtein, Jacob Goldstein, Barak Zafrir, Keren Zissman, Nissan Ben-Dov, Michael Gabrielly, Alex Fuks, Avinoam Shiran, Salim Adawi, Yaron Hellman, Johny Shahla, Salim Halabi, Moshe Y Flugelman, Shai Cohen, Irina Bergman, Sameer Kassem, Chen Shapira
BACKGROUND: Outcomes of patients with acute ST-elevation myocardial infarction (STEMI) are strongly correlated to the time interval from hospital entry to primary percutaneous coronary intervention (PPCI). Current guidelines recommend a door to balloon time of < 90 minutes. OBJECTIVES: To reduce the time from hospital admission to PPCI and to increase the proportion of patients treated within 90 minutes. METHODS: In March 2013 the authors launched a seven-component intervention program:  Direct patient evacuation by out-of-hospital emergency medical services to the coronary intensive care unit or catheterization laboratory Education program for the emergency department staff Dissemination of information regarding the urgency of the PPCI decision Activation of the catheterization team by a single phone call Reimbursement for transportation costs to on-call staff who use their own cars Improvement in the quality of medical records Investigation of failed cases and feedback...
September 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28970660/an-appraisal-of-mortality-in-intensive-care-unit-of-a-level-iii-military-hospital-of-bangladesh
#18
Md Rabiul Alam, Mainul Haque, Mozibul Haque
BACKGROUND: Mortalities in Intensive Care Units (ICUs) are high and widely variable. The unpredictability of death rates is attributable to age, sex, nature and severity of illness, comorbidity, well-timed medical attention, quality of the attending staffs, iatrogenic events, total management facilities, and overall grade of the ICU in general. MATERIALS AND METHODS: A total of seventy patients who died in the ICU of a Level III Combined Military Hospital within a period of 2 years were studied in retrospect to review the mortality pattern...
September 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28968525/high-flow-oxygen-therapy-in-immunocompromised-patients-with-acute-respiratory-failure-a-review-and-meta-analysis
#19
Hui-Bin Huang, Jin-Min Peng, Li Weng, Guang-Yun Liu, Bin Du
PURPOSE: Acute respiratory failure remains a common hazardous complication in immunocompromised patients and is associated with increased mortality rates when endotracheal intubation is need. We aimed to evaluate the effect of high-flow nasal cannula oxygen therapy (HFNC) compared with other oxygen technique for this patient population. METHODS: We searched Cochrane library, Embase, PubMed databases before Aug. 15, 2017 for eligible articles. A meta-analysis was performed for measuring short-term mortality (defined as ICU, hospital or 28-days mortality) and intubation rate as the primary outcomes, and length of stay in ICU as the secondary outcome...
September 22, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28965737/key-characteristics-of-rehabilitation-quality-improvement-publications-scoping-review-from-2010-to-2016
#20
REVIEW
Tiago S Jesus, Christina Papadimitriou, Cátia S Pinho, Helen Hoenig
OBJECTIVE: To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation. DATA SOURCES: Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for quality improvement and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (e.g. references-list scanning) were also performed. STUDY SELECTION: Two reviewers independently selected articles using working definitions of rehabilitation and QI study-types; out of 1,016 references, 112 full texts were assessed for eligibility...
September 28, 2017: Archives of Physical Medicine and Rehabilitation
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