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https://www.readbyqxmd.com/read/29890836/high-acuity-rural-transport-findings-from-a-qualitative-investigation
#1
Jude Kornelsen, Brent Hobbs, Holly Buhler, Rebecca Kaus, Kari Grant, Scott C Lamont, Stefan Grzybowski
INTRODUCTION: The High Acuity Response Team (HART) was introduced in British Columbia (BC), Canada, to fill a gap in transport for rural patients that was previously being met by nurses and physicians leaving their communities to escort patients in need of critical care. The HART team consists of a critical care registered nurse (CCRN) and registered respiratory therapist (RRT) and attends acute care patients in rural sites by either stabilizing them in their community or transporting them...
June 2018: Rural and Remote Health
https://www.readbyqxmd.com/read/29889726/evolution-of-delivery-room-management-for-meconium-stained-infants-recent-updates
#2
Shilpi Chabra
BACKGROUND: The approach to intrapartum and postnatal management of an infant born through meconium-stained amniotic fluid (MSAF) in the delivery room (DR) has changed several times over the last few decades, leading to confusion and anxiety among health care providers (nurses, nurse practitioners, respiratory therapists, midwives, and physicians). This article provides state-of-the-art insight into the evidence or lack thereof for the changes in guidelines. PURPOSE: To discuss the evidence for evolution of DR management of vigorous and nonvigorous infants born through any type of MSAF...
June 8, 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29878929/tracheostomy-care-practices-in-a-simulated-setting-an-exploratory-study
#3
Thomas J Bolsega, Mary Lou Sole
PURPOSE/AIMS: Many critically ill patients undergo a tracheostomy. Tracheostomy care is performed to maintain the airway and promote stoma skin integrity. Variation in practices may affect outcomes. The study purpose was to describe tracheostomy care practices of caregivers who perform tracheostomy care in critical care settings and compare practices with published recommendations. DESIGN: This is a descriptive, exploratory study of tracheostomy care practices of nurses and respiratory therapists using a simulated setting...
July 2018: Clinical Nurse Specialist CNS
https://www.readbyqxmd.com/read/29875114/critical-care-transport-of-patients-with-brain-injuries
#4
Rachel Zayas
Critical care transport began in the 1970s as a response to the growing need to be able to transport critically ill and injured patients to tertiary care centers for higher levels of care or specialized treatments. Patients in critical condition now are transported great distances to receive potentially lifesaving treatment and interventions. Modes of critical care transport include ambulances, helicopters, and airplanes. Critical care transport teams consist of highly skilled paramedics, registered nurses, respiratory therapists, nurse practitioners, and physicians...
2018: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/29871497/self-perceived-end-of-life-care-competencies-of-health-care-providers-at-a-large-academic-medical-center
#5
Marcos Montagnini, Heather M Smith, Deborah M Price, Bidisha Ghosh, Linda Strodtman
BACKGROUND: In the United States, most deaths occur in hospitals, with approximately 25% of hospitalized patients having palliative care needs. Therefore, the provision of good end-of-life (EOL) care to these patients is a priority. However, research assessing staff preparedness for the provision of EOL care to hospitalized patients is lacking. OBJECTIVE: To assess health-care professionals' self-perceived competencies regarding the provision of EOL care in hospitalized patients...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29863501/provider-perceptions-of-bubble-continuous-positive-airway-pressure-and-barriers-to-implementation-in-a-level-iii-neonatal-unit-in-south-india
#6
Mihir R Atreya, John M Lorenz, Vivek Narendran
BACKGROUND: Bubble continuous positive airway pressure (bCPAP) is a simple, safe, and cost-effective strategy to provide respiratory support to newborns with respiratory distress syndrome in resource-limited settings. PURPOSE: To understand whether implementation of bCPAP, relative to other modes of respiratory support in the care of newborns with respiratory distress syndrome, increases positive attitudes about its potential for consistent and widespread use among providers in neonatal intensive care units (NICUs) of lower middle-income countries...
May 31, 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29844215/comparison-of-flow-resistance-characteristics-and-placement-of-two-endotracheal-tubes
#7
Girish G Deshpande, John E Sanford, Sandeep Tripathi
BACKGROUND: In a traditional endotracheal tube (ETT), there is a linear outward pull through its attachment to the ventilator tubing that leads to risk of accidental dislodgement. This study was conducted to assess the ETT flow characteristics and to evaluate providers' intubation experience using two ETT's in a simulated setting. METHODS: Respiratory pressure-volume dynamics for the 2 ETTs were studied in a simulation laboratory by using 3 different flow settings and 2 different test lungs...
May 29, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29844212/mechanical-ventilation-related-safety-incidents-in-general-care-wards-and-icu-settings
#8
Tadashi Kamio, Ken Masamune
BACKGROUND: Although the ICU is the most appropriate place to care for mechanically ventilated patients, a considerable number are ventilated in general medical care wards all over the world. However, adverse events focusing on mechanically ventilated patients in general care have not been explored. METHODS: Data from the Japan Council for Quality Health Care database were analyzed. Patient safety incidents from January 2010 to November 2017 regarding mechanical ventilation were collected, and comparisons of patient safety incidents between ICUs/high care units (HCUs) and general care wards were made...
May 29, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29806826/treatment-of-liver-metastases-using-an-internal-target-volume-method-for-stereotactic-body-radiotherapy
#9
Wei-Jun Wang, Jeng-Fong Chiou, Yaoru Huang
The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For inoperable patients, local ablation therapies, such as stereotactic body radiotherapy (SBRT), can provide effective local tumor control with minimal toxicity. Because of its high precision and accuracy, SBRT delivers a higher radiation dose per fraction, is more effective, and targets smaller irradiation volumes than does conventional radiotherapy. In addition, steep dose gradients from target lesions to surrounding normal tissues are achieved using SBRT; thus, SBRT provides more effective tumor control and exhibits fewer side effects than conventional radiotherapy...
May 8, 2018: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29794208/an-update-on-the-global-initiative-for-chronic-obstructive-lung-disease-2017-guidelines-with-a-focus-on-classification-and-management-of-stable-copd
#10
Robert M Burkes, James F Donohue
The 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines offer important changes to the assessment and management of stable COPD of importance to practitioners, respiratory therapists, pharmacists, and nurses who care for patients with COPD. Therapies are now chosen based on the burden of symptoms and the history of COPD exacerbations, and inhaler regimens are modifiable based on continual clinical reassessment. Although identifying the degree of airway obstruction remains important for informing the clinical status of the patient with COPD, FEV1 is no longer used to direct the therapeutic approach...
June 2018: Respiratory Care
https://www.readbyqxmd.com/read/29792461/teamwork-in-the-intensive-care-unit
#11
Jennifer N Ervin, Jeremy M Kahn, Taya R Cohen, Laurie R Weingart
Intensive care units (ICUs) provide care to the most severely ill hospitalized patients. Although ICUs increasingly rely on interprofessional teams to provide critical care, little about actual teamwork in this context is well understood. The ICU team is typically comprised of physicians or intensivists, clinical pharmacists, respiratory therapists, dieticians, bedside nurses, clinical psychologists, and clinicians-in-training. ICU teams are distinguished from other health care teams in that they are low in temporal stability, which can impede important team dynamics...
May 2018: American Psychologist
https://www.readbyqxmd.com/read/29785148/the-use-of-augmented-reality-glasses-in-central-line-simulation-see-one-simulate-many-do-one-competently-and-teach-everyone
#12
Cynthia Y Huang, Jonathan B Thomas, Abdullah Alismail, Avi Cohen, Waleed Almutairi, Noha S Daher, Michael H Terry, Laren D Tan
Objective: The aim of this study was to investigate the feasibility of using augmented reality (AR) glasses in central line simulation by novice operators and compare its efficacy to standard central line simulation/teaching. Design: This was a prospective randomized controlled study enrolling 32 novice operators. Subjects were randomized on a 1:1 basis to either simulation using the augmented virtual reality glasses or simulation using conventional instruction...
2018: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/29775080/mindfulness-meditation-and-interprofessional-cardiopulmonary-resuscitation-a-mixed-methods-pilot-study
#13
Diana J Kelm, Jennifer L Ridgeway, Becca L Gas, Monali Mohan, David A Cook, Darlene R Nelson, Roberto P Benzo
PROBLEM: Mindfulness training includes mindfulness meditation, which has been shown to improve both attention and self-awareness. Medical providers in the intensive care unit often deal with difficult situations with strong emotions, life-and-death decisions, and both interpersonal and interprofessional conflicts. The effect of mindfulness meditation training on healthcare providers during acute care tasks such as cardiopulmonary resuscitation remains unknown. Mindfulness meditation has the potential to improve provider well-being and reduce stress in individuals involved in resuscitation teams, which could then translate into better team communication and delivery of care under stress...
May 18, 2018: Teaching and Learning in Medicine
https://www.readbyqxmd.com/read/29757061/exercise-induced-laryngeal-obstruction-in-athletes-contributory-factors-and-treatment-implications
#14
Liv-Jorunn Kolnes, Trine Stensrud
Otherwise healthy adolescent athletes presenting with respiratory symptoms consistent with exercise-induced laryngeal obstruction (EILO) are frequently encountered in clinical practice. The symptoms are often incorrectly considered to result from exercise-induced asthma, and may be wrongly treated as such. Given the potential implications for health and performance if EILO is left untreated, a more comprehensive understanding of contributory mechanisms is essential in order to create appropriate treatment procedures...
May 14, 2018: Physiotherapy Theory and Practice
https://www.readbyqxmd.com/read/29739858/communication-of-career-pathways-through-associate-degree-program-web-sites-a-baseline-assessment
#15
Ellen A Becker, Jenny Vargas
BACKGROUND: The American Association for Respiratory Care sponsored a series of conferences that addressed the competency of the future workforce of respiratory therapists (RTs). Based upon the findings from those conferences, several initiatives emerged that support RTs earning a baccalaureate (or bachelor's) degree. The objective of this study was to identify the ways that associate degree programs communicate career pathways toward a baccalaureate degree through their Web sites. METHODS: This cross-sectional observational study used a random sample of 100 of the 362 associate degree programs approved by the Commission on Accreditation for Respiratory Care...
May 8, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29731620/the-impact-of-patient-education-and-shared-decision-making-on-hospital-readmissions-for-copd
#16
Ashley W Collinsworth, Rachel M Brown, Cameron S James, Richard H Stanford, Daniel Alemayehu, Elisa L Priest
Purpose: Education on the self-management of COPD has been shown to improve patients' quality of life and reduce hospital admissions. This study aimed to assess the feasibility of a pilot, pragmatic COPD Chronic Care (CCC) education program led by registered respiratory therapists and determine the CCC's impact on hospital readmissions, patient activation, and health status. Patients and methods: This was a prospective, randomized, pilot study of inpatients with COPD admitted to a US community hospital between August 2014 and February 2016...
2018: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29698339/disparities-in-adherence-to-pediatric-diabetic-ketoacidosis-management-guidelines-across-a-spectrum-of-emergency-departments-in-the-state-of-indiana-an-observational-in-situ-simulation-based-study
#17
Kamal Abulebda, Samer Abu-Sultaneh, Erin E White, Michele L Kirby, Brian C Phillips, Courtney T Frye, Lee D Murphy, Riad Lutfi
BACKGROUND: Diabetic ketoacidosis (DKA) is a common presentation to an emergency department (ED), with the majority presenting to community EDs. Adherence to clinical guidelines in these EDs can reduce morbidity and mortality. Few methods to describe practice gaps for DKA management have been reported. OBJECTIVES: We hypothesized that high-fidelity in situ simulation can be used to measure and compare the quality of the care provided to pediatric patients with DKA presenting to community EDs in the state of Indiana...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29686761/implementation-of-a-formal-debriefing-program-after-pediatric-rapid-response-team-activations
#18
Linda Aponte-Patel, Arash Salavitabar, Pamela Fazzio, Andrew S Geneslaw, Pamela Good, Anita I Sen
Background : Debriefing after pediatric rapid response team activations (RRT-As) in a tertiary care children's hospital was identified to occur only sporadically. The lack of routine debriefing after RRT-As was identified as a missed learning opportunity. Objective : We implemented a formal debriefing program and assessed staff attitudes toward and experiences with debriefing after pediatric RRT-As. Methods : Real-time feedback for pediatrics residents captured clinical and debriefing data for each RRT-A from July 2014 to June 2016...
April 2018: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/29664875/do-not-resuscitate-orders-in-the-neonatal-icu-experiences-and-beliefs-among-staff
#19
Bonnie H Arzuaga, C Lydia Wraight, Christy L Cummings, Wenyang Mao, David Miedema, Dara D Brodsky
OBJECTIVES: Studies in adult patients have shown that do-not-resuscitate orders are often associated with decreased medical intervention. In neonatology, this phenomenon has not been investigated, and how do-not-resuscitate orders potentially affect clinical care is unknown. DESIGN: Retrospective medical record data review and staff survey responses about neonatal ICU do-not-resuscitate orders. SETTING: Four academic neonatal ICUs. SUBJECTS: Clinical staff members working in each neonatal ICU...
April 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29664873/effects-of-a-picu-status-asthmaticus-de-escalation-pathway-on-length-of-stay-and-albuterol-use
#20
Steven Brennan, Lia Lowrie, Jamie Wooldridge
OBJECTIVES: Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus. DESIGN: Time series quality improvement trial. SETTING: PICU in a tertiary care children's hospital. PATIENTS: Children age 2-18 years old with a known diagnosis of asthma presenting with status asthmaticus. INTERVENTION: One-hundred five admissions to a PICU for status asthmaticus were treated according to a new de-escalation pathway between August 15, 2015, and August 30, 2016...
April 16, 2018: Pediatric Critical Care Medicine
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