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https://www.readbyqxmd.com/read/29664875/do-not-resuscitate-orders-in-the-neonatal-icu-experiences-and-beliefs-among-staff
#1
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
#2
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
https://www.readbyqxmd.com/read/29651166/energy-expenditure-for-massage-therapists-during-performing-selected-classical-massage-techniques
#3
Magdalena Więcek, Jadwiga Szymura, Marcin Maciejczyk, Zbigniew Szyguła, Jerzy Cempla, Mateusz Borkowski
OBJECTIVES: The aim of the study is to evaluate the intensity of the effort and energy expenditure in the course of performing selected classical massage techniques and to assess the workload of a massage therapist during a work shift. MATERIAL AND METHODS: Thirteen massage therapists (age: 21.9±1.9 years old, body mass index: 24.5±2.8 kg×m<sup>-2</sup>, maximal oxygen consumption × body mass<sup>-1</sup> (VO<sub>2 max</sub>×BM<sup>-1</sup>): 42...
April 11, 2018: International Journal of Occupational Medicine and Environmental Health
https://www.readbyqxmd.com/read/29650863/-problems-of-home-visiting-speech-language-hearing-therapists-in-dysphagia-management
#4
Kaori Kojima, Ryota Mori, Takashi Nishizawa, Hiroyuki Fujii
There are fewer reports by speech-language-hearing therapists than those by physical therapists or occupational therapists for visiting rehabilitation. Therefore, we examined the present situation with emphasis on professional roles of speech-language- hearing therapists working in visiting rehabilitation, patient tendency, and dysphagia rehabilitation. A questionnaire survey and interview survey were conducted on 6 speech-language-hearing therapists working in visiting rehabilitation. In the questionnaire, personal attributes, subject area, details of dysphagia rehabilitation, professional duties, and tendency of patient in charge were collected...
March 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29649458/estimating-time-physicians-and-other-healthcare-workers-spend-with-patients-in-an-intensive-care-unit-using-a-sensor-network
#5
Rachel Butler, Mauricio Monsalve, Geb W Thomas, Ted Herman, Alberto M Segre, Philip M Polgreen, Manish Suneja
BACKGROUND: Time and motion studies have been used to investigate how much time various healthcare professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact using a novel method that does not rely on self-report or human observers...
April 9, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29628333/multidisciplinary-difficult-airway-course-an-essential-educational-component-of-a-hospital-wide-difficult-airway-response-program
#6
W Robert Leeper, Elliott R Haut, Vinciya Pandian, Sajan Nakka, Jeffrey Dodd-O, Nasir Bhatti, Elizabeth A Hunt, Mustapha Saheed, Nicholas Dalesio, Adam Schiavi, Christina Miller, Thomas D Kirsch, Lauren Berkow
OBJECTIVE: A hospital-wide difficult airway response team was developed in 2008 at The Johns Hopkins Hospital with three central pillars: operations, safety monitoring, and education. The objective of this study was to assess the outcomes of the educational pillar of the difficult airway response team program, known as the multidisciplinary difficult airway course (MDAC). DESIGN: The comprehensive, full-day MDAC involves trainees and staff from all provider groups who participate in airway management...
April 5, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29618112/critical-care-in-the-military-health-system-a-survey-based-summary-of-critical-care-services
#7
Jason J Nam, Christopher J Colombo, Cristin A Mount, Elizabeth A Mann-Salinas, Ferdinand Bacomo, Adam W Bostick, Konrad Davis, James K Aden, Kevin K Chung, Mary S McCarthy, Jeremy C Pamplin
Introduction: Critical care is an important component of in-patient and combat casualty care, and it is a major contributor to U.S. healthcare costs. Regular exposure to critically ill and injured patients may directly contribute to wartime skills retention for military caregivers. Data describing critical care services in the Military Health System (MHS), however, is lacking. This study was undertaken to describe MHS critical care services, their resource utilization, and differences in care practices amongst military treatment facilities (MTFs)...
March 29, 2018: Military Medicine
https://www.readbyqxmd.com/read/29614962/daily-routine-versus-on-demand-chest-radiograph-policy-and-practice-in-adult-icu-patients-clinicians-perspective
#8
Abdullah Al Shahrani, Khaled Al-Surimi
BACKGROUND: Chest radiographs are taken daily as a part of routine investigations in Intensive care unit (ICU) patients. They are less effective and unlikely to alter the management of the majority of these patients compared to the radiographs obtained when indicated. According to the American College of Radiology (ACR) Appropriateness criteria, only selective ordering of chest radiographs is recommended, including elderly or high risk patients. The aim of this study was to identify and assess the clinician's perspective in abandoning the current practice of daily routine chest radiograph and replacing with the on-demand radiograph in Saudi hospitals...
April 3, 2018: BMC Medical Imaging
https://www.readbyqxmd.com/read/29608902/effectiveness-of-home-based-exercises-without-supervision-by-physical-therapists-for-patients-with-early-stage-amyotrophic-lateral-sclerosis-a-pilot-study
#9
Kosuke Kitano, Takashi Asakawa, Naoto Kamide, Keisuke Yorimoto, Masaki Yoneda, Yutaka Kikuchi, Makoto Sawada, Tetsuo Komori
OBJECTIVE: This study aimed to verify the effects of structured home-based exercises without supervision by a physical therapist on patients with early-stage amyotrophic lateral sclerosis (ALS). DESIGN: This is a historical controlled study that is part of a multicenter collaborative study. SETTING: Rehabilitation departments at general hospitals and outpatient clinics with a neurology department in Japan. PARTICIPANTS: Twenty-one patients with ALS were enrolled and designated as the Home-EX group, and they performed unsupervised home-based exercises...
March 30, 2018: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/29595563/one-year-outcomes-in-patients-with-acute-respiratory-distress-syndrome-enrolled-in-a-randomized-clinical-trial-of-helmet-versus-facemask-noninvasive-ventilation
#10
Bhakti K Patel, Krysta S Wolfe, Erica L MacKenzie, Dhafer Salem, Cheryl L Esbrook, Amy J Pawlik, Megan Stulberg, Crystal Kemple, Megan Teele, Erin Zeleny, Julia Macleod, Anne S Pohlman, Jesse B Hall, John P Kress
OBJECTIVES: Many survivors of acute respiratory distress syndrome have poor long-term outcomes possibly due to supportive care practices during "invasive" mechanical ventilation. Helmet noninvasive ventilation in acute respiratory distress syndrome may reduce intubation rates; however, it is unknown if avoiding intubation with helmet noninvasive ventilation alters the consequences of surviving acute respiratory distress syndrome. DESIGN: Long-term follow-up data from a previously published randomized controlled trial...
March 27, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29559539/ventilator-boot-camp-improves-the-knowledge-and-skills-associated-with-mechanical-ventilator-use-during-interfacility-transport-of-intubated-pediatric-patients
#11
Jennifer L Walton, Diane K Dunn, Nhi Y Haines, Ilana Heisler, Michael T Bigham, Teresa A Volsko
BACKGROUND: The American Academy of Pediatrics Section on Transport recommends the use of portable ventilators during the transport of patients with advanced airways. We sought to identify knowledge gaps and evaluate the effectiveness of a transport ventilator competency boot camp. METHODS: Electronic health records of children requiring ventilatory support during air and ground interfacility transport from January 1 through December 31, 2015, were reviewed to determine when manual ventilation was used in lieu of a portable ventilator, and simulations were constructed from commonly occurring scenarios...
April 2018: Respiratory Care
https://www.readbyqxmd.com/read/29552425/clinician-driven-design-of-vitalpad-an-intelligent-monitoring-and-communication-device-to-improve-patient-safety-in-the-intensive-care-unit
#12
Luisa Flohr, Shaylene Beaudry, K Taneille Johnson, Nicholas West, Catherine M Burns, J Mark Ansermino, Guy A Dumont, David Wensley, Peter Skippen, Matthias Gorges
The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD , to improve the efficiency of clinical decision-making, communication, and thereby patient safety...
2018: IEEE Journal of Translational Engineering in Health and Medicine
https://www.readbyqxmd.com/read/29535260/high-flow-nasal-cannula-in-pediatric-patients-a-survey-of-clinical-practice
#13
Andrew G Miller, Michael A Gentle, Lisa M Tyler, Natalie Napolitano
BACKGROUND: High-flow nasal cannula (HFNC) use has greatly increased in recent years. In non-neonatal pediatric patients, there are limited data available to guide HFNC use, and clinical practice may vary significantly. The goal of this study was to evaluate current HFNC practice by surveying practicing pediatric respiratory therapists. METHODS: A survey instrument was posted on the American Association for Respiratory Care's AARConnect online social media platform in March 2017...
March 13, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29521782/trauma-providers-knowledge-views-and-practice-of-trauma-informed-care
#14
Marta M Bruce, Nancy Kassam-Adams, Mary Rogers, Karen M Anderson, Kerstin Prignitz Sluys, Therese S Richmond
Trauma-informed interventions have been implemented in various settings, but trauma-informed care (TIC) has not been widely incorporated into the treatment of adult patients with traumatic injuries. The purpose of this study was to examine health care provider knowledge, attitudes, practices, competence, and perceived barriers to implementation of TIC. This cross-sectional study used an anonymous web-based survey to assess attitudes, knowledge, perceived competence, and practice of TIC among trauma providers from an urban academic medical center with a regional resource trauma center...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29465178/implementation-of-a-unique-rrt-model-in-a-tertiary-care-centre-in-western-canada
#15
Teddie Tanguay, Reagan Bartel
In early 2010, the Royal Alexandra Hospital (RAH) was the only tertiary hospital in Edmonton, Alberta, without a rapid response team (RRT). Once funding was obtained, the RAH RRT was developed with the mission of "Helping you make it happen" with the underlying philosophy that any call is a good call and the team is there to support care on the wards. The RAH RRT is unique, as it uses a registered nurse/respiratory therapist model rather than the physician model used by most tertiary centres. The RAH RRT provides consistent and efficient response to deteriorating patients and visitors to the hospital...
May 2017: Canadian Journal of Critical Care Nursing
https://www.readbyqxmd.com/read/29455226/respiratory-support-attitudes-among-pediatric-intensive-care-staff-for-spinal-muscular-atrophy-patients-in-saudi-arabia
#16
Mohamad-Hani A Temsah, Fahad M Al-Sohime, Fahad A Bashiri, Ayman A Al-Eyadhy, Gamal M Hasan, Ali A Alhaboob
OBJECTIVE: To explore therapeutic attitude of healthcare providers practicing in pediatric critical care in Saudi Arabia toward patients with Spinal Muscular Atroph (SMA) Type I, and to explore their awareness about the International Consensus statement for SMA care. METHODS: A cross-sectional survey was conducted in April 2015 during 6th Saudi Critical Care Conference, targeting physicians and respiratory therapists practicing in Pediatric Critical Care. RESULTS: Sixty participants accepted to participate in this survey...
January 2018: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
https://www.readbyqxmd.com/read/29446155/not-just-trust-factors-influencing-learners-attempts-to-perform-technical-skills-on-real-patients
#17
Susan L Bannister, Mark S Dolson, Lorelei Lingard, David A Keegan
CONTEXT: As part of their training, physicians are required to learn how to perform technical skills on patients. The previous literature reveals that this learning is complex and that many opportunities to perform these skills are not converted into attempts to do so by learners. This study sought to explore and understand this phenomenon better. METHODS: A multi-phased qualitative study including ethnographic observations, interviews and focus groups was conducted to explore the factors that influence technical skill learning...
February 15, 2018: Medical Education
https://www.readbyqxmd.com/read/29425367/a-rapid-handheld-device-to-assess-respiratory-resistance-clinical-and-normative-evidence
#18
Aaron B Holley, Wesley D Boose, Michael Perkins, Karen L Sheikh, Nancy P Solomon, Angela M Dietsch, Jafar Vossoughi, Arthur T Johnson, Jacob F Collen
Introduction: Following reports of respiratory symptoms among service members returning from deployment to South West Asia (SWA), an expert panel recommended pre-deployment spirometry be used to assess disease burden. Unfortunately, testing with spirometry is high cost and time-consuming. The airflow perturbation device (APD) is a handheld monitor that rapidly measures respiratory resistance (APD-Rr) and has promising but limited clinical data. Its speed and portability make it ideally suited for large volume pre-deployment screening...
February 7, 2018: Military Medicine
https://www.readbyqxmd.com/read/29403646/barriers-and-facilitators-to-early-rehabilitation-in-mechanically-ventilated-patients-a-theory-driven-interview-study
#19
Shannon L Goddard, Fabiana Lorencatto, Ellen Koo, Louise Rose, Eddy Fan, Michelle E Kho, Dale M Needham, Gordon D Rubenfeld, Jill J Francis, Brian H Cuthbertson
Background: Despite a supportive evidence base and a push to implement, the uptake of early rehabilitation in critical care has been inconsistent. The objective of this study was to explore barriers and facilitators to early rehabilitation for critically ill patients receiving invasive mechanical ventilation. Methods: Using the Theoretical Domains Framework (TDF) of behavior change, we conducted semi-structured interviews exploring barriers and facilitators to early rehabilitation among four purposively sampled ICU clinician groups (nurses, rehabilitation professionals, respiratory therapists, and physicians)...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29397270/device-related-pressure-ulcers-pre-and-post-identification-and-intervention
#20
Pamela Clay, Casey Cruz, Keith Ayotte, Jeremy Jones, Susan B Fowler
PROBLEM: From 2014 to 2016, device related pressure injuries accounted for 62-81% of all hospital acquired pressure injuries. From January to June 2014, there were 5 BiPAP/CPAP pressure injuries noted, accounting for 3.579 injuries per 1000 ventilator days. In 2015, hospital data revealed that 26.5% of all hospital acquired pressure injuries occurred to prone surgical spine patients. METHODS: Collaborative teams including respiratory therapists and operating room staff were convened and crafted new strategies...
January 31, 2018: Journal of Pediatric Nursing
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