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https://www.readbyqxmd.com/read/28719134/development-and-implementation-of-a-clinical-pathway-for-cardiac-surgery-in-the-intensive-care-unit-effects-on-protocol-adherence
#1
Marion van der Kolk, Mark van den Boogaard, Corine Ter Brugge-Speelman, Jeroen Hol, Luc Noyez, Kees van Laarhoven, Hans van der Hoeven, Peter Pickkers
RATIONALE, AIMS AND OBJECTIVES: Cardiac surgery (CS) is facilitated by multiple perioperative guidelines and protocols. Use of a clinical pathway (CP) may facilitate the care of these patients. METHODS: This is a pre-post design study in the ICU of a tertiary referral centre. A CP for CS patients in the ICU was developed by ICU-nurses and enabled them to execute proactively predefined actions in accordance with and within the preset boundaries which were part of a variance report...
July 18, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28714831/improving-the-quality-of-nutrition-in-pediatric-trauma
#2
Alice Wang, Helena Pelletier, Diana Calligan, Angela Coates, Karen Allison Bailey
Purpose Nutrition plays a key role in the recovery of pediatric trauma patients. A catabolic state in trauma patients may hinder recovery and inadequate nutrition may increase morbidity, mortality and length of hospital stay. The purpose of this paper is to review the current nutrition support practices for pediatric trauma patients at McMaster Children's Hospital (MCH), describe patient demographics and identify areas to improve the quality of patient care. Design/methodology/approach A retrospective chart review was conducted on pediatric trauma patients (age<18 years) identified through the trauma registry of MCH...
July 10, 2017: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/28709989/evaluating-biapenem-dosage-regimens-in-intensive-care-unit-patients-with-pseudomonas-aeruginosa-infections-a-pharmacokinetic-pharmacodynamic-analysis-using-monte-carlo-simulation
#3
Yongfu Hang, Yafang Chen, Ling Xue, Shusen Sun, Long Liu, Jie Gao, Cheng Xie, Xianfeng Zhang, Jianguo Zhu, Jun Jin, Liyan Miao
This study sought to both identify optimal dosage regimens and estimate pharmacokinetic/pharmacodynamics characteristics of short-infusion (SI) versus extended-infusion (EI) for the use of biapenem against Pseudomonas aeruginosa infections in Chinese Intensive Care patients. A total of 85 strains of P. aeruginosa were collected, and the minimum inhibitory concentration (MIC) of biapenem was measured by the serial two-fold agar dilution method. We designed four frequently used clinical regimens: biapenem 300mg I...
July 11, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28707484/autoregressive-modeling-of-drift-and-random-error-to-characterize-a-continuous-intravascular-glucose-monitoring-sensor
#4
Tony Zhou, Jennifer L Dickson, J Geoffrey Chase
BACKGROUND: Continuous glucose monitoring (CGM) devices have been effective in managing diabetes and offer potential benefits for use in the intensive care unit (ICU). Use of CGM devices in the ICU has been limited, primarily due to the higher point accuracy errors over currently used traditional intermittent blood glucose (BG) measures. General models of CGM errors, including drift and random errors, are lacking, but would enable better design of protocols to utilize these devices. This article presents an autoregressive (AR) based modeling method that separately characterizes the drift and random noise of the GlySure CGM sensor (GlySure Limited, Oxfordshire, UK)...
July 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28705304/clinical-practice-of-acute-respiratory-distress-syndrome-in-japan-a-nationwide-survey-and-scientific-evidences
#5
Sadatomo Tasaka, Koichiro Tatsumi
BACKGROUND: There has been limited information about epidemiology and clinical practice of acute respiratory distress syndrome (ARDS) in Japan. METHODS: An invitation letter to the web-based survey was mailed to all 871 board certified hospitals of the Japanese Respiratory Society. The questionnaires were designed to collect data on epidemiology and clinical practice of ARDS, including diagnostic measures and therapeutics. RESULTS: Within 4 months of the survey period, valid responses were obtained from 296 (34%) hospitals...
July 2017: Respiratory Investigation
https://www.readbyqxmd.com/read/28699136/intrawound-application-of-vancomycin-changes-the-responsible-germ-in-elective-spine-surgery-without-significant-effect-on-the-rate-of-infection-a-randomized-prospective-study
#6
B Mirzashahi, M Chehrassan, S M J Mortazavi
PURPOSE: Surgical site infection (SSI) is a costly complication associated with spine surgery. The impact of intrawound vancomycin has not been strongly postulated to decrease the risk of surgical site infection. We designed study to determine whether intrawound vancomycin application reduces the risk of SSI in patients after spine surgery. METHODS: A prospective randomized control trial study to evaluate the patients with elective spine surgery in a period of 15 month was designed...
July 11, 2017: Musculoskeletal Surgery
https://www.readbyqxmd.com/read/28697503/update-of-sepsis-in-the-intensive-care-unit
#7
Kelly Roveran Genga, James A Russell
Sepsis, the most common cause of admission to an intensive care unit (ICU), has had an increased incidence and prevalence over the last years with a simultaneous decrease in its short-term mortality. Sepsis survivors are more frequently discharged from hospital and often experience long-term outcomes such as late mortality, immune dysfunction, secondary infections, impaired quality of life, and unplanned readmissions. Early recognition and management of sepsis have challenged emergency care and critical care physicians and nurses...
July 12, 2017: Journal of Innate Immunity
https://www.readbyqxmd.com/read/28693625/a-role-for-antimicrobial-stewardship-in-clinical-sepsis-pathways-a-prospective-interventional-study
#8
John Burston, Suman Adhikari, Andrew Hayen, Heather Doolan, Melissa L Kelly, Kathy Fu, Tomas O Jensen, Pamela Konecny
OBJECTIVE To evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management. DESIGN Interventional, nonrandomized, controlled study. SETTING Tertiary-care referral hospital, Sydney, Australia. PATIENTS Consecutive, adult, non-intensive care unit (non-ICU) inpatients triggering an institutional clinical sepsis pathway from May to August 2015. INTERVENTION All patients reviewed by an ID Fellow within 24 hours of sepsis pathway trigger underwent case review and clinic file documentation of recommendations...
July 11, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28692694/renal-replacement-therapy-practices-for-patients-with-acute-kidney-injury-in-china
#9
William R Clark, Xiaoqiang Ding, Haibo Qiu, Zhaohui Ni, Ping Chang, Ping Fu, Jiarui Xu, MinMin Wang, Li Yang, Jing Wang, Claudio Ronco
Recent data indicate AKI is very common among hospitalized Chinese patients and continuous renal replacement therapy (CRRT) is increasingly offered for treatment. However, only anecdotal information regarding CRRT's use in relation to other modalities and the specific manner in which it is prescribed exists currently. This report summarizes the results of a comprehensive physician survey designed to characterize contemporary dialytic management of AKI patients in China, especially with respect to the utilization of CRRT...
2017: PloS One
https://www.readbyqxmd.com/read/28692620/delirium-in-the-icu-what-about-the-floor
#10
Anthony Cahill, Christopher Pearcy, Vaidehi Agrawal, Phillip Sladek, Michael S Truitt
Delirium was first described in the 1800s as acute, fluctuating confusion. Recent studies note an incidence of 15% in adult intensive care unit patients. Here we present the first prospective study to evaluate the incidence and risk factors for delirium in patients admitted to the trauma surgeon (TS) in non-critical care areas (NCCAs). Patients 18 years or older admitted to any TS in the designated NCCA were evaluated and consented for participation over a 3-month period. Participants were screened with the Confusion Assessment Method (CAM) every 12 hr...
July 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28687380/patient-and-family-engagement-in-designing-and-implementing-a-weaning-trial-a-novel-research-paradigm-in-critical-care
#11
Karen E A Burns, John W Devlin, Nicholas S Hill
The call for meaningful patient and family engagement in research has recently gained considerable momentum. In this article, we define patient and family engagement broadly and specifically in clinical research. Using a multicenter, North American weaning trial as an exemplar, we describe our early experiences as clinical researchers with patient and family engagement. We illustrate the role of our Patient and Family Advisory Committee in trial design and implementation. Through our experiences, we share our insights regarding the perceived opportunities and also highlight some challenges associated with engaging patients and family engagement in critical care research...
July 4, 2017: Chest
https://www.readbyqxmd.com/read/28685304/perioperative-and-icu-healthcare-analytics-within-a-veterans-integrated-system-network-a-qualitative-gap-analysis
#12
Seshadri Mudumbai, Ferenc Ayer, Jerry Stefanko
Health care facilities are implementing analytics platforms as a way to document quality of care. However, few gap analyses exist on platforms specifically designed for patients treated in the Operating Room, Post-Anesthesia Care Unit, and Intensive Care Unit (ICU). As part of a quality improvement effort, we undertook a gap analysis of an existing analytics platform within the Veterans Healthcare Administration. The objectives were to identify themes associated with 1) current clinical use cases and stakeholder needs; 2) information flow and pain points; and 3) recommendations for future analytics development...
August 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28682835/technologic-distractions-part-1-summary-of-approaches-to-manage-alert-quantity-with-intent-to-reduce-alert-fatigue-and-suggestions-for-alert-fatigue-metrics
#13
Sandra L Kane-Gill, Michael F O'Connor, Jeffrey M Rothschild, Nicholas M Selby, Barbara McLean, Christopher P Bonafide, Maria M Cvach, Xiao Hu, Avinash Konkani, Michele M Pelter, Bradford D Winters
OBJECTIVE: To provide ICU clinicians with evidence-based guidance on tested interventions that reduce or prevent alert fatigue within clinical decision support systems. DESIGN: Systematic review of PubMed, Embase, SCOPUS, and CINAHL for relevant literature from 1966 to February 2017. PATIENTS: Focus on critically ill patients and included evaluations in other patient care settings, as well. INTERVENTIONS: Identified interventions designed to reduce or prevent alert fatigue within clinical decision support systems...
July 4, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28677173/handing-over-patients-from-the-icu-to-the-general-ward-a-focused-ethnographical-study-of-nurses-communication-practice
#14
Gitte Bunkenborg, Tina Bitsch Hansen, Bibi Hølge-Hazelton
AIM: To explore nursing practice and perception of engaging in communicative interaction when handing over multi morbid patients from the ICU to general medical or surgical wards. BACKGROUND: Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing and verbally when handing over patients from one setting to another. A deeper understanding of nurses' communicative interaction and of nurses' perception of their interaction is crucial to facilitate clinical interventions focusing to improve patient safety...
July 5, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28676896/the-impact-of-frailty-on-intensive-care-unit-outcomes-a-systematic-review-and-meta-analysis
#15
REVIEW
John Muscedere, Braden Waters, Aditya Varambally, Sean M Bagshaw, J Gordon Boyd, David Maslove, Stephanie Sibley, Kenneth Rockwood
PURPOSE: Functional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit (ICU) may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, and Clinicaltrials...
July 4, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28673267/sleep-disturbances-among-chinese-clinical-nurses-in-general-hospitals-and-its-influencing-factors
#16
Hongyun Dong, Qiong Zhang, Zihua Sun, Fengxin Sang, Yingzhi Xu
BACKGROUND: This study aimed to determine the prevalence of sleep disturbances among clinical nurses in general hospitals in Mainland China, and identify its associate factors. METHODS: Using a cross-sectional design, a total of 5012 clinical nurses selected by random cluster sampling completed the survey on the Pittsburgh Sleep Quality Index (PSQI), measures of quality of life indexed by the Medical Outcomes Study 12-item Short-Form Health Survey, occupational stress evaluated by the Job Content Questionnaire, lifestyle and sociodemographic details...
July 3, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28669363/the-effect-of-adding-comorbidities-to-current-centers-for-disease-control-and-prevention-central-line-associated-bloodstream-infection-risk-adjustment-methodology
#17
Sarah S Jackson, Surbhi Leekha, Laurence S Magder, Lisa Pineles, Deverick J Anderson, William E Trick, Keith F Woeltje, Keith S Kaye, Kristen Stafford, Kerri Thom, Timothy J Lowe, Anthony D Harris
BACKGROUND Risk adjustment is needed to fairly compare central-line-associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes...
July 3, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28662370/early-exposure-to-recommended-calorie-delivery-in-the-intensive-care-unit-is-associated-with-increased-mortality-in-patients-with-acute-respiratory-distress-syndrome
#18
Sarah J Peterson, Omar B Lateef, Sally Freels, Liam McKeever, Giamila Fantuzzi, Carol A Braunschweig
BACKGROUND: The Intensive Nutrition in Acute Lung Injury: Clinical Trial (INTACT), designed to evaluate outcomes of calorie delivery from acute respiratory distress syndrome (ARDS) diagnosis through hospital discharge, was stopped due to higher mortality in the intervention group. Post hoc analysis found timing and dose of calorie delivery influenced mortality. The objective of this retrospective cohort study was to determine if early vs late calorie exposure changed the hazard of death among a larger sample of patients with ARDS...
June 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28659433/effect-of-communication-skills-training-on-outcomes-in-critically-ill-patients-with-life-limiting-illness-referred-for-intensive-care-management-a-before-and-after-study
#19
Neil R Orford, Sharyn Milnes, Nicholas Simpson, Gerry Keely, Tania Elderkin, Allison Bone, Peter Martin, Rinaldo Bellomo, Michael Bailey, Charlie Corke
OBJECTIVES: To describe the effect of a communication skills training programme on patient-centred goals of care documentation and clinical outcomes in critically ill patients with life-limiting illnesses (LLI) referred for intensive care management. METHODS: Prospective before-and-after cohort study in a tertiary teaching hospital in Australia. The population was 222 adult patients with LLI referred to the intensive care unit (ICU). The study was divided into two periods, before (1 May to 31 July 2015) and after (15 September to 15December 2015) the intervention...
June 28, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28655326/treatment-of-severe-hospital-acquired-and-ventilator-associated-pneumonia-a-systematic-review-of-inclusion-and-judgment-criteria-used-in-randomized-controlled-trials
#20
Emmanuel Weiss, Wafa Essaied, Christophe Adrie, Jean-Ralph Zahar, Jean-François Timsit
BACKGROUND: Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) are often selected for randomized clinical trials (RCTs) aiming at new drug approval. Guidelines for the design of such RCTs have been repeatedly updated by regulatory agencies. We hypothesized that large variability in the enrolled populations, the endpoints assessed and the HAP/VAP definition criteria may impact the results of these studies, and addressed this through a systematic review of HAP/VAP RCTs. METHODS: A search (Pubmed-Embase-ICAAC-ECCMID) of all RCTs published between 1994 and 2016 comparing antimicrobial treatment for HAP/VAP in the intensive care unit was conducted...
June 27, 2017: Critical Care: the Official Journal of the Critical Care Forum
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