scholarly journals COVID-19 coagulopathy and thrombosis: Analysis of hospital protocols in response to the rapidly evolving pandemic

2020 ◽  
Vol 196 ◽  
pp. 355-358 ◽  
Author(s):  
Anna L. Parks ◽  
Andrew D. Auerbach ◽  
Jeffrey L. Schnipper ◽  
James E. Anstey ◽  
David G. Sterken ◽  
...  
Keyword(s):  
Hospital Protocols

scholarly journals Caring for Pregnant Patients with COVID-19: Practical Tips Getting from Policy to Practice

2020 ◽  
Vol 37 (08) ◽  
pp. 850-853 ◽  
Author(s):  
Viktoriya London ◽  
Rodney McLaren ◽  
Janet Stein ◽  
Fouad Atallah ◽  
Nelli Fisher ◽  
...  
Keyword(s):  
New York ◽  
Pregnant Women ◽  
National Standards ◽  
Key Points ◽  
High Prevalence ◽  
Psychosocial Challenges ◽  
Novel Coronavirus ◽  
Hospital Protocols ◽  
Zip Code

Novel coronavirus disease 2019 (COVID-19) is a pandemic with most American cases in New York. As an institution residing in a high-prevalence zip code, with over 8,000 births annually, we have cared for over 80 COVID-19-infected pregnant women, and have encountered many challenges in applying new national standards for care. In this article, we review how to change outpatient and inpatient practices, develop, and disseminate new hospital protocols, and we highlight the psychosocial challenges for pregnant patients and their providers. Key Points

Cost-utilization of peripheral intravenous cannulation in hospitalized adults: An observational study

2020 ◽  
Vol 21 (5) ◽  
pp. 687-693 ◽  
Author(s):  
Fredericus HJ van Loon ◽  
Tina Leggett ◽  
Arthur RA Bouwman ◽  
Angelique TM Dierick-van Daele
Keyword(s):  
Catheter Insertion ◽  
International Standards ◽  
Personnel Costs ◽  
Peripheral Intravenous Catheter ◽  
Nurses And Physicians ◽  
Supply Costs ◽  
Cost Utilization ◽  
The Cost ◽  
Hospital Protocols ◽  
Mean Time

Aim: In modern healthcare there is increased focus on optimizing efficiency for every treatment or performed procedure, of which reduction of costs is an important part. With this study, authors aimed to calculate the cost of peripheral intravenous cannulation including all components that influence its price. Methods: This observational cost-utilization study was conducted between May and October 2016. Hospitalized adults were included in this study, who received usual care. Peripheral intravenous cannulation was carried out according to current hospital protocols, based on international standards for peripheral intravenous catheter insertion. Device costs were assumed equal to the number of attempts multiplied by the fixed supply costs and applicable costs for additional attempts, whereas personnel costs for both nurses and physicians were based on their hourly salary. Results: A total of 1512 patients were included in this study, with a mean of 1.37 (±0.77) attempts and a mean time of 3.5 (±2.7) min were needed for a successful catheter insertion. Adjusted mean costs for peripheral intravenous cannulation were estimated to be €11.67 for each patient, but costs increase as the number of attempts for successful cannulation increases. The cost for patients with a successful first attempt was lower, at approximately €9.32 but increased markedly to €65.34 when five attempts were needed. Conclusion: Prevention of multiple attempts may lower the costs, and furthermore, additional technologies applied by nurses to individual patients based on predicted difficult intravenous access will make the application of these additional technologies, in turn, more efficient.

PS-002 Importance of pharmacovigilance for maintaining hospital protocols including highly complex drugs: our own EGFR-TKI affair

2015 ◽  
Vol 22 (Suppl 1) ◽  
pp. A137.4-A138
Author(s):  
D Marquez-Medina ◽  
M Gilabert-Sotoca ◽  
N Pons-Llobet ◽  
I Mangues-Bafalluy ◽  
M Martinez Sogués ◽  
...  
Keyword(s):  
Hospital Protocols ◽  
Egfr Tki

Determining Futility

2003 ◽  
Vol 12 (2) ◽  
pp. 214-223
Author(s):  
JOSEPH C. d'ORONZIO
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Family Support ◽  
Therapeutic Intervention ◽  
Ethics Committee ◽  
Critical Care Medicine ◽  
Hospital Policy ◽  
Care Services ◽  
Palliative Care Services ◽  
Hospital Protocols

The challenge of determining that therapeutic intervention is futile is a recurrent ethical theme in critical care medicine. The process by which that determination is reached often involves demanding collaborative and interdisciplinary conversation and deliberation within the context of hospital policy, including ethics committee guidelines. The subsequent decision as to what happens next depends on resources, such as palliative care services, hospice, other hospital protocols, and, of course, family support.

scholarly journals Breastfeeding Self-Efficacy and the Use of Prescription Medication: A Pilot Study

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Cynthia Mannion ◽  
Deborah Mansell
Keyword(s):  
Milk Production ◽  
Self Efficacy ◽  
Prescription Medication ◽  
Dopamine Antagonist ◽  
Test Statistic ◽  
Chi Square ◽  
Lactating Women ◽  
Risks And Benefits ◽  
Chi Square Test ◽  
Hospital Protocols

Objective. To examine the association of self-efficacy, perception of milk production, and lactating women’s use of medication prescribed to increase breast milk in a cohort of 18–40-year-old mothers over six months.Methods. Mothers (n=76) attending community clinics completed the Breastfeeding Self-Efficacy Scale and the Humenick/Hill Lactation Scale, a measure of perceived milk production, three times.Results. Domperidone, a dopamine antagonist, was used by 28% of participants. On average, those using domperidone had lower self-efficacy scores than those not using it (P<0.05) and were more likely to have used formula (Pearson chi-square test statistic =6.87,df=1,P<0.05). Breastfeeding self efficacy and perception of milk production were positively correlated.Conclusion. Breastfeeding assessment conducted prior to prescription of galactogogues is recommended for mothers and healthy term babies. Following Baby-Friendly hospital protocols and increasing self-efficacy for lactating women may be most effective in sustaining breastfeeding. Risks and benefits of various galactogogues are discussed.

scholarly journals A study of mechanical ventilation in children

2017 ◽  
Vol 4 (6) ◽  
pp. 2088 ◽  
Author(s):  
Nilofer S. Bhori ◽  
Sunil V. Ghate ◽  
Punit S. Chhajed
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Health Care Cost ◽  
Management Strategies ◽  
Laryngeal Edema ◽  
Mechanically Ventilated ◽  
Medical College ◽  
Diseased State ◽  
Hospital Protocols ◽  
State Infrastructure

Background: Mechanical ventilation (MV) is one of the most commonly performed procedures in PICU. The indications of MV are multiple. The management strategies also vary depending upon the diseased state, infrastructure and hospital protocols. Although benefits of MV are unquestionable, its use can also cause harm. This study was done to assess the frequency, indications, complications and immediate outcome of mechanically ventilated children, with an aim to improve management protocols and outcome.Methods: A prospective observational study of children (1 month to 13 years), needing invasive MV in PICU of a medical college. MV was initiated after assessment of indication/s. All patients were ventilated with pressure support modes. Complications and outcome were assessed. Results: Of 452 patients admitted to PICU, 72 (15.93%) needed MV. Most common indication was respiratory failure (20.83%). Mean duration of MV was 4.2±4.32 days. Mean hospital stay was 11.89±12.8 days. Of 72, 24 (33.33%) developed complication/s, commonest being laryngeal edema (11.11%). Mean duration of ventilation and hospital stay were significantly higher (p <0.01) in those who developed complication/s. The mortality rate of mechanically ventilated children was 38.89%. Initial mode of MV used was significantly associated (p <0.05) with mortality. Conclusion: Complications prolong the duration of mechanical ventilation and hospital stay. They increase mortality and health care cost in a developing country. Alternatives should be tried before starting invasive MV in children. 

scholarly journals Simple thrombin-based method for eliminating fibrinogen interference in serum protein electrophoresis of haemodialysed patients

2020 ◽  
Vol 30 (2) ◽  
pp. 265-271
Author(s):  
Anamarija Rade ◽  
Anamarija Đuras ◽  
Irena Kocijan ◽  
Patricija Banković Radovanović ◽  
Ana Turčić
Keyword(s):  
Serum Protein ◽  
Venous Catheter ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Blood Collection ◽  
Serum Samples ◽  
Becton Dickinson ◽  
Vascular Access Devices ◽  
Hospital Protocols ◽  
Clot Activator

Introduction: Serum samples of haemodialysed patients collected through vascular access devices, e.g. central venous catheter (CVC) can contain residual heparin, which can cause incomplete clotting and consequently fibrinogen interference in serum protein electrophoresis (SPE). We hypothesized that this problem may be overcome by addition of thrombin and aimed to find a simple thrombin-based method for fibrinogen interference removal. Materials and methods: Blood samples of 51 haemodialysed patients with CVC were drawn through catheter into Clot Activator Tube (CAT) and Rapid Serum Tube Thrombin (RST) vacutainers (Becton Dickinson, New Jersey, USA) following the routine hospital protocols and analysed with gel-electrophoresis (Sebia, Lisses, France). Samples were redrawn in the CAT tubes and re-analysed after being treated with thrombin using two methods: transferring CAT serum into RST vacutainer and treatment of CAT serum with fibrinogen reagent (Multifibren U, Siemens, Marburg, Germany). Results: Direct blood collection in RST proved to be slightly more efficient than CAT in removing the interfering band in beta fraction (CAT removed 6/51 and RST removed 12/51, P = 0.031). Transferring CAT serum into the RST vacutainer proved to be more efficient for subsequent removal of interfering band from CAT serum than the addition of fibrinogen reagent (39/45 vs. 0/45 samples with efficiently removed interfering band, P &lt; 0.001). Conclusion: Fibrinogen interference caused by incomplete clotting because of residual heparin can be overcome by addition of thrombin. Transferring CAT serum into the RST vacutainer was the most efficient method.

A BPMN Extension for the Annotation of HACCP Plans in Hospital Protocols

2018 ◽  
pp. 606-615
Author(s):  
Mateo Ramos Merino ◽  
Luis M. Álvarez Sabucedo ◽  
Juan M. Santos Gago ◽  
Víctor M. Alonso Rorís
Keyword(s):  
Hospital Protocols

Abstract 82: Awareness of Guidelines of Automated External Defibrillator Use in Children within Emergency Medical Services

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sarah E Haskell ◽  
Melanie A Kenney ◽  
Sonali Patel ◽  
Teri L Sanddal ◽  
Katrina L Altenhofen ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Survival Rates ◽  
Heart Association ◽  
Standard Of Care ◽  
Medical Providers ◽  
Automated External Defibrillators ◽  
Emergency Medical ◽  
One Year ◽  
Hospital Protocols ◽  
External Defibrillator

BACKGROUND . Ventricular fibrillation occurs in 10 –20% of pediatric cardiac arrests. Survival rates in children with ventricular fibrillation can be as high as 30% when the rhythm is identified and treated promptly. In the last five years, recommendations have been made for the use of automated external defibrillators(AED) in children 1– 8 years of age. OBJECTIVE . The goal of this study was to determine the awareness of American Heart Association (AHA) guidelines and statewide protocols concerning AED use in children ages 1– 8 among emergency medical providers after new guideline release. Availability of pediatric capable AED equipment was also assessed. METHODS . Surveys were distributed to EMS providers in Iowa and Montana within one year of the AHA advisory statement in 2003 recommending use of AEDs in children ages 1– 8, and again approximately one year after the 2005 AHA guidelines on cardiopulmonary resuscitation were published. In Iowa, there were concentrated efforts to disseminate information about AED use in children, while there were minimal efforts in Montana. RESULTS . Awareness of AHA guidelines for use of AEDs in children was low in both states in 2003 (29% in Iowa vs 9% in Montana, p< 0.001). After release of the 2005 guidelines, awareness improved significantly in both states but was still significantly greater in Iowa (83% vs. 60 %, p < 0.002). In 2003, less than 20% of respondents in both states reported access to pediatric capable AEDs. Availability of pediatric pads and cables increased significantly in 2006 but remained low in Montana (74% in Iowa vs 37% in Montana, p < 0.001). CONCLUSIONS . At the present time, publication of new or interim guidelines in the scientific literature alone is insufficient to ensure that awareness among providers and that new protocols are implemented. An effective and efficient method to disseminate new pediatric out-of-hospital protocols emergency care to become standard of care in a timely matter should be developed.

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