scholarly journals Cerebrospinal Fluid Pleocytosis in Critical Care Patients With Seizures

2017 ◽  
Vol 44 (4) ◽  
pp. 343-349
Author(s):  
Carly Scramstad ◽  
Alan C. Jackson
Keyword(s):  
Cerebrospinal Fluid ◽  
Critical Care ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Critical Care Units ◽  
Generalized Seizures ◽  
Csf Pleocytosis ◽  
Magnetic Resonance Imaging Mri ◽  
Critical Care Patients

AbstractObjectives: To assess the etiology of cerebrospinal fluid (CSF) pleocytosis in critical care patients with seizure(s) or status epilepticus (SE). Many previous studies, some performed decades ago, concluded that CSF pleocytosis may be entirely attributable to seizure activity. Methods: We undertook a retrospective chart review of adult patients with an admitting or acquired diagnosis of seizure(s) or SE in critical care units at the Winnipeg Health Sciences Centre between 2009 and 2012. Patients were identified through a critical care information database at a tertiary care center. We limited our study to patients who had lumbar punctures at our center within 5 days of seizure(s) or SE. Results: Of 426 patients with seizures in critical care units, 51 met the inclusion criteria. Seizure subtypes included focal seizures (5 or 10%), generalized seizures (14 or 27%), and SE (32 or 63%). Twelve (seven with SE) of the 51 (24%) were found to have CSF pleocytosis. A probable etiological cause for the CSF pleocytosis was identified in all 12 cases. Conclusions: We conclude that seizures do not directly induce a CSF pleocytosis. Instead, the CSF pleocytosis more likely reflects the underlying acute or chronic brain process responsible for the seizure(s). This was not readily apparent in early studies without magnetic resonance imaging (MRI) of the brain and currently available laboratory investigations. An etiological cause of CSF pleocytosis must always be sought when patients present with seizures and it should never be assumed that seizures are the cause.

scholarly journals Antimicrobial time-out for vancomycin by infectious disease physicians vs clinical pharmacists: a before-after crossover trial

2021 ◽  
Author(s):  
Shinya Hasegawa ◽  
Yasuaki Tagashira ◽  
Shutaro Murakami ◽  
Yasunori Urayama ◽  
Akane Takamatsu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Critical Care ◽  
Clinical Pharmacist ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Pharmacists ◽  
Time Out ◽  
Days Of Therapy ◽  
The Impact ◽  
Critical Care Patients

Abstract Background The present study assessed the impact of time-out on vancomycin use and compared the strategy’s efficacy when led by pharmacists versus infectious disease (ID) physicians at a tertiary care center. Methods Time-out consisting of a telephone call to inpatient providers and documentation of vancomycin use > 72 hours was performed by ID physicians and clinical pharmacists in the Departments of Medicine and Surgery/Critical Care. Patients in the Department of Medicine were assigned to the ID physician-led arm, and patients in the Department of Surgery/Critical Care were assigned to the clinical pharmacist-led arm in the initial, six-month phase and were switched in the second, six-month phase. The primary outcome was the change in weekly days of therapy (DOT) per 1,000 patient-days (PD), and vancomycin use was compared using interrupted time-series analysis. Results Of 587 patients receiving vancomycin, 132 participated, with 79 and 53 enrolled in the first and second phases, respectively. Overall vancomycin use decreased although the difference was statistically non-significant (change in slope, −0.25 weekly DOT per 1,000 PD; 95% confidence interval, −0.68 to 0.18, p = 0.24). The weekly vancomycin DOT per 1,000 PD remained unchanged during phase 1 but decreased significantly in phase 2 (change in slope, −0.49; −0.84 to −0.14, p = 0.007). Antimicrobial use decreased significantly in the surgery/critical care patients in the pharmacist-led arm (change in slope, −0.77; −1.33 to −0.22, p = 0.007). Conclusions Vancomycin time-out was moderately effective, and clinical pharmacist-led time-out with surgery/critical care patients substantially reduced vancomycin use.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Defining the role of the pediatric critical care nurse practitioner in a tertiary care center

2000 ◽  
Vol 28 (7) ◽  
pp. 2626-2630 ◽  
Author(s):  
Shari L. Derengowski ◽  
Sharon Y. Irving ◽  
Pamela V. Koogle ◽  
Robert M. Englander
Keyword(s):  
Critical Care ◽  
Nurse Practitioner ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Pediatric Critical Care ◽  
Care Nurse ◽  
Critical Care Nurse

Research Utilization in Critical Care: An Exemplar

1994 ◽  
Vol 5 (2) ◽  
pp. 124-132
Author(s):  
Marita G. Titler ◽  
Linda Moss ◽  
Jane Greiner ◽  
Michele Alpen ◽  
Gerry Jones ◽  
...  
Keyword(s):  
Critical Care ◽  
Pain Management ◽  
Research Utilization ◽  
Care Center ◽  
Tertiary Care ◽  
Practice Change ◽  
Research Committee ◽  
Staff Members ◽  
Number Of Patients ◽  
Management Protocol

The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain

scholarly journals Spectrum of respiratory viral infectionsin liver disease patients with cirrhosis admitted in critical care unit

2019 ◽  
Vol 11 (04) ◽  
pp. 356-360
Author(s):  
Vijeta Bajpai ◽  
Ekta Gupta ◽  
Lalita Gauri Mitra ◽  
Hemant Kumar ◽  
Rakhi Maiwall ◽  
...  
Keyword(s):  
Critical Care ◽  
Liver Disease ◽  
Clinical Outcome ◽  
Tertiary Care ◽  
Respiratory Viruses ◽  
Critical Care Units ◽  
Viral Transport Medium ◽  
Cirrhotic Patients ◽  
Bacterial Coinfection ◽  
A Prospective Study

Abstract BACKGROUND: Clinical significance of respiratory viruses (RVs) as an etiology of pneumonia in liver disease patients with cirrhosis is usually underestimated. Therefore, the aim of this study was to evaluate the spectrum of RVs in cirrhotic patients with pneumonia admitted in critical care units (CCUs) and its impact on the clinical outcome of cirrhotic patients. MATERIAL AND METHOD: A prospective study was conducted in a tertiary care CCU, and consecutive cirrhotic patients with pneumonia were included. Bronchoalveolar lavage or throat swab/nasal swab was collected in viral transport medium for analysis of RVs by multiplex real-time polymerase chain reaction. A total of 135 cirrhotic patients were included, viral and bacterial etiology of pneumonia was identified, and analysis was done with the clinical outcome. RESULTS: Overall, RVs were detected in 30 (22.2%) cirrhotic patients and viral–bacterial coinfection in 16 (11.8%) cirrhotic patients. The most common virus detected was rhinovirus in 9 (30%) patients. Mortality in cirrhotic patients with RV infection was significantly higher in comparison to cirrhotic patients with no RV infection (25 [83.3%] and 11 [12.3%], respectively, P < 0.001). CONCLUSION: Respiratory viruses in cirrhotic patients with pneumonia are associated with poor clinical outcome.

scholarly journals Incidental Petrous Apex Findings on Magnetic Resonance Imaging

2001 ◽  
Vol 80 (4) ◽  
pp. 200-206 ◽  
Author(s):  
John P. Leonetti ◽  
Harish Shownkeen ◽  
Sam J. Marzo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Retrospective Chart Review ◽  
Petrous Apex ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Clinical Surveillance

We performed a retrospective chart review to categorize a group of petrous apex findings that were noted incidentally on magnetic resonance imaging (MRI) in 88 patients. These patients were among those who had been seen at a tertiary care center between July 1988 and July 1998. These incidental findings, which were unrelated to the presenting clinical manifestations, included asymmetric fatty bone marrow (n = 41), inflammation (19), cholesterol granulomas (14), cholesteatomas (9), and neoplasms (5). Followup imaging and clinical surveillance of these patients has not demonstrated any significant change in the incidentally detected lesions. In all cases, the incidental MRI findings represented benign pathology.

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