scholarly journals Parenteral nutrition line sepsis: the difficulty in diagnosis

2010 ◽  
Vol 69 (4) ◽  
pp. 508-510 ◽  
Author(s):  
Derek McWhirter
Keyword(s):  
Parenteral Nutrition ◽  
Standard Technique ◽  
Exact Science ◽  
True Number ◽  
Hospitalised Patients ◽  
Microbiological Techniques ◽  
Modern Medical Practice ◽  
Definition Of ◽  
Line Infection ◽  
Line Sepsis

Parenteral nutrition (PN) line sepsis is a common and yet poorly managed complication in hospitalised patients receiving PN. Making a clinical diagnosis is difficult as the clinical picture can be very non-specific and definitions of what constitutes line infection can vary. Once there is clinical suspicion, proving it with microbiological techniques is not an exact science. Traditional techniques have required the removal of the PN line to allow microbiologists to perform analysis of it for infection. This has obvious drawbacks as it is often not easy to replace the line in these patients and the line is often later proven not to be the source of the sepsis. Although the gold-standard technique still requires removal of the line, there has been development in the field of diagnosis line infection while conserving the line. These include intra-luminal brushings of the line, differential blood cultures and simple swabs of the line hub. These techniques are not as sensitive but reduce the problems caused by removing and re-inserting the line in these patients. The definition of PN line sepsis varies between institutions. Rates can be expressed as a true number of cases, or can be expressed correctly as a number of cases per 1000 line days to standardise rates between units of differing sizes. Rates can also be altered if the diagnostic criteria are too strict or too lax. Accurate diagnosis of PN line sepsis remains difficult in modern medical practice.

Association of medical futility with do-not-resuscitate (DNR) code status in hospitalised patients

2021 ◽  
pp. medethics-2020-106977
Author(s):  
Christoph Becker ◽  
Alessandra Manzelli ◽  
Alexander Marti ◽  
Hasret Cam ◽  
Katharina Beck ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Medical Futility ◽  
University Hospital ◽  
Main Diagnosis ◽  
Do Not Resuscitate ◽  
Clinical Frailty Scale ◽  
Code Status ◽  
Probability Of Survival ◽  
Hospitalised Patients ◽  
Definition Of

Guidelines recommend a ‘do-not-resuscitate’ (DNR) code status for inpatients in which cardiopulmonary resuscitation (CPR) attempts are considered futile because of low probability of survival with good neurological outcome. We retrospectively assessed the prevalence of DNR code status and its association with presumed CPR futility defined by the Good Outcome Following Attempted Resuscitation score and the Clinical Frailty Scale in patients hospitalised in the Divisions of Internal Medicine and Traumatology/Orthopedics at the University Hospital of Basel between September 2018 and June 2019. The definition of presumed CPR futility was met in 467 (16.2%) of 2889 patients. 866 (30.0%) patients had a DNR code status. In a regression model adjusted for age, gender, main diagnosis, nationality, language and religion, presumed CPR futility was associated with a higher likelihood of a DNR code status (37.3% vs 7.1%, adjusted OR 2.99, 95% CI 2.31 to 3.88, p<0.001). In the subgroup of patients with presumed futile CPR, 144 of 467 (30.8%) had a full code status, which was independently associated with younger age, male gender, non-Christian religion and non-Swiss citizenship. We found a significant proportion of hospitalised patients to have a full code status despite the fact that CPR had to be considered futile according to an established definition. Whether these decisions were based on patient preferences or whether there was a lack of patient involvement in decision-making needs further investigation.

Phytosterolaemia associated with parenteral nutrition administration in adult patients

2020 ◽  
Vol 123 (12) ◽  
pp. 1365-1372 ◽  
Author(s):  
Josep M. Llop-Talaveron ◽  
Elisabet Leiva-Badosa ◽  
Ana Novak ◽  
Raúl Rigo-Bonnin ◽  
Josep R. Ticó-Grau ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Fish Oil ◽  
Total Cholesterol ◽  
Great Variability ◽  
Adult Patients ◽  
Lipid Emulsions ◽  
Patient Study ◽  
Hospitalised Patients

AbstractVegetable lipid emulsions (LE) contain non-declared phytosterols (PS). We aimed to determine PS content depending on the brand and LE batch, and in adult hospitalised patients treated with parenteral nutrition (PN), to establish the association between plasma and administered PS. Part I was the LE study: totals and fractions of PS in three to four non-consecutive batches from six LE were analysed. Part II was the patient study: patients with at least 7 previous days of PN with 0·8 g/kg per d of an olive/soyabean (O/S) LE were randomised (day 0) 1:1 to O/S or 100 % fish oil (FO) at a dose of 0·4 g/kg per d for 7 d (day 7). Plasma PS, its fractions, total cholesterol on days 0 and 7, their clearance and their association with PS administered by LE were studied. In part I, LE study: differences were found in the total PS, their fractions and cholesterol among different LE brands and batches. Exclusive soyabean LE had the highest content of PS (422·36 (sd 130·46) μg/ml). In part II, patient study: nineteen patients were included. In the O/S group, PS levels were maintained (1·11 (sd 6·98) μg/ml) from day 0 to 7, while in the FO group, significant decreases were seen in total PS (−6·21 (sd 4·73) μg/ml) and their fractions, except for campesterol and stigmasterol. Plasma PS on day 7 were significantly associated with PS administered (R2 0·443). PS content in different LE brands had great variability. PS administered during PN resulted in accumulation and could be prevented with the exclusive administration of FO LE.

scholarly journals Definition of Opportunistic Infections in Immunocompromised Children on the Basis of Etiologies and Clinical Features: A Summary for Practical Purposes

2019 ◽  
Vol 15 (4) ◽  
pp. 197-206 ◽  
Author(s):  
Niccolò Riccardi ◽  
Gioacchino Andrea Rotulo ◽  
Elio Castagnola
Keyword(s):  
Opportunistic Infections ◽  
Immunosuppressive Treatment ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Hospitalised Patients ◽  
Nonmalignant Disease ◽  
Life Threatening ◽  
Severe Infections ◽  
Definition Of ◽  
Immunodeficiency Syndrome

: Opportunistic Infections (OIs) still remain a major cause of morbidity and death in children with either malignant or nonmalignant disease. : OIs are defined as those infections occurring due to bacteria, fungi, viruses or commensal organisms that normally inhabit the human body and do not cause a disease in healthy people, but become pathogenic when the body's defense system is impaired. OIs can also be represented by unusually severe infections caused by common pathogens. An OI could present itself at the onset of a primary immunodeficiency syndrome as a life-threatening event. More often, OI is a therapyassociated complication in patients needing immunosuppressive treatment, among long-term hospitalised patients or in children who undergo bone marrow or solid organ transplantation. : The aim of the present review is to provide a comprehensive and ‘easy to read’ text that briefly summarises the currently available knowledge about OIs in order to define when an infection should be considered as opportunistic in pediatrics as a result of an underlying congenital or acquired immune-deficit.

scholarly journals Candida post gram-negative line sepsis in patients on Home Parenteral Nutrition: A study of 32 patients

2015 ◽  
Vol 10 (5) ◽  
pp. e209-e210
Author(s):  
V. Evans ◽  
A. Hughes ◽  
D. Forbes-Penfold ◽  
J. Koeglmeier ◽  
S. Hill
Keyword(s):  
Parenteral Nutrition ◽  
Home Parenteral Nutrition ◽  
Gram Negative ◽  
Line Sepsis

scholarly journals Line sepsis rates are significantly improved in parenteral nutrition patients by having a Nutrition Nurse

2011 ◽  
Vol 70 (OCE5) ◽  
Author(s):  
T. Tsakok ◽  
J. M. Dunn ◽  
P. Blaker ◽  
H. Morris ◽  
N. Ward ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Line Sepsis

scholarly journals Comparing Measures of Physician Market Concentration Using Tax Identification Numbers Versus Independent Negotiating Units

2019 ◽  
Vol 64 (1) ◽  
pp. 128-135
Author(s):  
Scott Ode ◽  
Bryan Dowd ◽  
Roger Feldman
Keyword(s):  
Health Plan ◽  
Claims Data ◽  
Market Concentration ◽  
Metropolitan Statistical Area ◽  
Health Plans ◽  
True Number ◽  
Insurance Product ◽  
Definition Of ◽  
Statistical Area

Analysts interested in physician market concentration often have access to tax identification numbers (TINs), but not the number of truly independent negotiating units (NUs). Health plans do know the true number of NUs, and, using 2014 claims data for Minnesota physicians from a large midwestern health plan, we compare Herfindahl-Hirschman Index (HHI) measures of physician market concentration using TINs versus NUs at the county and metropolitan statistical area (MSA) levels for thirteen specialties. We found that HHIs computed using TINs versus NUs were similar across Minnesota. Two MSAs in Minnesota met the Department of Justice’s definition of highly concentrated markets. There is reason to believe that the discrepancy between TIN and NU HHIs may vary by insurance product and region of the country, and so we encourage other researchers to work with health plans to replicate our study.

scholarly journals On the recovery and analysis of historical seismograms

2013 ◽  
Vol 56 (3) ◽  
Author(s):  
Barbara Palombo ◽  
Nicola Alessandro Pino
Keyword(s):  
Seismic Risk ◽  
Standard Technique ◽  
Source Area ◽  
Seismic Source ◽  
Correct Interpretation ◽  
Source Information ◽  
Specific Analysis ◽  
Quality And Reliability ◽  
Definition Of ◽  
Historical Seismograms

The analysis of historical seismograms has proven to be a fundamental tool to help with the definition of the seismic risk in specific regions. Indeed, modern quantitative reappraisal of relevant earthquakes that occurred before the 1960’s; i.e., prior to both the developments of modern recording instruments and the theoretical progress, has been essential for the assessment of the seismic potential of a source area. However, due to the characteristics (transducing and recording) of the old analog seismographs, the data available are affected by intrinsic uncertainties, and errors can be introduced during the processing of waveform digitization. These drawbacks can seriously influence the quality and reliability of an investigation. In general, no standard technique can be applied when dealing with historical seismograms. Thus, specific tests and cross-checks have to be designed to estimate the limits of each specific analysis. Here, we aim to provide an overview of the whole procedure while focusing on the most crucial steps, from the seismogram recovery to the application of modern techniques for the retrieval of the seismic source information. We also suggest possible checks for the robustness of the data and for the available instrument characteristics, with a description of the effects of various uncertainties on the results that can be obtained. We thus provide useful indications for the analysis of historical seismograms, and also for the correct interpretation of the resulting characteristics of the seismic source.

Caloric adequacy of parenteral nutrition and its influence on the clinical outcome of hospitalised patients

2022 ◽  
pp. 026010602110701
Author(s):  
Carmen de Cáceres ◽  
Teresa Rico ◽  
Cristina Abreu ◽  
Ana Isabel Velasco ◽  
Rafael Lozano ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Clinical Outcomes ◽  
Nutrient Intake ◽  
Prospective Observational Study ◽  
Positive Impact ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Anthropometric Parameters ◽  
Predictive Equations ◽  
Hospitalised Patients

Background: The adaptation of Parenteral Nutrition (PN) to actual energy requirements of hospitalised patients is essential, since excessive and insufficient nutritional intake have been associated with poor clinical outcomes. Aim: To evaluate the adaptation of prescribed PN to the estimated nutritional requirements using three predictive equations and the influence of excessive/insufficient nutrient intake on patient clinical outcomes (nutritional parameters, metabolic and infectious complications). Methods: Prospective, observational study in hospitalised patients nutritionally assessed. Data was collected the first and fifth/sixth day of PN with clinical (infection, length of hospital stay), biochemical (visceral proteins, cholesterol, glucose, triglycerides, lymphocytes, CRP) and anthropometric parameters (skin folds, height, weight). Theoretical requirements were calculated using Harris-Benedict (HB), Mifflin-St Jeor (MF) and 25 Kcal/Kg/day formulas. The HB formula was used to compare estimated and provided requirements. Results: A total of 94 patients (mean: 72 ± 13.7 years old) were included with initial mean weight and height of 69.2 Kg and 162.8 cm, respectively (mean BMI: 26.1 Kg/m2). No statistically significant differences were found between the actual (1620 Kcal/day) and estimated caloric mean calculated with HB (1643 Kcal/day) and MF (1628 Kcal/day). When comparing with the caloric estimation, 31.9% of patients were underfed, while 14.9% were overfed. Intergroup analysis demonstrated significant variations in albumin, prealbumin, glucose, cholesterol, triglycerides and MUAC, with a significant increase of hyperglycaemia (+37.86; p < 0.05) and hypertriglyceridemia (+63.10; p < 0.05), being higher in overfed patients. Conclusion: In our study, inadequate nutrient intake was associated with a higher degree of hyperglycaemia and hypertriglyceridemia, without positive impact on anthropometric parameters.

Proactive risk assessment through FMEA of Home Parenteral Nutrition care processes: a survey analysis

2020 ◽  
Vol 21 ◽  
Author(s):  
Giulio Toccafondi ◽  
Giulia Dagliana ◽  
Vittorio Fineschi ◽  
Paola Frati ◽  
Riccardo Tartaglia
Keyword(s):  
Risk Assessment ◽  
Patient Safety ◽  
Parenteral Nutrition ◽  
Community Care ◽  
Clinical Care ◽  
Care Process ◽  
Quality And Safety ◽  
Care Processes ◽  
Definition Of

Background: Home parenteral nutrition (HPN) is a lifesaving clinical care process. However, undetected hazards and vulnerabilities in care transitions from hospital to community care may pose risk to patient safety. Avoidable complications and adverse events may hinder the benefits of treatment. Objective: The analysis carried out aims at framing through human factors and ergonomics (HF/E) the critical issues for patient safety related to clinical care practices for HPN in healthcare organization. Methods: We present the results of a proactive risks assessment analysis based on the FMEA methodology (Failure Mode and Effects Analysis) carried out in three different areas of the regional health care system of Tuscany, Italy. The clinical risk management and patient safety unit assessed the risk perception of healthcare workers (HWs) in regard to patient safety and situational awareness throughout the HPN patient journey. Results: The analysis revealed heterogeneity in the Risk Priority Index (RPI) expressed by HWs. A lower RPI is associated with a HPN process that deploys in continuity between hospital care and community care. A higher RPI is associated with a quality and safety improvement process that is still ongoing. We also observed HWs expressing low RPI in the areas of the region where HPN has a hospital-focused approach and has limited adherence to patient safety requirements. Low RPI for HPN process may relate both to extensively deployed continuity of care and to jeopardized awareness on HPN phases and coordination. The analysis carried out enabled the definition of a common HPN workflow used as reference schema allowing for the definition of a set of recommendations for improving quality and safety of the care processes. Moreover, the outcome of the proactive risk assessment laid the groundwork for the advancement of the patient safety regional requirements. Conclusion: The analysis had the role of promoting the contextualization of the culture of quality and safety within the HPN process resulting into an improved awareness of the criticalities and the role of nutrition units throughout the care process.

Delirium in elderly patients: association with educational attainment

2016 ◽  
Vol 29 (2) ◽  
pp. 95-101 ◽  
Author(s):  
Sónia Martins ◽  
José Artur Paiva ◽  
Mário R. Simões ◽  
Lia Fernandes
Keyword(s):  
Elderly Patients ◽  
Educational Attainment ◽  
Cognitive Reserve ◽  
Statistical Significance ◽  
Strong Association ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Final Sample ◽  
Hospitalised Patients ◽  
Definition Of

ObjectiveAmong cognitive reserve markers, educational attainment is the most widely studied, with several studies establishing a strong association with risk of dementia. However, it has not yet been fully examined in delirium. This study aims to analyse the relationship between educational attainment and delirium.MethodsThe study included elderly hospitalised patients admitted (≥48 h) into an intermediate care unit (IMCU) of Intensive Care Medicine Service. Exclusion criteria were as follows: Glasgow Coma Scale (total≤11), blindness/deafness, inability to communicate or to speak Portuguese. The European Portuguese Version of the Confusion Assessment Method (CAM) was used for delirium assessment.ResultsThe final sample (n=157) had a mean age of 78.8 (SD=7.6) the majority being female (52.2%), married (51.5%) and with low educational level (49%). According to CAM, 21% of the patients had delirium. The delirium group presented the fewest years of education (median 1 vs. 4), with statistical significance (p=0.003). Delirium was more frequent among male patients [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.12–0.86; p=0.023], as well as those patients with lower education (OR 0.76; 95% CI 0.62–0.95; p=0.016), and with respiratory disease (OR 3.35; 95% CI 1.20–9.33; p=0.020), after controlling for age and medication.ConclusionSimilar to previous studies, these findings point to a negative correlation between education and delirium. This study appears as an attempt to contribute to the knowledge about the role of cognitive reserve in risk of delirium, particularly because is the first one that has been carried out in an IMCU, with lower educated elderly patients. Further studies are needed to clarify this relationship considering other markers (e.g. cognitive activities), which can contribute to the definition of preventive strategies.

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