scholarly journals Nursing care procedures in response to adverse events to blood donation

2014 ◽  
Vol 23 (3) ◽  
pp. 688-695 ◽  
Author(s):  
Karla Fabiana Nunes da Silva ◽  
Elizabeth Barichello ◽  
Ana Lúcia de Mattia ◽  
Maria Helena Barbosa
Keyword(s):  
Adverse Events ◽  
Nursing Care ◽  
Blood Donation ◽  
Statistical Significance ◽  
Critical Role ◽  
Clinical Manifestations ◽  
Vital Signs ◽  
Oral Hydration ◽  
Vital Signs Monitoring ◽  
Role Of Nursing

The aim of this study was to identify types of adverse events, clinical manifestations and nursing care procedures adopted in response to adverse events to blood donation, and to verify the association between these procedures and the adverse events. This was an epidemiological, retrospective study conducted through analysis of 1369 records of treatment of adverse events to blood donation, during the period between January 2009 and December 2011. Descriptive statistics and contingency tables were used to analyze associations through the use of Cramér's V. A total of 92.6% of adverse events were classified as mild, and clinical manifestations were malaise, dizziness, pallor and sweating. The Trendelenburg position, vital signs monitoring, oral hydration and directions for care after blood donation were the main procedures adopted. A statistical significance was observed between the nursing procedures and the types of adverse events. The results point to the critical role of nursing in treating adverse events to blood donation.

scholarly journals An Analysis of Exertional Safety After Blood Donation in Active Duty Military Personnel—A Feasibility Study

2020 ◽  
Author(s):  
Brandon M Carius ◽  
Mohamad Umar ◽  
James K Aden ◽  
Steve G Schauer
Keyword(s):  
Heart Rate ◽  
Adverse Events ◽  
Feasibility Study ◽  
Blood Donation ◽  
Vital Signs ◽  
Physical Fitness Test ◽  
Resuscitation Fluid ◽  
Baseline Testing ◽  
Military Populations ◽  
Armed Services

ABSTRACT Introduction Whole blood (WB) is the optimal resuscitation fluid in hemorrhagic shock. Military research focuses on mortality benefits of WB acquired through walking blood banks (WBBs). Few military-based studies on donation effects exist, almost exclusively performed on small special operation forces. No Department of Defense regulations for postdonation precautions in nonaviation crew members exist. Further study is warranted regarding safety and limitations in postdonation populations. Materials and Methods A feasibility (n = 25) prospective interventional study examined the safety of exertion (defined as a 1.6-km treadmill run at volunteers’ minimum passing pace for the Army Physical Fitness Test) following 1 unit of WB donation. Subjects served as their own controls, performing baseline testing 7 days before donation, with repeat testing 1 h following donation conducted by Armed Services Blood Program personnel. Adverse events, pre- and postexertion vital signs (VS) were evaluated. Results There were no adverse events throughout testing. Only resting heart rate (68 vs. 73 beats · min−1, p < 0.01) and postexertion heart rate were significantly different among pre- and postdonation VS. Additional significant findings were time to attain postexertion normocardia (116 vs. 147 seconds, p < 0.01). A small but statistically significant change in Borg perceived exertional scores was noted (10.3 vs. 10.8, p < 0.05). Conclusions This feasibility study demonstrates the first safety test of regular military populations performing exertion immediately following the standardized WB donation. VS changes may translate into a small but significant increase in perceived postdonation exertion. Future studies should expand duration and intensity of exertion to match combat conditions.

Predictors of Adverse Events in Patients After Discharge From the Intensive Care Unit

2008 ◽  
Vol 17 (3) ◽  
pp. 255-263 ◽  
Author(s):  
Wendy Chaboyer ◽  
Lukman Thalib ◽  
Michelle Foster ◽  
Carol Ball ◽  
Brent Richards
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Nursing Care ◽  
Univariate Analysis ◽  
Vital Signs ◽  
Chart Audit ◽  
Care Needs ◽  
Adult Intensive Care Unit ◽  
Vein Thrombosis

Background Patients discharged from the intensive care unit may be at risk of adverse events because of complex care needs. Objective To identify the types, frequency, and predictors of adverse events that occur in the 72 hours after discharge from an intensive care unit when no evidence of adverse events was apparent before discharge. Methods A predictive cohort study of 300 patients from an adult intensive care unit was undertaken. An internationally accepted protocol for chart audit was used. Frequency of adverse events was calculated, and logistic regression was used to determine independent predictors of adverse events. Results A total of 147 adverse events, 17 (11.6%) of which were defined as major, were incurred by 92 patients (30.7%). The 3 most common adverse events, hospital-incurred infection or sepsis (n = 32, 21.8%), hospital-incurred accident or injury (n = 17, 11.6%), and other complication such as deep vein thrombosis, pulmonary edema, or myocardial infarction (n = 17, 11.6%) accounted for 44.9% (n = 66) of all adverse events. Two predictors, respiratory rate less than 10/min or greater than or equal to 25/min and pulse rate exceeding 110/min, were significant independent predictors; requiring a high level of nursing care at the time of discharge was a significant predictor in univariate analysis but not in multivariate analysis. Conclusion Taking, recording, and reporting vital signs are important. Nursing care requirements of patients at discharge from the intensive care unit may be worthy of further investigation in studies of patients after discharge.

scholarly journals Reversing the Stop Signs to Proactive Nursing Care in DNR Patients

2015 ◽  
Author(s):  
Natalie Volpe
Keyword(s):  
Critical Care ◽  
Interpersonal Relationships ◽  
Health Care Providers ◽  
Nursing Care ◽  
Vital Signs ◽  
Care Providers ◽  
Do Not Resuscitate ◽  
Structured Interviews ◽  
Code Status ◽  
Vital Signs Monitoring

<p>Research has supported that patients with a do-not-resuscitate (DNR) code status receive less aggressive treatment and have higher mortality rates compared to those without DNR orders, after adjusting for confounding factors (Cohn, Fritz, Frankau, Laroche, & Fuld, 2012). Health care providers erroneously understand DNR status to imply that a patient is dying and should not undergo other life-saving interventions (Hewitt & Marco, 2004). Surveyed critical care nurses revealed that they believed that interventions such as complete history and physicals, checking vital signs, monitoring neuro status, and ICU admission should not be performed as regular interventions on patients with a DNR status (Sherman & Branum, 1995). The purpose of this paper was to explore the factors that contribute to less aggressive nursing care in DNR patients that are not actively dying from a terminal illness. This study employed a<strong> </strong>qualitative approach using semi-structured interviews. The sample consisted of five critical care registered nurses. Three common themes were revealed: the definition of DNR code status; interpersonal relationships between nurse/patient; and personal views and feelings directing nursing care. Recommendations and implications for practice are discussed.</p>

scholarly journals Adaptive threshold-based alarm strategies for continuous vital signs monitoring

2021 ◽  
Author(s):  
Mathilde C. van Rossum ◽  
Lyan B. Vlaskamp ◽  
Linda M. Posthuma ◽  
Maarten J. Visscher ◽  
Martine J. M. Breteler ◽  
...  
Keyword(s):  
Early Detection ◽  
Adverse Events ◽  
Vital Sign ◽  
Vital Signs ◽  
Adaptive Threshold ◽  
Situational Factors ◽  
Alarm Fatigue ◽  
Vital Signs Monitoring ◽  
Surgical Ward ◽  
Increased Sensitivity

AbstractContinuous vital signs monitoring in post-surgical ward patients may support early detection of clinical deterioration, but novel alarm approaches are required to ensure timely notification of abnormalities and prevent alarm-fatigue. The current study explored the performance of classical and various adaptive threshold-based alarm strategies to warn for vital sign abnormalities observed during development of an adverse event. A classical threshold-based alarm strategy used for continuous vital signs monitoring in surgical ward patients was evaluated retrospectively. Next, (combinations of) six methods to adapt alarm thresholds to personal or situational factors were simulated in the same dataset. Alarm performance was assessed using the overall alarm rate and sensitivity to detect adverse events. Using a wireless patch-based monitoring system, 3999 h of vital signs data was obtained in 39 patients. The clinically used classical alarm system produced 0.49 alarms/patient/day, and alarms were generated for 11 out of 18 observed adverse events. Each of the tested adaptive strategies either increased sensitivity to detect adverse events or reduced overall alarm rate. Combining specific strategies improved overall performance most and resulted in earlier presentation of alarms in case of adverse events. Strategies that adapt vital sign alarm thresholds to personal or situational factors may improve early detection of adverse events or reduce alarm rates as compared to classical alarm strategies. Accordingly, further investigation of the potential of adaptive alarms for continuous vital signs monitoring in ward patients is warranted.

Trend of Regular Voluntary Blood Donation and its Associated Factors in Karachi - A Comparative Analysis of Medical and Non-medical Undergraduate Students

2020 ◽  
Author(s):  
Nazish Jaffar
Keyword(s):  
Medical Students ◽  
Undergraduate Students ◽  
Blood Donation ◽  
Statistical Significance ◽  
Study Groups ◽  
Medical Group ◽  
Cross Sectional ◽  
Blood Donations ◽  
Medical Undergraduate ◽  
Donated Blood

Background: Regular voluntary unpaid blood donation assures safe blood supply in association with minimum infection transmission. The purpose of this study was to identify the frequency of regular voluntary blood donation and to evaluate the causes of donating blood as well as factors impeding blood donations among the medical and nonmedical students of Karachi. Methods: A comparative cross sectional study was conducted among medical and nonmedical students of JSMU and NED University respectively from May to October 2018. Sample size was 272 including 137 medical and 135 non-medical students. Data was analyzed using SPSS version 22.0. Chi-square test of independence/ Fischer’s exact test were applied to assess statistical significance. Result: In medical group 5/21(23.8%) voluntary regular donors were recorded. In non-medical group, voluntary regular donors were found to be 8/30 (26.6%) (p>0.00). Medical students most commonly 15/21 (71.4%) donated blood voluntarily in a camp while non-medical participants frequently donated blood as replacement donors 13/30 (43.3%) (p>0.00). Major hindering factor for blood donation in both study groups was non-participation in blood donation derives i.e. 66/116 (56.8%) in medical and 53/105 (50.4%) in non-medical groups respectively. Anemia, 20/116 (17.2%) in medical and 15/105 (14.2%) in nonmedical students was the second major cause of not donating blood. Conclusion: The frequency of regular voluntary blood donations is very low among undergraduates. However, comparatively, the trend is slightly higher among non-medical group. The major hindrance in not donating blood was non-participation in blood donating derives.

scholarly journals Platelet Depletion is Effective in Ameliorating Anxiety-Like Behavior and Reducing the Pro-Inflammatory Environment in the Hippocampus in Murine Experimental Autoimmune Encephalomyelitis

2019 ◽  
Vol 8 (2) ◽  
pp. 162 ◽  
Author(s):  
Pece Kocovski ◽  
Xiangrui Jiang ◽  
Claretta D’Souza ◽  
Zhenjiang Li ◽  
Phuc Dang ◽  
...  
Keyword(s):  
Experimental Autoimmune Encephalomyelitis ◽  
Neuropsychiatric Symptoms ◽  
Critical Role ◽  
Clinical Manifestations ◽  
Lymphocytic Infiltration ◽  
Disease Stage ◽  
Autoimmune Encephalomyelitis ◽  
Significant Difference ◽  
Platelet Depletion ◽  
Experimental Autoimmune

The neuropsychiatric symptoms of multiple sclerosis (MS), such as anxiety and depression, can result from disease activity itself as well as psychological reaction to an unfavorable diagnosis. Accordingly, the literature reports evidence of increased anxiety-like behavior in experimental autoimmune encephalomyelitis (EAE), an accepted MS model. Due to the recently described critical role of platelets in inflammation and autoimmune disease, we examined the relationship between platelets, inflammation, and anxiety-like behavior in EAE. In the elevated plus maze, EAE-induced C57BL/6J mice showed decreased time spent in the open arms relative to vehicle-only controls, demonstrating an increase in anxiety-like behavior. This effect occurred in the presence of platelet–neuron association, but absence of lymphocytic infiltration, in the hippocampal parenchyma. Platelet depletion at the pre-clinical disease stage, using antibody-mediated lysis prevented the EAE-induced increase in anxiety-like behavior, while no significant difference in distance moved was recorded. Furthermore, platelet depletion was also associated with reduction of the pro-inflammatory environment to control levels in the hippocampus and prevention of EAE disease symptomology. These studies demonstrate the high efficacy of a platelet-targeting approach in preventing anxiety-like symptoms and clinical manifestations of EAE and have implications for the treatment of neuropsychiatric symptoms in MS.

657 Interleukin-6 receptor blockade for management of immune checkpoint inhibitor related adverse events in patients with melanoma

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A694-A694
Author(s):  
Chantal Saberian ◽  
Faisal Fa’ak ◽  
Jean Tayar ◽  
Maryam Buni ◽  
Sang Kim ◽  
...  
Keyword(s):  
Adverse Events ◽  
Disease Activity ◽  
Median Time ◽  
Interleukin 6 ◽  
Immune Checkpoint ◽  
Activity Index ◽  
Critical Role ◽  
Cancer Center ◽  
Interleukin 6 Receptor ◽  
Md Anderson

BackgroundManagement of certain immune mediated adverse events (irAEs) can be challenging and may require prolonged/chronic immune suppression with corticosteroids or other immunosuppressant which could compromise and even reverse the efficacy of immune checkpoint inhibitors (ICI). While the exact immunobiology of irAEs is not fully understood there is enough evidence that IL-6 induced Th-17 that may play critical role in the pathogenesis. Herein, we describe our clinical experience using interleukin-6 receptor (IL-6R) blockade in management of irAEs in melanoma patients.MethodsWe searched MD Anderson databases to identify cancer patients who had received ICIs between January 2004 and March 2020. Of 11,391 ICI-treated patients, 21 patients with melanoma who received IL-6R blockade after ICI infusion were identified and their medical records were reviewed.ResultsMedian age was 61 years (41–82), 52% were females, 90% received anti-programmed cell death-1 antibodies. Fourteen patients (67%) had de novo onset irAEs (11 had arthritis, and 1 each with polymyalgia rheumatica, oral mucositis, and CNS vasculitis), and 7 patients (33%) had flare of their pre-existing autoimmune diseases (5 had had rheumatoid arthritis, and 1 each with myasthenia gravis and Crohn’s disease). Median time from ICI initiation to irAEs was 91 days (range, 1–496) and to initiation of IL-6R blockade was 6.6 months (range, 0.6–24.3). Median number of IL-6R blockade was 12 (range, 1–35), and 16 patients (76%) were concomitantly receiving corticosteroids of median dose of 10 mg (range, 5–20 mg). Of the 21 patients, irAEs improved in 14 (67%) (95% CI: 46%-87%). Of 13 evaluable patients with arthritis, 11 (85%) achieved remission or minimal disease activity as defined by the clinical disease activity index. Median time from initiation of IL-6R blockade till improvement of irAEs was 2.9 months (range, 1.5–36.9). Nineteen patients tolerated well IL-6R blockade, while two patients stopped treatment due to abdominal pain and sinus tachycardia. The median CRP levels at irAEs was 84 mg/L (0.6–187) and decreased to 1.9 mg/L (0.56–12) at 10 weeks after initiation of IL-6R blockade (P=0.02). Of the 17 evaluable patients, the overall tumor response rate by RECIST-1.1 criteria was similar before and after IL-6R blockade initiation (41% vs. 53%).ConclusionsOur data demonstrated that IL-6R blockade could be an effective therapy for irAEs management without dampening the efficacy of ICIs. Prospective clinical trials with longitudinal blood, tumor, and inflamed tissue biopsies are planned to accurately validate these findings and better study the immunobiology of irAEs.Ethics ApprovalThe study was approved by The University of Texas MD Anderson Cancer Center intuition’s Ethics Board, approval number PA19-0089

scholarly journals Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Andrew W. Kirkpatrick ◽  
Jessica L. McKee ◽  
John M. Conly
Keyword(s):  
At Risk ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Human Life ◽  
Vital Signs ◽  
Home Monitoring ◽  
Cost Effective ◽  
Care Providers ◽  
Vital Signs Monitoring ◽  
Ultrasound Probes

AbstractCOVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

scholarly journals AB0381 THE UTILITY OF HYDROXYCHLOROQUINE (HCQ) THERAPY FOR TWO YEARS AS A SPARING CORTICOSTEROID AGENCY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1490.3-1491
Author(s):  
K. Inoue ◽  
K. Misaki ◽  
N. Dobashi ◽  
M. Miyazaki ◽  
Y. Mako ◽  
...  
Keyword(s):  
Adverse Events ◽  
Maintenance Therapy ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Statistical Significance ◽  
Disease Activity Index ◽  
Patient Characteristics ◽  
Serum Complement ◽  
Wbc Count ◽  
Study Dose

Background:Prednisolone (PSL) and HCQ are key drugs in the therapy of SLE. However, since PSL induce many harmful adverse events, PSL is preferred to be reduced especially in the maintenance therapy. The efficacy of HCQ for reducing the dose of PSL has not been revealed yet. So, we focused on the cessation of PSL under the treatment of HCQ with conventional SLE therapy.Objectives:The aim of this study is to evaluate the efficacy and the safety of HCQ as co-treatment in the standard therapy of SLE.Methods:SLE patients (n=30) under the maintenance therapy were enrolled in this study. Dose of PSL, titer of anti-DNA antibody, WBC count, serum complement and SLE disease activity index (SLEDAI) were examined retrospectively at 0 and 12 months after administration of HCQ.Results:Baseline patient-characteristics are as follows (mean±S.E); the age of patients was 54.4±3.2 years old, 21 patients (70%) were female, the disease duration was 108.5±25.2 months, SLEDAI was 4.0±0.9, the dose of PSL was 10.3±1.7 mg/day, the titer of anti-DNA antibody was 7.3±1.8 IU/ml, C3 was 85±4.3 mg/dl and C4 was 18±1.6 mg/dl.The mean dose of PSL was reduced with statistically significance (pre-administration of HCQ:10.3±1.7 mg/day, 24 months after administration of HCQ:2.2±0.3 mg/day,p<0.0001). Furthermore, in this observation period, 6 patients could achieve the cessation of PSL.SLEDAI was also significantly reduced (4.0±0.9 vs 1.0±0.3,p<0.01).There was no statistical significance between before treatment by HCQ and after treatment in the titer of anti-DNA antibody (7.3±1.8 vs 2.8±1.6 IU/ml,p=0.06), WBC count (6208±4.9 vs 5096±3.3 /μl,p=0.06) and serum complement level (C3 85±4.3 mg/dl vs 89±4.0 mg/dl,p=0.52, C4 18±1.6 mg/dl vs 19±1.4 mg/dl,p=0.45). Relapse of SLE was clarified in only one patient.As for adverse events (AEs), Severe bacterial infection (n=4), herpes zoster (n=1) and patellar tendon rupture (n=1) were revealed. All cases of the AEs were fully recovered.Conclusion:Our study suggested that co-treatment with HCQ on standard SLE therapy could be enable to prevent the flare of SLE and reduce the dose of PSL with statistical significance. In some cases, we could achieve the cessation of PSL treatment.References:None.Disclosure of Interests:None declared

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