scholarly journals Evaluation of the identification protocol for newborns in a private hospital

2012 ◽  
Vol 20 (4) ◽  
pp. 659-667 ◽  
Author(s):  
Ellen Regina Sevilla Quadrado ◽  
Daisy Maria Rizatto Tronchin
Keyword(s):  
Private Hospital ◽  
Intensive Therapy ◽  
Case Series ◽  
Conformity Index ◽  
Intensive Therapy Unit ◽  
Second Stage ◽  
Significant Difference ◽  
Three Stages ◽  
Random Probability

This exploratory-descriptive quantitative study aimed to evaluate the protocol for identifying newborns admitted to the Neonatal Intensive and Semi-intensive Therapy Unit of a private hospital. The case series was made up of 540 observation opportunities, selected by simple random probability sampling. The data was collected between May and August 2010 according to a form and analyzed by descriptive statistic. The protocol's general performance had a conformity index of 82.2%. There were three stages to the protocol: identification components, the identification wristbands' condition and the number of identification wristbands. The highest percentage of conformity (93%) was attributed to the second stage and the lowest (89.3%) to the third, presenting a statistically significant difference of p= 0.046. In the group of 'special' neonates, 88.5% conformity was achieved. These results will make it possible to restructure the protocol for identifying newborns and to establish care and managerial goals so as to improve the quality of care and the patients' safety.

scholarly journals An analytical observational study on the prognostic implication of postoperative serial serum lactate level for complications and predicting length of intensive therapy unit stay after major abdominal surgery

2021 ◽  
Vol 9 (5) ◽  
pp. 1428
Author(s):  
Moumita Mondal ◽  
Sankari Santra ◽  
Rajat Choudhuri ◽  
Amartya Das
Keyword(s):  
Respiratory Failure ◽  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Intensive Therapy ◽  
Wound Dehiscence ◽  
Serum Lactate ◽  
Serum Lactate Level ◽  
Intensive Therapy Unit ◽  
Significant Difference ◽  
Lactate Levels

Background: Post-operative microcirculatory alteration causes hypoperfusion, tissue hypoxia and organ dysfunction, resulting in significant morbidity and mortality. Increase in serum lactate level in response to tissue hypoxia may serve as a cost effective tool to assess status of all organ dysfunction being sensitive but not organ specific and may help in early prognostication. Aim of this study was to investigate the association of blood lactate levels during the first 24 hours after surgery with postoperative morbidity and mortality, with length of ITU stay and to correlate the lactate values at various time points with different postoperative complications (POC).Methods: 150 patients undergoing elective abdominal surgery were included. Blood lactate (mmol/lit) levels were measured immediately on admission to the Intensive Therapy Unit (ITU) and at 6, 12, and 24 hours of admission. The parameters of clinical outcome included were mortality, shock, Acute kidney injury (AKI), respiratory failure, wound dehiscence and length of ITU stay. Heart Rate, Mean Arterial Pressure, spo2, Temperature and Urine output were also measured.Results: There was statistically significant difference in the lactate levels measured at the above mentioned point of time (0, 6, 12 and 24h) in cases with death and without fatal outcome, with and without respiratory failure, with and without AKI, with and without shock and in cases with and without wound dehiscence (p<0.05). There was a statistically significant difference in urine output, duration of ITU stay and duration of intubation (p<0.05).Conclusions: Increased serum lactate levels were significantly associated with postoperative complications, mortality and length of ITU stay in patients undergoing major elective abdominal surgery.

The Evidence Base of Neuropsychological Rehabilitation in Acquired Brain Impairment (ABI): How Good is the Research?

2006 ◽  
Vol 7 (2) ◽  
pp. 119-132 ◽  
Author(s):  
Michael Perdices ◽  
Regina Schultz ◽  
Robyn Tate ◽  
Skye McDonald ◽  
Leanne Togher ◽  
...  
Keyword(s):  
Research Design ◽  
Methodological Quality ◽  
Case Series ◽  
Evidence Base ◽  
Speech Disorders ◽  
Single Subject ◽  
Target Area ◽  
Level Of Evidence ◽  
Significant Difference

AbstractIn the context of evidence-based clinical practice (EBCP), the reliability of empirical data is largely determined by the methodological quality of research design. PsycBITE™ (Psychological Database of Brain Impairment Treatment Efficacy) is a web-based database listing all published, empirical reports on the effectiveness of nonpharmacological interventions for the psychological consequences of acquired brain impairment (ABI). The aim of this study was to survey the listings of PsycBITE™ and examine the methodological quality of the reports it contains. Reports listed in PsycBITE™ include systematic reviews (SRs), randomised controlled trials (RCTs), non-RCTs, case series (CSs) and single-subject designs (SSDs). They are indexed according to research design, neurological group, patient age group, target area and intervention type. The PEDro Scale is used to rate the methodological quality of RCTs, nonRCTs and CSs, with maximum obtainable methodological quality rating (MQR) of 10/10, 8/10 and 2/10 respectively. A search identified 1298 reports indexed in PsycBITE™. The largest proportion was SSDs (39%), followed by CSs (22%), RCTs (21%), non-RCTs (11%) and SRs (7%). The majority of reports was concerned with stroke (41%), traumatic brain injury (29%) and Alzheimer's and related dementias (22%). The most frequently investigated deficits were communication/language/speech disorders (24%); independent/self-care activities (19%); behaviour problems (17%); memory impairments (17%); anxiety, depression, stress, adjustment (15%). Approximately half of the RCTs, non-RCTs and CSs were rated for methodological quality. Mean MQR scores for RCTs, non-RCTs and CSs were 4.49, 2.85 and 1.15 respectively. While some PEDro criteria were met by a high proportion of RCTs and non-RCTs (≥ 70%), other criteria were only met by a small proportion of reports (as low as 1.6%). There was no significant difference in MQR scores between RCTs focusing on different neurological groups or target areas. Furthermore, there was no discernible improvement in MQR score for RCTs published over the last three decades. The methodological quality of studies investigating the efficacy of rehabilitation interventions in ABI has been consistently modest over several decades. This is largely attributable to poor adherence to fundamental tenets of research design, and requires urgent remediation. RCTs (and to a lesser extent, non-RCTs) are research methodologies which can potentially yield a high level of evidence, but only if they are adequately designed. PsycBITE™ has the facility to raise awareness of these issues and be instrumental in promoting EBCP in the field of ABI.

Quality of Voice Evaluation in Patients Treated by Supracricoid Laryngectomy and Modified Supracricoid Laryngectomy

2011 ◽  
Vol 145 (5) ◽  
pp. 789-795 ◽  
Author(s):  
Eugenia Allegra ◽  
Nicola Lombardo ◽  
Alessandro La Boria ◽  
Giuseppe Rotundo ◽  
Maria Rita Bianco ◽  
...  
Keyword(s):  
Case Series ◽  
Voice Handicap Index ◽  
Partial Laryngectomy ◽  
Supracricoid Laryngectomy ◽  
Nasogastric Feeding ◽  
Tube Removal ◽  
Significant Difference ◽  
Quality Of Voice ◽  
Length Of Hospitalization

Objective. To compare quality of voice in patients treated by supracricoid laryngectomy and patients treated by modified supracricoid laryngectomy using the sternohyoid muscle for neoglottis reconstruction. Study Design. Case series. Setting. Teaching hospital. Subjects and Methods. This study was performed between 2004 and 2008 on 28 consecutive patients affected by T1b-T2 laryngeal carcinoma. Eleven patients were treated by supracricoid laryngectomy, and 17 patients were treated by modified supracricoid laryngectomy. For each patient, postoperative parameters such as decannulation time, nasogastric feeding tube, and length of hospitalization were noted. Vocal function, Voice Handicap Index scores, and perceptual voice analysis scores on intelligibility, noise, fluency, and voice scale were evaluated. Results. The postoperative course of the patients treated by modified supracricoid laryngectomy was similar to patients treated by supracricoid laryngectomy. No delay in the length of hospitalization was detected in patients undergoing surgery with the new technique. A significant difference was detected in the nasogastric tube removal time and decannulation time. The data from intelligibility, noise, fluency, and voice scale analyses revealed a better quality of voice in patients treated by modified supracricoid partial laryngectomy with a significant difference in intelligibility, fluency, and voicing. The Voice Handicap Index mean value of physical, functional, and emotional subscales confirmed patients’ perceptions of a minor voice handicap in patients treated by modified supracricoid laryngectomy, with a significant difference on the physical subscale. Conclusion. Modified supracricoid laryngectomy seems to be a good way to improve quality of voice and quality of life in patients with early laryngeal cancer.

Plasma Cysteine and Sulphate Levels in Patients with Cirrhosis of the Liver

1994 ◽  
Vol 87 (3) ◽  
pp. 357-362 ◽  
Author(s):  
M. H. Davies ◽  
L. Klovrza ◽  
R. H. Waring ◽  
E. Elias
Keyword(s):  
Liver Disease ◽  
Primary Biliary Cirrhosis ◽  
Intensive Therapy ◽  
Biliary Cirrhosis ◽  
Intensive Therapy Unit ◽  
Control Subjects ◽  
Significant Difference ◽  
Catabolic State ◽  
Healthy Control ◽  
Muscle Breakdown

1. Fasting levels of plasma cysteine, plasma sulphate and the plasma cysteine/sulphate ratio were measured in patients with primary biliary cirrhosis and compared with those in patients with other liver disease, general intensive therapy unit patients and healthy subjects. 2. Plasma cysteine was significantly elevated in patients with primary biliary cirrhosis (median 0.364 nmol/mg of protein, P < 0.0001) and patients with other liver disease (median 0.445 nmol/mg of protein, P < 0.0001), compared with healthy control subjects (median 0.125 nmol/mg of protein) and increased progressively with the severity of liver disease. Plasma cysteine was also elevated in intensive therapy unit patients (median 1.564 nmol/mg of protein) compared with healthy control subjects (P < 0.0001) and patients with other liver disease (P < 0.0001). 3. Plasma sulphate was reduced significantly only in patients with primary biliary cirrhosis (median 0.822 nmol/mg of protein) compared with healthy control subjects (median 1.37 nmol/mg of protein, P < 0.05). There was no significant difference in plasma sulphate between disease groups. 4. The plasma cysteine/sulphate ratio was significantly elevated in patients with primary biliary cirrhosis (median 0.448, P < 0.0001) and patients with other liver diseases (median 0.394, P < 0.0001) compared with healthy control subjects (median 0.095). The ratio was also elevated in intensive therapy unit patients (median 1.650, P < 0.0001) compared with healthy control subjects and liver disease groups (P < 0.0001). 5. In conclusion, plasma cysteine rises in primary biliary cirrhosis and other forms of liver disease. This effect is not specific to liver disease, since cysteine is elevated in an heterogeneous group receiving intensive care. Impairment of trans-methylation and trans-sulphuration pathways does not explain the finding of increased plasma cysteine. Since cysteine is elevated in non-hepatic disease, it may reflect the effect of muscle breakdown and the catabolic state. Impaired activity of cysteine dioxygenase and impaired mitochondrial function may be contributory, but this requires further study. These metabolic changes may reflect progressively diminished detoxification capacity within the liver and other tissues.

scholarly journals SIGNIFICADO DO PROTOCOLO DE ÚLCERA POR PRESSÃO: QUALIFICANDO A GERÊNCIA DO CUIDADO DO ENFERMEIRO

2017 ◽  
Vol 8 (3) ◽  
Author(s):  
Rhea Sílvia Avila Soares ◽  
Marciane Kessler ◽  
Thaís Dresch Eberhardt ◽  
Suzinara Beartriz Soares De Lima ◽  
Silviamar Camponogara ◽  
...  
Keyword(s):  
Nursing Care ◽  
Pressure Ulcer ◽  
Matrix Theory ◽  
Intensive Therapy ◽  
University Hospital ◽  
Intensive Therapy Unit ◽  
The Matrix ◽  
Terapia Intensiva ◽  
South Of Brazil

Objetivo: compreender o significado do protocolo assistencial de Úlceras por Pressão para enfermeiros no gerenciamento do cuidado de enfermagem. Metodologia: utilizou-se a Teoria da Complexidade como referencial teórico e a Teoria Fundamentada nos Dados como referencial metodológico. A coleta dos dados foi realizada em hospital universitário do Sul do Brasil, no período de julho a setembro de 2014. Foram entrevistados 22 enfermeiros, lotados na Unidade de Terapia Intensiva Adulto, Clínica Médica II e Unidade Cardíaca Intensiva. Resultados: a partir da interconexão das categorias, o fenômeno central desvelado que representa a Matrix Teórica foi: “Significando o protocolo de Úlcera por Pressão como instrumento de qualificação para o cuidado gerencial do enfermeiro”. Conclusão: o gerenciamento do cuidado de enfermagem ao paciente com Úlcera por Pressão, utilizando o protocolo como instrumento gerencial, foi revelado pelos enfermeiros como uma prática que agrega qualidade aos cuidados realizados.Descritores: Enfermagem, Protocolos, Úlcera por Pressão, Gerência.MEANING OF PRESSURE ULCER PROTOCOL: IMPROVING THE NURSING CARE MANAGEMENTObjective: To understand the meaning of the assistance ulcer protocol for care nurses managing the nursing care. Methodology: The Complexity Theory was used as theoretical framework and Grounded Theory as methodological one. The data collection was conducted in university hospital South of Brazil, between july to september of 2014. 22 nurses were interviewed, crowded in the Adult Intensive Therapy Unit, Medical Clinic II and Intensive Cardiac Unit. Results: Based on the interconnection of categories, the main phenomenon found that represents the Matrix Theory was: “Meaning the Pressure Ulcer Protocol as instrument for improvement of the nurse managerial care”. Conclusion: Management of nursing care with patient with pressure ulcer using the protocols as managerial instrument was highlighted for nurses as a practice that improves the quality of care provided.Descriptors: Nursing, Protocols, Pressure Ulcer, Management.SIGNIFICADO DEL PROTOCOLO DE ULCERA POR PRESSIÓN: CALIFICANDO LA GERENCIA DEL CUIDADO PARA EL ENFERMEIROObjetivo: Comprender el significado del protocolo de atención de las úlceras de presión cuidados para las enfermeros en el cuidado gerencial de enfermería. Metodología: El estudio utilizo la teoría de la complexidad como referencial teórico y teoría fundamentada en los datos como referencial metodológico. 22 enfermeros fueron entrevistados en hospital universitario del Sur del Brasil. Resultados: Con base en la interconexión de las categorías, el fenómeno central encontrado fue “Significando el protocolo de ulcera por presión como instrumento de calificación para el cuidado gerencial del enfermero”. Conclusión: El gerenciamiento del cuidado de enfermería al paciente con ulcera por presión por meo de protocolos como instrumento gerencial fue revelado como una práctica que agrega calidad a los cuidados realizados.Descriptores: Enfermería, Protocolos, Úlcera por Presión, Gerencia.

A Psychiatric Study of a Pediatric Intensive Therapy Unit

1972 ◽  
Vol 11 (2) ◽  
pp. 76-82 ◽  
Author(s):  
Jack G. May
Keyword(s):  
Quality Of Care ◽  
Emotional Support ◽  
Intensive Therapy ◽  
Emotional Responses ◽  
Inappropriate Behavior ◽  
Intensive Therapy Unit ◽  
Positive Functioning ◽  
Sick Children ◽  
Psychiatric Study

A pediatric intensive therapy unit (ITU) was studied psychiatrically for six months. The emotional responses of children in an ITU are posi tive; they react with much less fear, regression, anger, depression and inappropriate behavior than expected. Parents are uniform in their enthusiasm and praise for the excellence of care, the unlimited visiting and the emotional support given by the staff. The nurses are the key to the positive functioning of ITU, with good quality of care the most important emotional supportive factor. A psychiatric consultant helps the staff maintain proficiency by helping them deal with intrastaff and patient conflicts when these arise. Pediatric ITU is a superior means of delivering physical and emotional care to very sick children.

Sacral electroacupuncture as a treatment for urge urinary incontinence: a prospective case series

2020 ◽  
pp. 096452842096884
Author(s):  
Shan Chen ◽  
Siyou Wang ◽  
Lihua Xuan ◽  
Fu Xu ◽  
Hanti Lu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Case Series ◽  
Urge Urinary Incontinence ◽  
Life Questionnaire ◽  
Improvement Rate ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

Objective: To examine the impact of electroacupuncture (EA) at the ‘four sacral points’ on urge urinary incontinence (UUI). Methods: Twenty-five patients diagnosed with UUI or urgency-predominant mixed urinary incontinence (MUI) were treated by EA at the ‘four sacral points’. EA was performed in the sacrococcygeal region using disposable sterile 0.40-mm-diameter acupuncture needles that were either 100 or 125 mm in length. Treatments were delivered once every other day. Before and after treatment, a questionnaire measuring symptom severity and quality of life associated with UUI was administered. Results: The median total score (interquartile range) from the severity of symptoms and the quality of life questionnaire (Q-score) of the participants was significantly reduced from 12 (7.5, 15) before treatment to 3 (0, 6) after 6 (6, 12) EA treatments. The Q-score of urgency-predominant MUI and UUI was 8 (5, 14.5) and 12.5 (11, 15), respectively, before treatment; after treatment these were reduced to 2 (0, 7.5) and 4.5 (2, 6), respectively. There was no statistically significant difference in the Q-score between urgency-predominant MUI and UUI before and after treatment. Upon treatment completion, seven patients (28%) were ‘cured’ (improvement rate 100%). Treatments were considered ‘markedly effective’ (improvement rate 75% to <100%) in four patients (16%), ‘effective’ (improvement rate 50% to <75%) in eight patients (32%), ‘minimally effective’ (improvement rate 25% to <50%) in three patients (12%), and ‘ineffective’ (improvement rate <25%) in three patients (12%). The overall success rate (comprising ‘cured’, ‘markedly effective’ and ‘effective’ categories) was 76%, and no adverse effects associated with acupuncture treatment were reported. Conclusion: EA at the ‘four sacral points’ was associated with statistically significant improvements in UUI.

Effect of moral empowerment program on moral distress in intensive care unit nurses

2018 ◽  
Vol 26 (5) ◽  
pp. 1494-1504 ◽  
Author(s):  
Safura Abbasi ◽  
Somayeh Ghafari ◽  
Mohsen Shahriari ◽  
Nahid Shahgholian
Keyword(s):  
Intensive Care Unit ◽  
Quality Of Care ◽  
Moral Distress ◽  
Medical Sciences ◽  
Significant Difference ◽  
Three Stages ◽  
The Mean ◽  
Experimental Group ◽  
Empowerment Program

Background: Moral distress has been experienced by about 67% of critical care nurses which causes many complications such as job dissatisfaction, loss of capacity for caring, and turnover for nurses and poor quality of care for patients as well as health system. Objective: The purpose of this research was to provide a moral empowerment program to nursing directors, school of nursing, and the heads of hospitals to reduce moral distress in nurses and improve the quality of care. Methods: This research was a randomized clinical trial conducted in two groups and three stages before, after 2 weeks, and 1 month after the intervention in order to evaluate the changes in moral distress of 60 nurses working in adults’ intensive care unit wards of Al-Zahra teaching hospital of Isfahan University of Medical Sciences. Data were collected using the standard Hamric’s Moral Distress Scale (2012) and analyzed using SPSS software version 22. Ethical considerations: This study was approved by the Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran. Results: Results showed that in the three stages, there was no significant difference between the mean score of moral distress before (4.12 ± 2.70), 2 weeks after (4.23 ± 2.70), and 1 month after the intervention (4.04 ± 2.54) in the control group (p > 0.05), while in the experimental group, there was a significant difference between the three stages (p < 0.05). The mean score of moral distress in the experimental group before intervention (4.05 ± 2.26) and 2 weeks after the intervention (3.38 ± 2.11) was not significant (p > 0.05). However, this score significantly decreased 1 month after the intervention (2.64 ± 2.23; p < 0.05). Conclusion: In this research, it was observed that moral empowerment program has been effective in reducing the mean score of moral distress. Therefore, it is recommended that nursing managers and hospital directors implement empowerment program, in order to reduce the moral distress of nurses and improve the quality of care.

scholarly journals The Effects of Preoperative Education, Marking and Adequate Positioning of Stoma on Self-Esteem and The Quality of Life of Patients with Intestinal Ostomy and Their Families

2020 ◽  
Vol 4 (2) ◽  
pp. 205-217
Author(s):  
Vesna Konjevoda ◽  
Snježana Čukljek ◽  
Sanja Ledinski Fičko ◽  
Martina Smrekar
Keyword(s):  
Quality Of Life ◽  
Self Esteem ◽  
Public Health Care ◽  
Preoperative Education ◽  
Second Stage ◽  
Search Terms ◽  
Three Stages ◽  
Insight Into ◽  
Made In

Aim. The purpose of this systematic review is to examine all available research studies on quality of life of ostomy patients and their families, which is contingent upon the effects of adequate preoperational education, the best and most acceptable ostomy site marking on the patients’ abdomen, and subsequently, the effect on the ostomy patients’ self-esteem. Methods. A literature search was carried out using scientific electronic databases - Science Direct, PubMed and Medline. Analysed period was from 2010 to 2016 in order to get insight into the most recent findings. Search terms included preoperative education, stoma marking, quality of life, self-esteem, influence on family life. Overview of articles was made in three stages. Results. We found 1440 scientific articles. In the first stage, we eliminated 1271 articles because they were unsuitable. In the second stage, we analysed 34 articles and made a conclusion based on 13 full text available articles. Conclusion. The patient is content while being treated in the hospital; however, only after the patient has been released do the hardships occur, which are often the main cause of discontent, isolation, anxiety, and fear – thus resulting in diminished quality of life. Preoperational education and marking the most acceptable place for ostomy procedure significantly affect the self-esteem and the quality of life of ostomy patients and their families. Ostomy patients need to be followed up, and the home care system, as well as the support systems of public health care for patients with a gastrointestinal ostomy, need to be strengthened.

Mode of delivery and outcomes of infants with gastroschisis: a meta-analysis of observational studies

2017 ◽  
Vol 103 (4) ◽  
pp. F355-F363 ◽  
Author(s):  
Dina W Kirollos ◽  
Mohamed E Abdel-Latif
Keyword(s):  
Vaginal Delivery ◽  
Observational Studies ◽  
Meta Analysis ◽  
Mode Of Delivery ◽  
Case Series ◽  
Sensitivity Analyses ◽  
Short Gut Syndrome ◽  
Significant Difference ◽  
The Impact

BackgroundThere is controversy among the literature for electing caesarean section (CS) delivery for infants with gastroschisis in an attempt to reduce mortality and morbidity.ObjectiveThis meta-analysis investigates whether there is enough evidence to support CS delivery over vaginal delivery.Data sourcesWe conducted our search in April 2017. We searched Cochrane, Medline, Premedline, Embase, CINAHL, GoogleScholar and Web of Science. We also searched conferences for abstracts online. Additional studies were retrieved by reviewing reference lists.Study selectionObservational studies, excluding case series, were eligible if data compared relevant outcomes of infants with gastroschisis in relation to mode of delivery.Data extractionRelevant information were extracted and assessed the methodological quality of the retrieved records.ResultsThirty-eight studies were included. Evidence suggested that mode of delivery is not significantly associated with overall mortality (OR 0.82, 95% CI 0.57 to 1.18), primary repair (OR 0.82, 95% CI 0.57 to 1.18), neonatal mortality (OR 1.08, 95% CI 0.54 to 2.15), necrotising enterocolitis, secondary repair, sepsis, short gut syndrome, duration until enteral feeding and duration of hospital stay. Furthermore, sensitivity analyses based on economic status and quality of study showed no significant difference between the impact of mode of delivery for all investigated outcomes.LimitationsDue to uncontrolled variables between and within studies, particularly regarding characteristics of delivery and postdelivery care, it is difficult to extract meaningful results from the literature.ConclusionsThere is insufficient evidence to advocate the use of CS over vaginal delivery for infants with gastroschisis.

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