Pattern of albumin consumption in patients hospitalized in intensive care unit of two teaching hospitals in Iran

2021 ◽  
Author(s):  
Hadis Valapour ◽  
Mohammad Hossien Jarrahzadeh ◽  
Seyed Mojtaba Sohrevardi
Keyword(s):  
Intensive Care ◽  
Health Care Professionals ◽  
Analytical Study ◽  
Burn Injury ◽  
Human Albumin ◽  
Teaching Hospitals ◽  
Major Surgery ◽  
Consumption Pattern ◽  
Expensive Drug ◽  
The Us

Aims: The goal of this study was to evaluate the consumption pattern of human albumin according to the available and reliable guidelines. Methods:  This research was a descriptive-analytical study. The study sample consisted of patients admitted to the intensive care units (ICUs) of Shahid Sadoughi and Rahnemoon Yazd Teaching Hospitals. In this study, 67 patients were selected. The study was carried out over three months. During the study, the albumin request by ICUs was investigated. Along with observing albumin orders' para-clinic findings were evaluated. The specific form of albumin consumption and prescription prepared by the Hospital Steering Board of Pharmacy was completed for each patient individually. Results: In this study, 65.7% of prescribed albumin was infused for approved cases by the US food and drug administration (FDA). Administration after burn injury with 32.8% and hypoalbuminemia with 19.4% of cases were the most frequently reasonable prescribed albumin. About 34.3% of prescribed albumin (18 cases) did not have FDA-approved indications. Albumin infusion after patients edema in 14.9% of cases, nutritional support 6 % and Major surgery 6% have been the most frequently incorrect prescribed albumin. Conclusion: Based on the findings of this study, the prescription of albumin in patients admitted to ICUs of Sadoughi and Rahnemoon teaching hospitals from October to December 2015 was not completely in accordance with the guidelines. So , consulting with relevant health care professionals can be helpful to improve the proper administration of this essential and expensive drug.

Surgical intensive care unit (ICU) delirium: A “psychosomatic” problem?

2010 ◽  
Vol 8 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Michel Reich ◽  
Regis Rohn ◽  
Daniele Lefevre
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Psychological Factors ◽  
Death Anxiety ◽  
Defense Mechanism ◽  
Cognitive Disorders ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Delirium

AbstractObjective:Intensive Care Unit (ICU) delirium is a common complication after major surgery and related among other potential medical precipitants to either pre-existing cognitive impairment or the intensity and length of anesthesiology or the type of surgery. Nevertheless, in some rare situations, an organic etiology is not always found, which can be frustrating for the medical team. Some clinicians working in an intensive care unit have a reluctance to seek another hypothesis in the psychological field.Method:To illustrate this, we report the case of a 59-year-old woman who developed a massive delirium during her intensive care unit stay after being operated on for a left retroperitoneal sarcoma. Interestingly, she had had no previous cognitive disorders and a somatic explanation for her psychiatric disorder could not been found. Just before the surgery, she was grieving the recent loss of a colleague of the same age, and also a close friend, and therefore had a death anxiety.Results:With this case report, we would like to point out the importance of psychological factors that might precipitate delirium in a predominately somatic environment such as an intensive care unit.Significance of results:ICU delirium can sometimes be considered as a “psychosomatic” problem with either a stress response syndrome after surgery or a defense mechanism against death anxiety. Clinicians should be aware of the possibility of such psychological factors even if they always must first rule out potential somatic causes for delirium and encourage thorough investigation and treatment of these medical causes. A collaboration with the psycho-oncologist is recommended to better manage this “psychosomatic” problem.

scholarly journals The carbon footprint of dietary guidelines around the world: a seven country modeling study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Brittany Kovacs ◽  
Lindsey Miller ◽  
Martin C. Heller ◽  
Donald Rose
Keyword(s):  
The Netherlands ◽  
Carbon Footprint ◽  
The United States ◽  
Dietary Guidelines ◽  
Consumption Patterns ◽  
Consumption Pattern ◽  
Carbon Footprints ◽  
Country Level ◽  
The Us ◽  
The World

Abstract Background Do the environmental impacts inherent in national food-based dietary guidelines (FBDG) vary around the world, and, if so, how? Most previous studies that consider this question focus on a single country or compare countries’ guidelines without controlling for differences in country-level consumption patterns. To address this gap, we model the carbon footprint of the dietary guidelines from seven different countries, examine the key contributors to this, and control for consumption differences between countries. Methods In this purposive sample, we obtained FBDG from national sources for Germany, India, the Netherlands, Oman, Thailand, Uruguay, and the United States. These were used to structure recommended diets using 6 food groups: protein foods, dairy, grains, fruits, vegetables, and oils/fats. To determine specific quantities of individual foods within these groups, we used data on food supplies available for human consumption for each country from the UN Food and Agriculture Organization’s food balance sheets. The greenhouse gas emissions (GHGE) used to produce the foods in these consumption patterns were linked from our own database, constructed from an exhaustive review of the life cycle assessment literature. All guidelines were scaled to a 2000-kcal diet. Results Daily recommended amounts of dairy foods ranged from a low of 118 ml/d for Oman to a high of 710 ml/d for the US. The GHGE associated with these two recommendations were 0.17 and 1.10 kg CO2-eq/d, respectively. The GHGE associated with the protein food recommendations ranged from 0.03 kg CO2-eq/d in India  to 1.84 kg CO2-eq/d in the US, for recommended amounts of 75 g/d and 156 g/d, respectively. Overall, US recommendations had the highest carbon footprint at 3.83 kg CO2-eq/d, 4.5 times that of the recommended diet for India, which had the smallest footprint. After controlling for country-level consumption patterns by applying the US consumption pattern to all countries, US recommendations were still the highest, 19% and 47% higher than those of the Netherlands and Germany, respectively. Conclusions Despite our common human biology, FBDG vary tremendously from one country to the next, as do the associated carbon footprints of these guidelines. Understanding the carbon footprints of different recommendations can assist in future decision-making to incorporate environmental sustainability in dietary guidance.

scholarly journals Bedside Nurse Acceptance of Intensive Care Unit Telemedicine Presence

2018 ◽  
Vol 38 (6) ◽  
pp. e1-e4 ◽  
Author(s):  
Christina Canfield ◽  
Sandra Galvin
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Nurse Practitioners ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Perception Of Support ◽  
Evidence Based Care

Since 2010, health care organizations have rapidly adopted telemedicine as part of their health care delivery system to inpatients and outpatients. The application of telemedicine in the intensive care unit is often referred to as tele-ICU. In telemedicine, nurses, nurse practitioners, physicians, and other health care professionals provide patient monitoring and intervention from a remote location. Tele-ICU presence has demonstrated positive outcomes such as increased adherence to evidence-based care and improved perception of support at the bedside. Despite the successes, acceptance of tele-ICU varies. Known barriers to acceptance include perceptions of intrusiveness and invasion of privacy.

Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals

2018 ◽  
Vol 39 (12) ◽  
pp. 1494-1496 ◽  
Author(s):  
Ana Cecilia Bardossy ◽  
Takiah Williams ◽  
Karen Jones ◽  
Susan Szpunar ◽  
Marcus Zervos ◽  
...  
Keyword(s):  
Intensive Care ◽  
Urinary Tract ◽  
Intensive Care Units ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Urinary Catheter ◽  
Teaching Hospitals ◽  
Positive Urine ◽  
Tract Infections ◽  
Catheter Care

AbstractWe compared interventions to improve urinary catheter care and urine culturing in adult intensive care units of 2 teaching hospitals. Compared to hospital A, hospital B had lower catheter utilization, more compliance with appropriate indications and maintenance, but higher urine culture use and more positive urine cultures per 1,000 patient days.

scholarly journals Smart Glasses for Caring Situations in Complex Care Environments: Scoping Review

10.2196/16055 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e16055
Author(s):  
Charlotte Romare ◽  
Lisa Skär
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Scoping Review ◽  
Health Care Professionals ◽  
Qualitative Content Analysis ◽  
High Tech ◽  
Anesthesia Care ◽  
Complex Care ◽  
Smart Glasses

Background Anesthesia departments and intensive care units represent two advanced, high-tech, and complex care environments. Health care in those environments involves different types of technology to provide safe, high-quality care. Smart glasses have previously been used in different health care settings and have been suggested to assist health care professionals in numerous areas. However, smart glasses in the complex contexts of anesthesia care and intensive care are new and innovative. An overview of existing research related to these contexts is needed before implementing smart glasses into complex care environments. Objective The aim of this study was to highlight potential benefits and limitations with health care professionals' use of smart glasses in situations occurring in complex care environments. Methods A scoping review with six steps was conducted to fulfill the objective. Database searches were conducted in PubMed and Scopus; original articles about health care professionals’ use of smart glasses in complex care environments and/or situations occurring in those environments were included. The searches yielded a total of 20 articles that were included in the review. Results Three categories were created during the qualitative content analysis: (1) smart glasses as a versatile tool that offers opportunities and challenges, (2) smart glasses entail positive and negative impacts on health care professionals, and (3) smart glasses' quality of use provides facilities and leaves room for improvement. Smart glasses were found to be both a helpful tool and a hindrance in caring situations that might occur in complex care environments. This review provides an increased understanding about different situations where smart glasses might be used by health care professionals in clinical practice in anesthesia care and intensive care; however, research about smart glasses in clinical complex care environments is limited. Conclusions Thoughtful implementation and improved hardware are needed to meet health care professionals’ needs. New technology brings challenges; more research is required to elucidate how smart glasses affect patient safety, health care professionals, and quality of care in complex care environments.

scholarly journals Intensive Care Unit Acquired Hypernatremia after Major Surgery is Associated with Urine Concentrating Defect: An Observational Study

2020 ◽  
Author(s):  
Philipp Deetjen ◽  
Ulrich Jaschinski ◽  
Axel Heller
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Water Balance ◽  
Water Conservation ◽  
Sodium Excretion ◽  
Free Water ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Water Excretion

Abstract Background: Although intensive care acquired hypernatremia is a common event, limited knowledge exists about the pathogenesis of this disorder. The present study attempts to show that patients undergoing major surgery develop hypernatremia in the presence of both high salt and volume load and concentration disorder of the kidney with insufficient sodium excretion.Methods: In a retrospective study, all patients who were admitted to a 40-bed tertiary surgical intensive care unit of a university hospital from July 2019 to December 2019 with major surgery were examined. Hypernatremia was defined as a sodium value exceeding 145 mmol/l. In addition to the analysis of all patients, complete water and salt balances were performed in a smaller subgroup with 142 patients.Results: 23.9% of patients undergoing major surgery developed hypernatremia, whereby hypernatremia was associated with increased mortality. Patients with hypernatremia showed a renal concentration defect with decreased urine sodium concentration (65 (IQR: 44.8-90) mmol/l vs 78 (IQR: 46-107) mmol/l, p = 0.007) and decreased urine osmolality (514 (IQR: 465-605) mmol/l vs 602 (IQR: 467-740) mmol/l, p < 0.001). In the subgroup of patients with complete sodium and water balance, a positive salt and water balance was observed. After propensity score matching, we found a significantly increased electrolyte free water clearance (1020 ±1740 ml vs -560 ±1620 ml, p <0.001) in the hypernatremia group, together with an inadequately lower total sodium urine excretion (401 ±303 mmol vs 593 ±400 mmol, p = 0.02). Conclusion: The present study shows that postoperative hypernatremia is associated with an imbalance between perioperative salt and water load and renal sodium and water handling with inadequately low renal sodium excretion and inadequately high renal water excretion. The underlying renal concentration disorder may be explained by a defect in a natriuretic-ureotelic response a recently described renal urea-mediated water conservation mechanism after salt exposure.

Abstract 237: Patient and Center Level Characteristics for Critically Ill Cardiac Encounters Across 2 Care Settings

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Panagis Galiatsatos ◽  
Tiffany Powell-Wiley ◽  
Xiaobai Li ◽  
Sameer Kadri ◽  
Dorothea McAreavey ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Severity Of Illness ◽  
Teaching Hospitals ◽  
Hospital Death ◽  
Hospital Level ◽  
Convenience Sample ◽  
Advanced Therapies ◽  
Group 2 ◽  
Group 1

Introduction: Cardiac intensive care involves delivery of comprehensive critical care using advanced therapies for high-risk conditions. It is unclear if the outcomes such patients experience are evenly distributed throughout all care settings and what patient- and hospital-level factors impact these health outcomes. We evaluated the distribution of case-mix, acuity and processes of care from a nationally reflective convenience sample of intensive care units (ICUs). Methods: The Cerner Healthfacts Database was used to identify critically ill cardiac encounters (CICE). The sample consisted of inpatients hospitalized between January 2009 and December 2014 coded with a cardiac principal diagnosis and requiring direct admission or transfer to an ICU within 48 hours of hospital admission. Hospitals were dichotomized into those with a single undifferentiated ICU (Group 1) and those with a multidisciplinary ICU framework (≥1 ICU including at least 1 cardiac type; Group 2). Results: There were a total of 44012 individual hospital encounters in 68 hospitals, including 18001 patients in Group 1 and 26011 in Group 2. The majority of hospitals in Group 2 were teaching. There were no difference in admission SOFA score for cardiac patients admitted to the ICU, and no difference in the unadjusted in-hospital death rates. Further hospital-level factors are in Table 1. Acute myocardial infarction was the leading diagnosis in Group 1 (6429 encounters; 35.7% of total encounters) and Group 2 (11394 encounters; 43.8% of total encounters). Conclusion: Critically ill patients with cardiac diagnoses demonstrated equivalent baseline severity of illness, in-hospital mortality and lengths of stay when admitted to hospitals with single of multiple ICU care settings. However, hospitals with a multi-ICU setting tended to be teaching hospitals.

Propofol as a Drug of Diversion: Changing Disposal Practices to Reduce Risk

2021 ◽  
Vol 41 (6) ◽  
pp. 45-53
Author(s):  
Michael T. Ring ◽  
Dale M. Pfrimmer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Activated Carbon ◽  
Health Care Professionals ◽  
Ecological Impact ◽  
High Volume ◽  
Operating Rooms ◽  
Ease Of Use ◽  
Control Mechanisms ◽  
Drug Diversion

Background Propofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods. Local Problem Objectives were to reduce the risk of drug diversion and diminish the environmental impact of medication discarded down the sink. Disposing of residual propofol into activated carbon pouches was successful and sustainable in operating rooms at the study institution. Literature findings supported this intervention because of propofol’s potential for abuse, ongoing diversion events, ease of access, poor control mechanisms, lack of standardization, excessive waste, and ecological impact. Methods The intensive care unit with the highest propofol use was selected to replicate the propofol disposal process used in the operating rooms. Activated carbon pouches and bottle cap removal tools were located in each intensive care unit room at the nurses’ workstation for ease of use. Audits of unsecured waste bins and staff surveys of institutional policy awareness, disposal processes, barriers, and concerns were completed before and after the intervention. Results Survey results determined significant concern for drug diversion risk. The pilot project displayed success: 44.1% of propofol bottles in waste bins were full before the intervention and 0% were full afterward. Conclusion Following institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.

Adults Who Lack Capacity to Consent and Deprivation of Liberty

2020 ◽  
pp. 93-110
Author(s):  
Daniele Bryden
Keyword(s):  
Intensive Care ◽  
Best Interests ◽  
Care Practice ◽  
Intensive Care Treatment ◽  
The Us ◽  
Life Threatening ◽  
Substituted Judgement ◽  
Sound Mind ◽  
Definition Of ◽  
Mental Capacity Act

The basic presumption of the Mental Capacity Act that an individual has capacity to make decisions regarding treatment is frequently challenged within intensive care practice where individuals are often incapacitated due to the nature of their condition or treatment for it. Because many conditions are life-threatening, treatment is frequently administered on the basis of an assumption that it provides an overall benefit to the person and that their interests are best served by preservation of life. There is now a statutory definition of best interests although factors in its determination can at times be opaque, which suggests a gradual move towards the US-based ‘substituted judgement’ test. An individual can be lawfully prevented from leaving the intensive care unit while receiving intensive care treatment provided that treatment is given in good faith and is materially the same as would be given to a person of sound mind with the same physical illness.

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