scholarly journals Real-time Adaptive & Predictive Indicator of Deterioration (RAPID) A collaborative development by Birmingham Children’s Hospital, McLaren Applied Technologies Limited, Aston University, Isansys Lifecare Ltd & University of Birmingham

2020 ◽  
Author(s):  
Heather Duncan ◽  
Balazs Fule ◽  
David Lowe
Keyword(s):  
Intensive Care ◽  
Early Warning ◽  
Early Warning Systems ◽  
Patient Specific ◽  
Formula One ◽  
Children's Hospital ◽  
High Dependency ◽  
Hospital Patients ◽  
Children’S Hospital ◽  
Life Threatening

Abstract 1.5 million UK children are admitted to hospital every year. Approximately 650 suffer cardiac arrest and 2,900 will die in hospital. Early warning systems are recommended to reduce avoidable complications and death. To reduce or eliminate avoidable life-threatening illness developing in hospital, patients need to be identified reliably and quickly to people who can treat them effectively. We are combining the clinical expertise of a Specialist Children’s Hospital with the technology expertise of Formula One racing to monitor and care for children more effectively. This project will build upon prior work in Intensive Care where we have used McLaren Formula One technology to accentuate changes in monitored physiology and develop smart patient specific alarms (http://www.bbc.co.uk/news/technology-18997318). We will have children in the cardiac wards continuously monitored with small wireless sensors. We will combine their vital sign information with other risks related to their general health and display this combined early warning to doctors and nurses. When children are deteriorating they can quickly be identified, the required expert can be called to the bedside and, if necessary, the child could be moved to High Dependency or Intensive Care.This study is to establish that we can collect continuous remote monitoring and act on it to improve patient outcomes. The benefits to patients participating in this study will be reduced duration of stay in hospital and Intensive Care, reduced acute life-threatening events, and less anxiety about intermittent observations or deterioration.Beyond this project, we will take the technology to the rest of the hospital patients and then out of the hospital to patients at home and paramedics at the roadside.

scholarly journals Comparing Vancomycin Area Under the Curve With a Pharmacist Protocol that Incorporates Trough and Maximum Doses at a Children's Hospital

2021 ◽  
Vol 26 (7) ◽  
pp. 740-745
Author(s):  
Betool O. Al-Mazraawy ◽  
Jennifer E. Girotto
Keyword(s):  
Area Under The Curve ◽  
Kidney Injury ◽  
Population Data ◽  
Patient Specific ◽  
Prospective Data ◽  
Children's Hospital ◽  
Dose Modification ◽  
Hospital Patients ◽  
Children’S Hospital ◽  
Secondary Analyses

OBJECTIVE Updated vancomycin guidelines suggest dose adjustment based on area under the curve in a 24-hour period (AUC24). This study aims to determine whether a pharmacist managed vancomycin protocol that incorporates maximum dosing paired with trough monitoring can achieve appropriate vancomycin AUC24 exposures. METHODS A retrospective review was performed evaluating vancomycin usage from October 2018 through September 2019 at a children's hospital. Patients with less than 4 doses or lack a trough concentration were excluded. Vancomycin AUC24 were estimated using 2 calculations: 1) the Le method, incorporating age and serum creatinine, and 2) the trapezoidal method based upon population data and patient-specific trough. Target AUC24 ranges were assessed. AUC24 goals were 400 to 600 mg·hr/L, but due to known variations between calculations, a variance of 20 mg·hr/L was allowed for each end of the goal. Secondary analyses included evaluations of efficacy and toxicity. RESULTS Two-hundred twenty-three patients were included. Initial doses were estimated to meet AUC24 goals in only 63%. After trough-based dose modification, 81% achieved a therapeutic AUC24. Using the trapezoidal method, therapeutic concentrations were found in 51% of patients based on the initial dose and 77% after dose modification. Only 6.3% of patients had kidney injury with only 1 of those patients having any calculated AUC24 > 600 mg·hr/L and none above 620 mg·hr/L. No clinical failures were identified. CONCLUSIONS Increased initial dosing in infants and children is needed to result in AUC24 exposures recommended in the guidelines. Maximum dosing paired with trough monitoring may be an alternative to AUC24 monitoring in areas that are unable to perform AUC24 calculations. Prospective data are needed to validate these conclusions.

An Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit

2003 ◽  
Vol 24 (5) ◽  
pp. 317-321 ◽  
Author(s):  
Lisa Saiman ◽  
Alicia Cronquist ◽  
Fann Wu ◽  
Juyan Zhou ◽  
David Rubenstein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Methicillin Resistant ◽  
Children's Hospital ◽  
Surveillance Cultures ◽  
Children’S Hospital ◽  
Incident Cases

AbstractObjective:To describe the epidemiologic and molecular investigations that successfully contained an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal intensive care unit (NICU).Design:Isolates of MRSA were typed by pulsed-field gel electrophoresis (PFGE) and S. aureus protein A (spa).Setting:A level III-IV, 45-bed NICU located in a children's hospital within a medical center.Patients:Incident cases had MRSA isolated from clinical cultures (eg, blood) or surveillance cultures (ie, anterior nares).Interventions:Infected and colonized infants were placed on contact precautions, cohorted, and treated with mupirocin. Surveillance cultures were performed for healthcare workers (HCWs). Colonized HCWs were treated with topical mupirocin and hexachlorophene showers.Results:From January to March 2001, the outbreak strain of MRSA PFGE clone B, was harbored by 13 infants. Three (1.3%) of 235 HCWs were colonized with MRSA. Two HCWs, who rotated between the adult and the pediatric facility, harbored clone C. One HCW, who exclusively worked in the children's hospital, was colonized with clone B. From January 1999 to November 2000, 22 patients hospitalized in the adult facility were infected or colonized with clone B. Spa typing and PFGE yielded concordant results. PFGE clone B was identified as spa type 16, associated with outbreaks in Brazil and Hungary.Conclusions:A possible route of MRSA transmission was elucidated by molecular typing. MRSA appears to have been transferred from our adult facility to our pediatric facility by a rotating HCW. Spa typing allowed comparison of our institution's MRSA strains with previously characterized outbreak clones.

Application of Early Warning Nursing System During COVID-19 Epidemic in Children’s Hospital

Nano LIFE ◽  
2021 ◽  
pp. 2140004
Author(s):  
Wenying Yao ◽  
Jinxia Yang ◽  
Xin Wang ◽  
Min Shen
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Warning System ◽  
Popular Science ◽  
The Novel ◽  
Children's Hospital ◽  
Hospital Nursing ◽  
Children’S Hospital ◽  
Novel Coronavirus ◽  
And Control

Aim: To develop a nursing early warning system in children’s hospital during the outbreak of the novel coronavirus pneumonia, and to accomplish the construction and application of this system, so as to provide decision-support of the prevention and control for COVID-19 in children’s medical institutions. Method: Children’s hospital nursing early warning system was divided into three modules: hospital nursing early warning platform includes internal and external early warning platform, nursing staff early warning program includes protection, human resources early warning plan and patient early warning program includes outpatient, emergency and ward early warning plan. The data of epidemic training, assessment, prevention and control screening from January to June 2020 were collected from the nursing early warning system to evaluate the application effect of the system. Results: A total of 18 procedures and specifications were formulated, nine hospital-level trainings and about 1000 department-level trainings were organized, two hospital-level assessments (pass rate 95.6% and 98.2%), and 78 nurses were reserved, and 10 popular science articles, five popular science videos were published during the application of the nursing early warning system. A total of 583,435 children and 139,308 caregivers were screened in outpatient, emergency and wards during pre-checks, 2385 suspected cases of novel coronavirus pneumonia were confirmed (0.41%) after the screening and 1 case (0.0002%) was finally confirmed. Conclusion: The nursing early warning system of children’s hospital can prevent and control the novel coronavirus pneumonia epidemic from each module, ensure early warning and triage of suspected infected patients, reduce the risk of cross-infection in hospital and improve the safety of the children’s hospital medical environment.

scholarly journals Sepsis epidemiology and outcome in the paediatric intensive care unit of Vilnius University Children’s Hospital

2017 ◽  
Vol 24 (2) ◽  
pp. 113-120
Author(s):  
Odeta Bobelytė ◽  
Ieva Gailiūtė ◽  
Vytautas Zubka ◽  
Virginija Žilinskaitė
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Paediatric Intensive Care Unit ◽  
Paediatric Intensive Care ◽  
Multi Drug Resistance ◽  
Registration System ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Vilnius University ◽  
Hospital Acquired

Research was carried out at the paediatric intensive care unit (paediatric ICU) of the  Children’s Hospital, affiliate of Vilnius University Hospital Santariškių klinikos. Background. Being the most common cause of children’s death, sepsis is a challenge for most physicians. In order to improve the outcomes, it is important to know the aetiology and peculiarities of sepsis in a particular region and hospital. The aim of this study was to analyse the outcomes of sepsis in a paediatric intensive care unit and their relation with patients’ characteristics and causative microorganisms. Materials and Methods. A retrospective analysis of the Sepsis Registration System in Vilnius University Children’s hospital was started in 2012. From 2012 to 2015, we found 529 sepsis cases in our hospital, 203 of which were found to be fulfilling all of the inclusion criteria (patient’s age >28 days on admission, taken blood culture/positive PCR test, need for paediatric ICU hospitalization) and were included in the final analysis. Abbreviations: ICD – international disease classification PCR – polymerase chain reaction Results. Sepsis made 4% of all patients of the paediatric ICU in the period from 2012 to 2015 and caused 32% of deaths in the unit. Paediatric mortality reached 14% of all sepsis cases in our analysis, the majority of them due to hospital-acquired sepsis that occurred in patients suffering from oncologic or hematologic diseases. Another significant part of the patients that did not survive were previously healthy with no co-morbidities. The  most common microorganism in lethal community-acquired cases was N. meningitidis and in hospital-acquired sepsis – Staphylococcus spp. Multi-drug resistance was observed, especially in the cases of hospital-acquired sepsis. Conclusions. A large percentage of lethal outcomes that occur in the paediatric ICU are due to sepsis. The majority of lethal cases of sepsis occur in patients suffering from chronic co-morbidities, such as oncologic, hematologic, neurologic, and others.

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