scholarly journals Disease-Related Risk Factors for CVC-Related Symptomatic Thrombosis in Surgical ICU Inpatients

2020 ◽  
Author(s):  
Xiaochun Liu ◽  
Yunlin Zhu ◽  
Zhiming Kuang ◽  
Guofu Zheng ◽  
Yuanfei Liu
Keyword(s):  
Risk Factors ◽  
Electronic Medical Record System ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Record System ◽  
Related Risk ◽  
Medical Record System ◽  
Surgical Icu ◽  
Independent Risk Factors

Abstract To report the rate of symptomatic catheter-related venous thrombosis (CRVT) in surgical intensive care unit patients receiving central venous catheters (CVC) and analyze the disease-related risk factors for symptomatic CRVT in SICU patients. A retrospective analysis was performed on 1643 critically ill patients admitted to the SICU from January 2015 to December 2019. Cases were divided into two groups based on the presence of symptomatic CRVT, and the variables of interest were extracted from the electronic medical record system. Logistic univariate and multivariate regression analyses were used to determine the risk factors of SCRVT. A total of 209 symptomatic CRVT events occurred among 2114 catheters. Multivariate analysis showed that trauma (odds ratio [OR], 2.046; 95% confidence interval [CI] [1.325-3.160], P = 0.001), major surgery (OR, 2.457; 95% CI [1.641-3.679], P = 0.000), and heart failure (OR, 2.087; 95% CI [1.401-3.111], P = 0.000) were independent risk factors for symptomatic CRVT in SICU. The AUROC for this model was 0.610 (95% CI [0.569-0.651], P=0.000). The incidence rate was 9.89%. For patients hospitalized in the SICU, especially those admitted with these three conditions, thromboprophylaxis and/or mechanical prophylaxis should be actively provided to reduce the occurrence of symptomatic CRVT.

A Heterogeneous Outbreak ofEnterobacter cloacae and Serratia marcescensInfections in a Surgical Intensive Care Unit

2000 ◽  
Vol 21 (7) ◽  
pp. 465-469 ◽  
Author(s):  
Grant Dorsey ◽  
Hena T. Borneo ◽  
Sumi J. Sun ◽  
Jennifer Wells ◽  
Lynn Steele ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Invasive Disease ◽  
Surgical Intensive Care Unit ◽  
Pfge Analysis ◽  
Surgical Intensive Care ◽  
Central Lines ◽  
Staffing Levels ◽  
Outbreak Period ◽  
Related Risk

Objective:To investigate an outbreak of invasive disease due toEnterobacter cloacaeandSerratia marcescensin a surgical intensive care unit (ICU).Design:Pulsed-field gel electrophoresis (PFGE) analysis of restriction fragments was used to characterize the outbreak isolate genotypes. A retrospective cohort study of surgical ICU patients was conducted to identify risk factors associated with invasive disease. Unit staffing data were analyzed to compare staffing levels during the outbreak to those prior to and following the outbreak.Setting:An urban hospital in San Francisco, California.Patients:During the outbreak period, December 1997 through January 1998, there were 52 patients with a minimum ICU stay of ≥72 hours. Of these, 10 patients fit our case definition of recovery ofE cloacaeorS marcescensfrom a sterile site.Results:PFGE analysis revealed a highly heterogeneous population of isolates. Bivariate analysis of patient-related risk factors revealed duration of central lines, respiratory colonization, being a burn patient, and the use of gentamicin or nafcillin to be significantly associated with invasive disease. Both respiratory colonization and duration of central lines remained statistically significant in a multivariate analysis. Staffing data suggested a temporal correlation between understaffing and the outbreak period.Conclusions:Molecular epidemiological techniques provided a rapid means of ruling out a point source or significant cross-contamination as modes of transmission. In this setting, patient-related risk factors, such as respiratory colonization and duration of central lines, may provide a focus for heightened surveillance, infection control measures, and empirical therapy during outbreaks caused by common nosocomial pathogens. In addition, understaffing of nurses may have played a role in this outbreak, highlighting the importance of monitoring staffing levels.

scholarly journals Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

2006 ◽  
Vol 27 (10) ◽  
pp. 1032-1040 ◽  
Author(s):  
David K. Warren ◽  
Rebecca M. Guth ◽  
Craig M. Coopersmith ◽  
Liana R. Merz ◽  
Jeanne E. Zack ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Active Surveillance ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Admission ◽  
The Past ◽  
Surgical Icu ◽  
Mrsa Colonization

Background.Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.Objective.To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.Design.Prospective cohort study.Setting.Surgical ICU at a teaching hospital.Patients.All patients admitted to the surgical ICU.Results.Active surveillance for MRSA by nasal culture was performed at ICU admission during a 15-month period. Patients who stayed in the ICU for more than 48 hours had nasal cultures performed weekly and at discharge from the ICU, and clinical data were collected prospectively. Of 1,469 patients, 122 (8%) were colonized with MRSA at admission; 75 (61%) were identified by surveillance alone. Among 775 patients who stayed in the ICU for more than 48 hours, risk factors for MRSA colonization at admission included the following: hospital admission in the past year (1-2 admissions: adjusted odds ratio [aOR], 2.60 [95% confidence interval {CI}, 1.47-4.60]; more than 2 admissions: aOR, 3.56 [95% CI, 1.72-7.40]), a hospital stay of 5 days or more prior to ICU admission (aOR, 2.54 [95% CI, 1.49-4.32]), chronic obstructive pulmonary disease (aOR, 2.16 [95% CI, 1.17-3.96]), diabetes mellitus (aOR, 1.87 [95% CI, 1.10-3.19]), and isolation of MRSA in the past 6 months (aOR, 8.18 [95% CI, 3.38-19.79]). Sixty-nine (10%) of 670 initially MRSA-negative patients acquired MRSA in the ICU (corresponding to 10.7 cases per 1,000 ICU-days at risk). Risk factors for MRSA acquisition included tracheostomy in the ICU (aOR, 2.18 [95% CI, 1.13-4.20]); decubitus ulcer (aOR, 1.72 [95% CI, 0.97-3.06]), and receipt of enteral nutrition via nasoenteric tube (aOR, 3.73 [95% CI, 1.86-7.51]), percutaneous tube (aOR, 2.35 [95% CI, 0.74-7.49]), or both (aOR, 3.33 [95% CI, 1.13-9.77]).Conclusions.Active surveillance detected a sizable proportion of MRSA-colonized patients not identified by clinical culture. MRSA colonization on admission was associated with recent healthcare contact and underlying disease. Acquisition was associated with potentially modifiable processes of care.

Mild to Moderate to Severe: What Drives the Severity of ARDS in Trauma Patients?

2018 ◽  
Vol 84 (6) ◽  
pp. 808-812 ◽  
Author(s):  
Pamela Daher ◽  
Pedro G. Teixeira ◽  
Thomas B. Coopwood ◽  
Lawrence H. Brown ◽  
Sadia Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chest Trauma ◽  
Surgical Intensive Care Unit ◽  
Trauma Patients ◽  
Surgical Intensive Care ◽  
Total Blood ◽  
Factors Associated ◽  
Severity Of Disease ◽  
Chest Injuries ◽  
Independent Risk Factors

Acute respiratory distress syndrome (ARDS) is a complex inflammatory process with multifactorial etiologies. Risk factors for its development have been extensively studied, but factors associated with worsening severity of disease, as defined by the Berlin criteria, are poorly understood. A retrospective chart and trauma registry review identified trauma patients in our surgical intensive care unit who developed ARDS, defined according to the Berlin definition, between 2010 and 2015. The primary outcome was development of mild, moderate, or severe ARDS. A logistic regression model identified risk factors associated with developing ARDS and with worsening severity of disease. Of 2704 total patients, 432 (16%) developed ARDS. Of those, 100 (23%) were categorized as mild, 176 (41%) as moderate, and 156 (36%) as severe. Two thousand two hundred and seventy-two patients who did not develop ARDS served as controls. Male gender, blunt trauma, severe head and chest injuries, and red blood cell as well as total blood product transfusions are independent risk factors associated with ARDS. Worsening severity of disease is associated with severe chest trauma and volume of plasma transfusion. Novel findings in our study include the association between plasma transfusions and specifically severe chest trauma with worsening severity of ARDS in trauma patients.

Risk Factors for Pressure Ulcer Development in a Best Practice Surgical Intensive Care Unit

2007 ◽  
Vol 73 (12) ◽  
pp. 1215-1217 ◽  
Author(s):  
Heidi Frankel ◽  
Jason Sperry ◽  
Lewis Kaplan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Pressure Ulcers ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Cord Injury ◽  
Surgical Icu

We describe the incidence of and define risk factors for pressure ulcers (PU) in the surgical intensive care unit (ICU). Twelve months of data were collected on all patients admitted to the intensivist-run surgical ICU of a university hospital. PU patients were those who developed a new stage II or greater lesion during or after a surgical ICU stay as identified in Project Impact®, ICD9 discharge, or ICU complications databases. Patients were nursed in pressure-relieving beds with nutrition initiated by 72 hours. χ2, t test, and logistic regression statistics were used. Three percent (25/820) developed PU. Age, ICU length of stay, Acute Physiology and Chronic Health Evaluation Score (APACHE), and gender were not different between those with and without PU. Patients with PU had a higher blood urea nitrogen/creatinine (30.5/2.2 mg/dL vs 22.0/1.6 mg/dL) and were more frequently vascular patients (28 vs 14.1%), diabetics (40 vs 17.2%), paraplegics (8 vs 0.2%) (all P < 0.01), and patients on pressors (28.0 vs 11.8%, P < 0.02). Multivariate analysis revealed that diabetes (odds ratio [OR] 2.7, 95%, confidence interval [CI] 1.1-6.4), spinal cord injury (OR 16.8, 95%, CI 1.5-183), age > 60 years (OR 2.9,95%, CI 1.2-7.1), and a creatinine >3 mg/dL (OR 3.7,95%, CI 1.2-9.3) were independent predictors of PU. Despite universal use of specialty beds and early nutrition, pressure ulcers developed in 3 per cent. Independent risk factors include age greater than 60 years, diabetes, spinal cord injury, and renal insufficiency. Additional modalities, such as aggressive early mobilization, might be warranted in this cohort.

CHECK UP: A student-designed model for creating innovative patient education materials that your patients will actually use

2021 ◽  
pp. 009121742110352
Author(s):  
Megan M Cory ◽  
Wasif A Osmani ◽  
Kevin S Cory ◽  
Staci Young ◽  
Rebecca Lundh
Keyword(s):  
Patient Education ◽  
Health Education ◽  
Health Information ◽  
Underserved Populations ◽  
Electronic Medical Record System ◽  
Repeated Exposure ◽  
Record System ◽  
Health Promoting Behaviors ◽  
Patient Recall ◽  
Medical Record System

Objective As appointments become more rushed, it is crucial that primary care clinicians consider new and effective ways to provide preventive health education to patients. Currently, patient education is often handouts printed from the electronic medical record system; however, these pieces of paper often do not have the desired impact. Well-established advertising methods reveal that repeated exposure is key in recall and swaying consumer decisions. The Creating Health Education for Constructive Knowledge in Underserved Populations (CHECK UP) Program is a medical student-led program that aims to improve patient recall of health information, health promoting behaviors and health outcomes by applying modified advertising concepts to the delivery of health education. Methods Patients were given large magnets containing health education information. These patients were interviewed 3–4 months afterwards to assess use and effectiveness of magnets as a means to provide health education. Results In total, 25 of the 28 patients given CHECK UP magnets agreed to participate. The majority of participants (23/25) kept the magnets and reported that they, as well as others in their households, see the magnets daily. All 23 participants recalled at least 1 health tip from 1 of the magnets. Conclusions The use of non-traditional materials for patient education allowed for repeated exposure and recall of health information. Consideration for modified use of evidence-based advertising and marketing strategies for the delivery of patient education may be an easy and effective way to provide information to patients outside of the clinical setting and promote health behavioral changes.

scholarly journals Forecast of Outpatient Visits to a Tertiary Eyecare Network in India Using the EyeSmart Electronic Medical Record System

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 749
Author(s):  
Gumpili Sai Prashanthi ◽  
Nareen Molugu ◽  
Priyanka Kammari ◽  
Ranganath Vadapalli ◽  
Anthony Vipin Das
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Time Series Data ◽  
Resource Planning ◽  
Healthcare Services ◽  
Electronic Medical Record System ◽  
Series Data ◽  
Record System ◽  
Outpatient Visits ◽  
Medical Record System

India is home to 1.3 billion people. The geography and the magnitude of the population present unique challenges in the delivery of healthcare services. The implementation of electronic health records and tools for conducting predictive modeling enables opportunities to explore time series data like patient inflow to the hospital. This study aims to analyze expected outpatient visits to the tertiary eyecare network in India using datasets from a domestically developed electronic medical record system (eyeSmart™) implemented across a large multitier ophthalmology network in India. Demographic information of 3,384,157 patient visits was obtained from eyeSmart EMR from August 2010 to December 2017 across the L.V. Prasad Eye Institute network. Age, gender, date of visit and time status of the patients were selected for analysis. The datapoints for each parameter from the patient visits were modeled using the seasonal autoregressive integrated moving average (SARIMA) modeling. SARIMA (0,0,1)(0,1,7)7 provided the best fit for predicting total outpatient visits. This study describes the prediction method of forecasting outpatient visits to a large eyecare network in India. The results of our model hold the potential to be used to support the decisions of resource planning in the delivery of eyecare services to patients.

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.

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