scholarly journals Patient Safety and Unplanned Extubation in a Pediatric Intensive Care Unit: A Analytical Observational Study

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Elaine Rossi Ribeiro
Keyword(s):  
Observational Study ◽  
Medical Records ◽  
Unknown Origin ◽  
Female Gender ◽  
Unplanned Extubation ◽  
Large Hospital ◽  
Unplanned Extubations ◽  
Surgical Icu ◽  
Protocol Evaluation ◽  
Domain 3

Introduction: Unplanned extubation (UE) is characterized by the removal or displacement of the endotracheal tube (ETT). Objectives: To analyze the incidence of unplanned extubation, characterize the most prevalent cases of unplanned extubation and analyze an extubation protocol. Methodology: This study is characterized as an analytical observational study design, performed in two stages: field research to collect and analyze data from medical records and analysis of the NPE protocol used by a large hospital. Results: In the collected medical records, rates of 7.75 UE/100 days of MV for general and surgical ICU and 4.68 UE/100 days of MV for cardiopediatric ICU were found. The female gender was predominant in the group of patients evaluated and the cause of unknown origin was the most prevalent. We identified 19 unplanned extubations in the general and surgical ICU, and 9 episodes of unplanned extubation in the cardiopediatric ICU, 28 occurrences. For the protocol evaluation the AGREE II instrument was used and the following scores were obtained: domain 1 with 85.19%; domain 2 with 72.22%; domain 3 with 35.42%; domain 4 with 96.30%; domain 5 with 76.39% and domain 6 with 100%. The general score of the protocol evaluation was grade four. Conclusion: The data presented can be of great benefit for prevention, identification and early intervention of UE episodes in pediatric patients with higher risk factors.

scholarly journals Factors That Cause Concerns after Cardioverter Defibrillator Implantation

2021 ◽  
Vol 18 (11) ◽  
pp. 6095
Author(s):  
Olimpia Karczewska ◽  
Agnieszka Młynarska
Keyword(s):  
Observational Study ◽  
Secondary Prevention ◽  
Negative Emotions ◽  
Female Gender ◽  
Multiple Regression Model ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Input Method ◽  
Two Stages

Background and Objectives: The aim of the study was to assess the factors that influence the occurrence of concerns and their intensification after the implantation of a cardioverter defibrillator. Materials and Methods: This was a prospective and observational study including 158 patients. The study was conducted in two stages: stage I before implantable cardioverter defibrillator (ICD) implantation and stage II follow-up visit six months after ICD implantation. Standardized questionnaires were used in both stages. Results: Age and female gender were significantly correlated with the occurrence and intensity of concerns. Patients who had a device implanted for secondary prevention also experienced higher levels of concern. Additionally, a multiple regression model using the stepwise input method was performed. The model was statistically significant and explained 42% of the observed variance in the dependent variable (p = 0.0001, R2 = 0.4215). The analysis showed that age (p = 0.0036), insomnia (p = 0.0276), anxiety (p = 0.0000) and negative emotions (p = 0.0374) were important predictors of the dependent variable and enabled higher levels of the number of concerns to be predicted. Conclusions: There is a relationship between the severity of the concerns related to an implanted ICD and age, gender, anxiety, negative emotions and insomnia. Indications for ICD implantation may be associated with increased concerns about ICD.

scholarly journals Long-term postoperative opioid prescription after cholecystectomy or gastric by-pass surgery: a retrospective observational study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Viktoria Larsson ◽  
Cecilia Nordenson ◽  
Pontus Karling
Keyword(s):  
Observational Study ◽  
Postoperative Period ◽  
Medical Records ◽  
Early Postoperative Period ◽  
Retrospective Observational Study ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Post Surgery ◽  
Gastric By Pass

Abstract Objectives Opioids are commonly prescribed post-surgery. We investigated the proportion of patients who were prescribed any opioids 6–12 months after two common surgeries – laparoscopic cholecystectomy and gastric by-pass (GBP) surgery. A secondary aim was to examine risk factors prior to surgery associated with the prescription of any opioids after surgery. Methods We performed a retrospective observational study on data from medical records from patients who underwent cholecystectomy (n=297) or GBP (n=93) in 2018 in the Region of Västerbotten, Sweden. Data on prescriptions for opioids and other drugs were collected from the patients` medical records. Results There were 109 patients (28%) who were prescribed opioids after discharge from surgery but only 20 patients (5%) who still received opioid prescriptions 6–12 months after surgery. All 20 of these patients had also been prescribed opioids within three months before surgery, most commonly for back and joint pain. Only 1 out of 56 patients who were prescribed opioids preoperatively due to gallbladder pain still received prescriptions for opioids 6–12 months after surgery. Although opioid use in the early postoperative period was more common among patients who underwent cholecystectomy, the patients who underwent GBP were more prone to be “long-term” users of opioids. In the patients who were prescribed opioids within three months prior to surgery, 8 out of 13 patients who underwent GBP and 12 of the 96 patients who underwent cholecystectomy were still prescribed opioids 6–12 months after surgery (OR 11.2; 95% CI 3.1–39.9, p=0,0002). Affective disorders were common among “long-term” users of opioids and prior benzodiazepine and amitriptyline use were significantly associated with “long-term” opioid use. Conclusions The proportion of patients that used opioids 6–12 months after cholecystectomy or GBP was low. Patients with preoperative opioid-use experienced a significantly higher risk of “long-term” opioid use when undergoing GBP compared to cholecystectomy. The indication for being prescribed opioids in the “long-term” were mostly unrelated to surgery. No patient who was naïve to opioids prior surgery was prescribed opioids 6–12 months after surgery. Although opioids are commonly prescribed in the preoperative and in the early postoperative period to patients with gallbladder disease, there is a low risk that these prescriptions will lead to long-term opioid use. The reasons for being prescribed opioids in the long-term are often due to causes not related to surgery.

Predicting Reintubation After Unplanned Extubations in Children: Art or Science?

2016 ◽  
Vol 33 (8) ◽  
pp. 467-474
Author(s):  
Paulo Sérgio Lucas da Silva ◽  
Maria Eunice Reis ◽  
Thais Suelotto Machado Fonseca ◽  
Marcelo Cunio Machado Fonseca
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Pediatric Intensive Care ◽  
Unplanned Extubation ◽  
Ventilator Support ◽  
Unplanned Extubations ◽  
Mechanical Ventilation Support ◽  
Incidence Risk

Purpose: Reintubation following unplanned extubation (UE) is often required and associated with increased morbidity; however, knowledge of risk factors leading to reintubation and subsequent outcomes in children is still lacking. We sought to determine the incidence, risk factors, and outcomes related to reintubation after UEs. Methods: All mechanically ventilated children were prospectively tracked for UEs over a 7-year period in a pediatric intensive care unit. For each UE event, data associated with reintubation within 24 hours and outcomes were collected. Results: Of 757 intubated patients, 87 UE occurred out of 11 335 intubation days (0.76 UE/100 intubation days), with 57 (65%) requiring reintubation. Most of the UEs that did not require reintubation were already weaning ventilator settings prior to UE (73%). Univariate analysis showed that younger children (<1 year) required reintubation more frequently after an UE. Patients experiencing UE during weaning experienced significantly fewer reintubations, whereas 90% of patients with full mechanical ventilation support required reintubation. Logistic regression revealed that requirement of full ventilator support (odds ratio: 37.5) and a COMFORT score <26 (odds ratio: 5.5) were associated with UE failure. There were no differences between reintubated and nonreintubated patients regarding the length of hospital stay, ventilator-associated pneumonia rate, need for tracheostomy, and mortality. Cardiovascular and respiratory complications were seen in 33% of the reintubations. Conclusion: The rate of reintubation is high in children experiencing UE. Requirement of full ventilator support and a COMFORT score <26 are associated with reintubation. Prospective research is required to better understand the reintubation decisions and needs.

scholarly journals Associations between double-checking and medication administration errors: a direct observational study of paediatric inpatients

2020 ◽  
pp. bmjqs-2020-011473
Author(s):  
Johanna I Westbrook ◽  
Ling Li ◽  
Magdalena Z Raban ◽  
Amanda Woods ◽  
Alain K Koyama ◽  
...  
Keyword(s):  
Observational Study ◽  
Medical Records ◽  
Medication Administration ◽  
Clinical Settings ◽  
Paediatric Hospital ◽  
Factors Associated ◽  
Medication Administration Errors ◽  
Multivariable Regression ◽  
Very High ◽  
Considerable Resource

BackgroundDouble-checking the administration of medications has been standard practice in paediatric hospitals around the world for decades. While the practice is widespread, evidence of its effectiveness in reducing errors or harm is scarce.ObjectivesTo measure the association between double-checking, and the occurrence and potential severity of medication administration errors (MAEs); check duration; and factors associated with double-checking adherence.MethodsDirect observational study of 298 nurses, administering 5140 medication doses to 1523 patients, across nine wards, in a paediatric hospital. Independent observers recorded details of administrations and double-checking (independent; primed—one nurse shares information which may influence the checking nurse; incomplete; or none) in real time during weekdays and weekends between 07:00 and 22:00. Observational medication data were compared with patients’ medical records by a reviewer (blinded to checking-status), to identify MAEs. MAEs were rated for potential severity. Observations included administrations where double-checking was mandated, or optional. Multivariable regression examined the association between double-checking, MAEs and potential severity; and factors associated with policy adherence.ResultsFor 3563 administrations double-checking was mandated. Of these, 36 (1·0%) received independent double-checks, 3296 (92·5%) primed and 231 (6·5%) no/incomplete double-checks. For 1577 administrations double-checking was not mandatory, but in 26·3% (n=416) nurses chose to double-check. Where double-checking was mandated there was no significant association between double-checking and MAEs (OR 0·89 (0·65–1·21); p=0·44), or potential MAE severity (OR 0·86 (0·65–1·15); p=0·31). Where double-checking was not mandated, but performed, MAEs were less likely to occur (OR 0·71 (0·54–0·95); p=0·02) and had lower potential severity (OR 0·75 (0·57–0·99); p=0·04). Each double-check took an average of 6·4 min (107 hours/1000 administrations).ConclusionsCompliance with mandated double-checking was very high, but rarely independent. Primed double-checking was highly prevalent but compared with single-checking conferred no benefit in terms of reduced errors or severity. Our findings raise questions about if, when and how double-checking policies deliver safety benefits and warrant the considerable resource investments required in modern clinical settings.

Chemotherapy Near the End of Life in Onco–Hematological Adult Patients

2020 ◽  
Vol 37 (8) ◽  
pp. 641-647
Author(s):  
Marina Sánchez-Cuervo ◽  
Lorena García-Basas ◽  
Esther Gómez de Salazar-López de Silanes ◽  
Cristina Pueyo-López ◽  
Teresa Bermejo-Vicedo
Keyword(s):  
Observational Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Odds Ratio ◽  
Chemotherapy Regimen ◽  
Female Gender ◽  
Tertiary Hospital ◽  
Life Care ◽  
Oncological Patients ◽  
Scarce Data

Objective: The use of chemotherapy near the end of life is not advisable. There are scarce data in Europe but shows signs of aggressiveness. We designed this study to analyze the proportion of onco–hematological patients receiving chemotherapy within their last 2 weeks of life as well as starting a new chemotherapy regimen in the 30 days prior to death. Methods: A retrospective observational study was conducted in a tertiary hospital. Adults who died of an onco-hematological neoplasia while hospitalized between April 2017 and March 2018 were included. We assessed the use of chemotherapy over the course of the last 14 days of life, defined as the administration of at least one dose of chemotherapy. We also examined the proportion of patients starting a new chemotherapy regimen in the last 30 days of life. Results: A total of 298 inpatients died in the Hematology and Oncology units. During the last 14 days, 28.2% (n = 11) of hematological and 26.3% (n = 68) of oncological patients received chemotherapy; the overall rate was 26.5% (n = 79). Furthermore, the proportion of patients starting a new chemotherapy regimen in the last 30 days of life was high (20.5% and 20.8%, respectively). Female gender (odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.18-3.35) and age <45 (OR = 2.68, 95% CI = 1.05-6.88) were associated with higher rates of chemotherapy. Conclusion: The proportion of patients receiving chemotherapy in the last 14 days of life was high, as well as the proportion of patients starting a new regimen in their last 30 days. This was indicative of excessive aggressiveness at the end-of-life care.

scholarly journals Predicting Japanese Kampo formulas by analyzing database of medical records: a preliminary observational study

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Tetsuhiro Yoshino ◽  
Kotoe Katayama ◽  
Yuko Horiba ◽  
Kaori Munakata ◽  
Rui Yamaguchi ◽  
...  
Keyword(s):  
Observational Study ◽  
Medical Records

scholarly journals Prevalence of toddler, child and adolescent overweight and obesity derived from primary care electronic medical records: an observational study

CMAJ Open ◽  
2016 ◽  
Vol 4 (3) ◽  
pp. E538-E544 ◽  
Author(s):  
Suzanne Biro ◽  
Dave Barber ◽  
Tyler Williamson ◽  
Rachael Morkem ◽  
Shahriar Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Child And Adolescent ◽  
Overweight And Obesity ◽  
Adolescent Overweight

scholarly journals Clinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
E. Franceschini ◽  
C. Puzzolante ◽  
M. Menozzi ◽  
L. Rossi ◽  
A. Bedini ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Observational Study ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Mediterranean Area ◽  
Retrospective Observational Study ◽  
Attributable Mortality ◽  
Microbiological Characteristics ◽  
The One ◽  
Bone Marrow Blood

Background. Visceral leishmaniasis (VL) caused byLeishmania infantumis endemic in the Mediterranean area. In the last decades a northward spread of the parasite has been observed in Italy. This paper describes a VL outbreak in Modena province (Emilia-Romagna, Northern Italy) between 2012 and 2015.Methods. Retrospective, observational study to evaluate epidemiological, microbiological characteristics, and clinical management of VL in patients referring to Policlinico Modena Hospital.Results. Sixteen cases of VL occurred in the study period. An immunosuppressive condition was present in 81.3%. Clinical presentation included anemia, fever, leukopenia, thrombocytopenia, and hepatosplenomegaly. Serology was positive in 73.3% of cases, peripheral blood PCR in 92.3%, and bone marrow blood PCR in 100%. Culture was positive in 3/6 cases (50%) and all the isolates were identified asL. infantumby ITS1/ITS2 sequencing. The median time between symptom onset and diagnosis was 22 days (range 6–131 days). All patients were treated with liposomal amphotericin b. 18.8% had a VL recurrence and were treated with miltefosine. Attributable mortality was 6.3%.Conclusions. VL due toL. infantumcould determine periodical outbreaks, as the one described; thus it is important to include VL in the differential diagnosis of fever of unknown origin, even in low-endemic areas.

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