EVALUATION OF NURSING NOTES BEFORE AND AFTER A TRAINING ACTIVITY IN A UNIVERSITY HOSPITAL

Objective: To verify if the nursing notes improved before and after a training of short duration and the factors those determine this change. Method: We analyzed 1551 reports/nursing notes in two inpatient units and two intensive care units. There was used a form in which there were recorded the adequacies or otherwise of the annotations in function of: the course, shift, professional category, and days of hospitalization of the patient. Results: We observed that there was improvement in the records made after the training course, with an increase of the adequacies. The intensive therapy units showed higher scores for appropriateness to the wards. The time of hospitalization of the patient eventually influences the scores of adequacies. The score of appropriateness of annotations was not different between the professional categories. Conclusion: The action of training of short duration was effective in improving the nursing notes, strengthening the role of continuous education in health services.

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528. Longitudinal Evaluation of Chlorhexidine Resistance Among Multidrug-Resistant Organisms in Relation to Intervention of Daily Chlorhexidine Bathing in Adult Intensive Care Units

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.597 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S254-S254

Author(s):

Min Ja Kim ◽

You Seung Chung ◽

Hojin Lee ◽

Jin Woong Suh ◽

Yoojung Cheong ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Clinical Laboratory ◽

Multidrug Resistant ◽

University Hospital ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Multidrug Resistant Organisms ◽

Before And After ◽

The Republic

Abstract Background Chlorhexidine digluconate (CHG), the most widely used antiseptic, has recently been applied to patient washing to decolonize the multidrug-resistant organisms (MDROs), but there are little data on susceptibilities of MDROs to CHG. The purpose of this study was to evaluate CHG resistance among MDROs before and after the intervention of daily CHG bathing in adult intensive care units (ICUs). Methods The intervention of daily body washing with 2% CHG cloths were taken in adult patients the medical or surgical ICU of 23-bed by a crossover manner for 6 months (MICU, July to December 2017; SICU, January to June 2018) in a 1,050-bed, university hospital in the Republic of Korea. Available MDRO isolates were randomly selected from clinical cultures of ICU patients within 6 months before, during and after the intervention, including MRSA, MR-CoNS, VRE, Carbapenem-resistant Pseudomonas aeruginosa (CR-PA), CR-Acinetobacter baumannii (CR-AB). Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method set by the Clinical Laboratory Standards Institute. Determination of the minimum bactericidal concentrations (MBCs) was performed by subculturing 10 µL from each well without visible microbial growth. Cumulative amounts of CHG used in both ICUs was estimated across the study period from January 2008 to June 2018. Results The cumulative CHG consumption from both ICUs increased sharply from 27,503 g to 29,556 g after one-year intervention. The ranges of MICs and MBCs of CHG among MDRO clinical isolates selected by a 6-month phase are summarized in Table 1. Particularly, CR-PA and CR-AB isolates revealed four to eight times higher MICs and MBCs compared with the majority of Gram-positives excepting some VRE isolates. On the other hand, neither MICs and MBCs ranges of CHG from the MDRO isolates nor the monthly incidence of the MDROs from both ICUs were significantly increased before and after the intervention of daily CHG bathing. Conclusion This study indicates that some Gram-negative MDRO isolates with higher MICs and MBCs of CHG might be from longstanding exposure to CHG or efflux pumps. Although 2% daily CHG bathing uses over 1,000 times higher concentrations than the lethal concentration, it might be needed to monitor CHG resistance among MDROs. Disclosures All authors: No reported disclosures.

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Different methods to estimate serum free cortisol: a comparison during cortisol tetracosactide testing

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2014-0912 ◽

2015 ◽

Vol 53 (9) ◽

Cited By ~ 3

Author(s):

Julie Brossaud ◽

Blandine Gatta ◽

Antoine Tabarin ◽

Jean-Benoît Corcuff

Keyword(s):

Intensive Care ◽

Roc Curves ◽

Serum Cortisol ◽

Cortisol Concentration ◽

University Hospital ◽

Serum Free ◽

Concentration Determination ◽

Total Cortisol ◽

Free Cortisol ◽

Before And After

AbstractSerum cortisol is routinely quantified by immunoassays. In intensive care units serum free cortisol (FC) determination has been described as a better indicator of survival than total cortisol (TC). To estimate FC different methods are available including saliva sampling. We compared five methods to estimate FC, before and after an ACTH stimulating test in patients suspected of adrenal insufficiency.Serum and saliva was collected from 130 patients from the Endocrine Department of a university hospital before and after tetracosactide injection for TC determination. FC was estimated: after serum ultrafiltration, quadratic (Coolens’) or cubic (Dorin’s) equations, using TC/cortisol-binding globulin concentrations ratio or using cortisol concentration determination in saliva.FC concentrations obtained by different techniques were significantly correlated and Passing-Bablok regressions showed no deviation from linearity between salFC and filtFC or quadFC. Using the routine assumption that the patients were correctly diagnosed using a post-tetracosactide TC threshold of 550 nmol/L the FC methods generating the best ROC curves wereFC concentrations obtained by different techniques are significantly but not similarly correlated with TC. As,

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Civil Commitment in Dane County, Wisconsin: 1969 through 1984

The Journal of Psychiatry & Law ◽

10.1177/009318539202000205 ◽

1992 ◽

Vol 20 (2) ◽

pp. 207-242 ◽

Cited By ~ 1

Author(s):

Michael J. Leiber

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Research Design ◽

Civil Commitment ◽

Health Network ◽

Financial Responsibility ◽

Comprehensive Examination ◽

Before And After

Although a number of studies have evaluated reform in commitment proceedings, these have been subject to criticism for failing to conduct a comprehensive examination and/or allow for a reasonable amount of time for the reform to be implemented. The objective of this study was to address these concerns by examining the patterns and trends of a J 975 reform on civil commitment in Dane County, Wisconsin. Utilizing a “before and after” research design, the findings suggest that the implementation of reform is specific to certain areas and varies by the year(s) assessed. The role of the mental health network and the restructuring of the financial responsibility for mental health services are seen as pivotal in why reform was more or less successful.

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Longitudinal Study of Viral and Bacterial Contamination of Hospital Pediatricians’ Mobile Phones

Microorganisms ◽

10.3390/microorganisms8122011 ◽

2020 ◽

Vol 8 (12) ◽

pp. 2011

Author(s):

Aymeric Cantais ◽

Florence Grattard ◽

Julie Gagnaire ◽

Olivier Mory ◽

Aurélie Plat ◽

...

Keyword(s):

Longitudinal Study ◽

Mobile Phones ◽

Healthcare Workers ◽

Winter Season ◽

University Hospital ◽

Infectious Agents ◽

Study Results ◽

Before And After ◽

The University

Mobile phones (MPs) of healthcare workers (HCWs) may represent an important source of transmission of infectious agents. This longitudinal study documents the contamination of these tools. Ten MPs handled by senior pediatricians were sampled once a week during 23 weeks in three pediatric wards of the University Hospital of Saint-Etienne, France. Cultures were performed for bacteria and multiplex PCR assays for a panel of respiratory and enteric viruses. A questionnaire on hygiene habits regarding phoning and care was filled-in by pediatricians before and after the study. From a total of 230 samples, 145 (63%) were contaminated by at least one pathogen. The MPs from emergency departments were the most impacted. Viruses were detected in 179 samples; bacteria were isolated in 59 samples. Contamination increased during the winter epidemic peak. A cross-contamination by Paracoccus yeei between hands and MPs of different HCWs was demonstrated. The communication of the study results influenced the hygiene behaviors. This study highlights the contamination of MPs by pathogens that are resistant in the environment, and its sustainability along the winter season. The role of MPs as vectors of nosocomial infection needs to be better investigated.

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The Developing Role of Occupational Therapy in Psychiatric Intensive Care

British Journal of Occupational Therapy ◽

10.1177/030802269605900403 ◽

1996 ◽

Vol 59 (4) ◽

pp. 161-164 ◽

Cited By ~ 8

Author(s):

Diana Best

Keyword(s):

Mental Health ◽

Intensive Care ◽

Mental Health Services ◽

Health Services ◽

Occupational Therapy ◽

Service Delivery ◽

Psychiatric Inpatient ◽

Client Group ◽

Established Role

Occupational therapy has an established role in the delivery of mental health services. Psychiatric Intensive Care Units (PICUs) are a development found in many psychiatric inpatient facilities and their numbers are increasing. The introduction of occupational therapy to a recently established PICU is examined. A comparison is made between PICU and forensic client groups, and the developing need for PICUs as a distinct service and the client group they serve are described. An example of successful service delivery of occupational therapy in a PICU is offered, and the challenges to the therapist working in this demanding and rewarding setting are outlined.

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Virtual Reality Hypnosis for Anxiety and Pain Management in Intensive Care Units. A Prospective Randomized Trial Among Cardiac Surgery Patients.

10.21203/rs.3.rs-60523/v1 ◽

2020 ◽

Author(s):

Floriane Marie Rousseaux ◽

Nadia Dardenne ◽

Paul B Massion ◽

Didier Ledoux ◽

Marie-Elisabeth Faymonville ◽

...

Keyword(s):

Virtual Reality ◽

Cardiac Surgery ◽

Intensive Care ◽

Intensive Care Units ◽

University Hospital ◽

Control Group ◽

Controlled Clinical Trial ◽

Significant Difference ◽

Before And After ◽

French Speaking

Abstract Background: Although non-pharmacological tools are nowadays commonly used in medical settings, virtual reality and hypnosis are little studied in complex contexts such as intensive care, where patients need significant physical and psychological assistance. The aim of the project is to evaluate the benefits of hypnosis, virtual reality (VR) and the combination of hypnosis and virtual reality (VRH) on anxiety and pain on patients before and after a cardiac surgery.Methods: This prospective randomized and controlled clinical trial was conducted in the University Hospital of Liege (Belgium). Participants are adults undergoing cardiac surgery, French speaking. Exclusion criteria are patients with psychiatric diseases, claustrophobia, acrophobia, heavy hearing impairment, visual impairment, extreme fatigue, verbal incoherence, surgery cancelled or postponed. The day before the surgery, patients were randomly assigned to four arms (control, hypnosis, VR and VRH) and had 20 minutes of one of the technique. They received the same intervention one day after surgery, in intensive care units. Anxiety, pain, fatigue, relaxation and physiological parameters were evaluated before and after each session.Results: 100 patients (66.38 ± 11.48 years; 76 men, 24 women) were included. Results showed that anxiety decreased from baseline to postoperative day in all groups. Relaxation increased in all groups in preoperative (p = .000) and postoperative period (p = 0.03). There were no significant results for pain and fatigue (p > 0.05). There was no significant difference between control group and hypnosis, VR or VRH.Conclusion: Anxiety decreased and relaxation increased in all groups, including control group. We cannot affirm that one technique is better than another is. Nevertheless, this study helps to expand the knowledge regarding application of virtual reality, hypnosis and virtual reality hypnosis in the specific contexts of cardiac surgery and intensive care units. Additional studies are required to compare and evaluate the costs-effectiveness of these techniques for critical care patients and caregivers (see Figure 1).Trial registration: ClinicalTrials.gov: NCT03820700. https://clinicaltrials.gov/ct2/show/NCT03820700. Registered on January 29 2019. Retrospectively registered.

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Therapy of severe acute gastrointestinal injury: main stages and role of pharmaconutrients

Medical alphabet ◽

10.33667/2078-5631-2020-7-49-52 ◽

2020 ◽

pp. 49-52

Author(s):

I. A. Machulina ◽

A. E. Shestopalov ◽

E. A. Evdokimov

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Therapy ◽

Gastrointestinal Function ◽

Gastrointestinal Injury ◽

Function Recovery ◽

Underlying Pathology ◽

Acute Gastrointestinal Injury

Acute gastrointestinal injury develops in more than half of all patients in the intensive care unit, regardless of the underlying pathology. Determining the stage of acute gastrointestinal injury is necessary to choose the appropriate strategy of intensive therapy, leading to the fast gastrointestinal function recovery. The described strategy of intensive therapy, certain approaches to enteral therapy allow to improve prognosis and to reduce the duration of the disease among patients with severe gastrointestinal injury.

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Impact of early tracheotomy for successful prognosis of patients

Emergency Medical Service ◽

10.36740/emems202004103 ◽

2020 ◽

Vol 7 (4) ◽

pp. 261-266

Author(s):

Mateusz Lech ◽

Paulina Bakier ◽

Sylwia Jabłońska ◽

Rafał Milewski ◽

Emilia Duchnowska ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Prolonged Mechanical Ventilation ◽

Intensive Therapy ◽

University Hospital ◽

Individual Treatment ◽

Clinical Issue ◽

Early Tracheostomy ◽

Risk Of Death

Introduction: Complications associated with intra-hospital infections are an important clinical issue determining the further condition of hospitalized patients. One of the most invasive and of high risk of complications in ICU conditions is the otolaryngological procedure of opening the anterior wall of the trachea, aimed at introducing the tube into the lumen of the respiratory tract, enabling subsequent ventilation. Epidemiological data indicate that in Poland the percentage of patients admitted to the ICU annually, due to respiratory failure, who require the implementation of mechanical ventilation reaches 74%, where 41% is qualified for prolonged ventilation and requires a tracheostomy. The aim: The epidemiological analysis of patients under the care of the Department of Anaesthesiology and Intensive Care of University Hospital in Bialystok. Particular attention was paid to patients who underwent tracheostomy. Material and methods: The study material was collected based on the analysis of the patient’s individual treatment process cards, the results of microbiological tests functioning in the Department of Anaesthesiology and Intensive Therapy of the University Hospital in Bialystok. 115 patients were qualified for the study, including 48 women and 67 men. Results: Retrospective studies were based on medical records of 115 patients treated in the Intensive Care Unit of the Department of Anaesthesiology and Intensive Care, University Hospital in Bialystok in 2017-2018. The analysis involved patients after tracheostomy tube implementation, 48 were women and 67 men. Among the analyzed cases, 53 deaths (46.1%) occurred, and 62 subjects were discharged from the ICU (53.9%). Conclusions: Early tracheostomy significantly improved patients’ prognosis and reduced the risk of death. Cardio-respiratory failure with respiratory arrest may often be associated with the need for prolonged mechanical ventilation applied in patients with the aforementioned disease. Therefore, prevention in the form of early tracheostomy is important.

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An Outbreak of Heterogeneous Glycopeptide-IntermediateStaphylococcus aureusRelated to a Device Source in an Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/663703 ◽

2012 ◽

Vol 33 (2) ◽

pp. 167-174 ◽

Cited By ~ 10

Author(s):

Sylvie Parer ◽

Anne Lotthé ◽

Patrick Chardon ◽

Rosie Poncet ◽

Hélène Jean-Pierre ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care ◽

Normal Activity ◽

University Hospital ◽

Surface Sampling ◽

Environmental Cleaning ◽

Environmental Investigation ◽

Contact Isolation

Objective.The emergence ofStaphylococcus aureuswith reduced susceptibility to glycopeptides (glycopeptide-intermediateS. aureus[GISA] and heterogeneous GISA [h-GISA]) leads to intensive care unit (ICU) outbreaks that frequently result in ward closure. We investigated the role of hospital hygiene in the transmission and eradication of an h-GISA outbreak.Design.The study is a description of an original environmental investigation around a series of 12 cases.Setting and Patients.The outbreak occurred in a 20-bed polyvalent/trauma ICU in a 2,800-bed tertiary care university hospital in France.Interventions.Specimens were obtained for surveillance and diagnostic cultures from all patients in the unit. Surface sampling was also performed. Geographic cohorting, contact isolation, emphasis on adherence to infection control practices, and environmental cleaning were implemented.Results.Twelve patients with h-GISA infection (n= 5) or colonization (n= 7) were identified. The mean interval between admission and h-GISA detection was 23.6 days (range, 10–89 days), with a median of 16.5 days. Environmental investigation identified an unexpected reservoir, namely, SpO2sensors. The outbreak was controlled by a combination of measures, including eradication of this reservoir, avoiding total ward closure.Conclusions.Targeted surface sampling helps to secure the environment through active investigation of various reservoirs while maintaining normal activity on the ward. In our study, this method led to the detection of an unsuspected reservoir, the eradication of which helped control the h-GISA epidemic. Further applications of this original investigative procedure should allow confirmation of its relevance and efficiency.Infect Control Hosp Epidemiol2012;33(2):167-174

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