scholarly journals Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 1017
Author(s):  
Takeshi Unoki ◽  
Yusuke Kawai ◽  
Miya Hamamoto ◽  
Mitsuhiro Tamoto ◽  
Takeharu Miyamoto ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Median Number ◽  
Postal Questionnaire ◽  
Postal Survey ◽  
Severe Respiratory Failure ◽  
Task Sharing ◽  
Cross Sectional ◽  
Median Proportion ◽  
Vv Ecmo

This study aimed to estimate the number of nurses who independently care for patients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous extracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. We performed a cross-sectional study using postal questionnaire surveys. The study included 725 Japanese intensive care units (ICUs). Data were analyzed using descriptive statistics. Among the 725 ICUs, we obtained 302 responses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% (IQR: 42.3–77.3). The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7–63.3%) in the ICUs that had experience with VV-ECMO use. With regard to task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always titrated sedative dosage in 44.5% of ICUs. Nurse staffing might be inadequate in all ICUs, especially for the management of patients with severe respiratory failure. The proportion of competent nurses to care for severe respiratory failure in ICUs should be considered when determining the workforce of nurses.

scholarly journals Workforce and Task Sharing For Nurses in the Japanese Intensive Care Unit -Cross Sectional Postal Survey

2021 ◽  
Author(s):  
Takeshi Unoki ◽  
Yusuke Kawai ◽  
Miya Hamamoto ◽  
Mitsuhiro Tamoto ◽  
Takeharu Miyamoto ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Work Force ◽  
Median Number ◽  
Postal Survey ◽  
Severe Respiratory Failure ◽  
Task Sharing ◽  
Cross Sectional ◽  
Median Proportion ◽  
Vv Ecmo

Aim: The aim of this study was to estimate the number of nurses who independently care for pa-tients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous ex-tracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. Methods: We conducted a cross-sectional study using postal surveys. The study included 725 Japanese intensive care units (ICUs). Descriptive statistics were conducted. Results: Among the 725 ICUs, we obtained 302 re-sponses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% [IQR: 42.3-77.3]. The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7-63.3%) in the ICU experiencing VV-ECMO use. Concerning task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always ti-trated sedatives in 44.5% of ICUs. Conclusion: Nurse staffing might be inadequate in all ICUs, es-pecially for severe respiratory failure. The proportion of competent nurses for caring for severe respiratory failure in ICUs should be considered when determining the work force of nurses.

Factors Affecting the Referral of Potentially Malignant Lesions from Primary Dental Care: A Pilot Study in South Yorkshire

2009 ◽  
Vol os16 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Paul R Brocklehurst ◽  
Sarah R Baker ◽  
Paul M Speight
Keyword(s):  
Primary Care ◽  
Oral Cancer ◽  
Early Stage ◽  
Essential Element ◽  
Poor Response ◽  
Clinical Excellence ◽  
Median Number ◽  
Cross Sectional Study ◽  
Postal Questionnaire ◽  
Cross Sectional

Aims Early diagnosis of oral cancer is an essential element of prevention, yet many patients present late, suggesting that criteria used for referral miss the small or early-stage lesions. The aims of this study were to determine what cues are used by primary care dentists when making the decision to refer a suspicious lesion, and to investigate their recent referral behaviour. Methods A cross-sectional study using a postal questionnaire was undertaken in a major conurbation in South Yorkshire. The questionnaire was sent to all 95 practices in the area concerned. Primary care dentists were asked to score a range of cues on a five-point scale and list their top ten. Experience of referrals made in the last 12 months was also recorded. Results Forty-two questionnaires were returned (44.2%). The cues that primary care dentists ‘agreed’ or ‘strongly agreed’ would initiate a referral were: ‘fixed’, ‘smokes >20 cigarettes/day’, ‘indurated’, ‘ragged borders’ and ‘ulceration’. The most cited top-ten cues were ‘ulcerated’, ‘fixed to underlying tissues’, ‘smoking’ and ‘indurated’. The median number of lesions referred was 0.77 per 1000 adult patients. Twenty-six dentists recorded their experience of 29 lesions. Of these, 17% had been found by the patient whereas 80% had been found at a routine dental examination. Seventy-nine per cent had been present for more than six weeks. Reasons for referral included atypical appearance (38%), ulceration (21%) and location (21%). Fifty-four per cent of primary care dentists described their relationship with secondary care as either ‘good’ or ‘excellent’. Conclusions The most cited cues related to established or advanced disease, not to ‘red’ and ‘white’ lesions, which the National Institute for Health and Clinical Excellence (NICE) recommend for early referral. Even allowing for the relatively poor response rate, this suggests that some small lesions of oral cancer are being missed.

scholarly journals Capabilities of a mobile extracorporeal membrane oxygenation service for severe respiratory failure delivered by intensive care specialists

Anaesthesia ◽  
2015 ◽  
Vol 70 (6) ◽  
pp. 707-714 ◽  
Author(s):  
P. B. Sherren ◽  
S. J. Shepherd ◽  
G. W. Glover ◽  
C. I. S. Meadows ◽  
C. Langrish ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Severe Respiratory Failure ◽  
Membrane Oxygenation

scholarly journals Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

2020 ◽  
Vol 15 ◽  
Author(s):  
Valentina Di Lecce ◽  
Giovanna Elisiana Carpagnano ◽  
Paola Pierucci ◽  
Vitaliano Nicola Quaranta ◽  
Federica Barratta ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Clinical Outcomes ◽  
Intensive Care Units ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Severe Respiratory Failure ◽  
Non Invasive ◽  
Baseline Characteristics ◽  
Almost All

The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11th to May 31st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO2/FiO2 ratio between 100 and 200 and 17% showed Pa02/FiO2 ratio <100. Mean Pa02/FiO2 ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% was transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.

scholarly journals Non-Invasive Ventilation in a Paediatric Intensive Care Unit (PICU) with Respiratory Failure: Experience at a Tertiary Care Hospital in Dhaka

2019 ◽  
Vol 30 (Number 1) ◽  
pp. 20-25
Author(s):  
S Hoque ◽  
ASM N U Ahmed
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Co2 Concentration ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Cross Sectional ◽  
The Mean

Noninvasive ventilation (NIV) has now become an integral tool within the treatment of both acute and chronic respiratory failure, and at an equivalent time reducing the necessity for invasive ventilation. A cross sectional, retrospective study based on a retrospective review of hospital medical records of patients who underwent NIV in the period between January 2017 and December 2019, to determinate the efficacy of NIV in pediatrics whom admitted to Pediatric intensive care unit (PICU) with respiratory failure (short term evaluation), demographic and clinical data were collected before and after applying the NIV. The data included heart rate (HR), respiratory rate (RR), oxygen concentration (P02) and CO2 concentration (PCO2). NIV was used for a total of 61 pediatric patients admitted to PICU during the period of the study. Pneumonia was the commonest indication for the NIV (n=25, 41.0%), and continuous positive airway pressure (CPAP) was used in 52(85.2%) patients. The mean duration of NIV was 817.2 days, there was a significant clinical improvement after one hour from application of NIV The mean improvement in RR was from 48.412.2 to 35.01I.5 (P=0.000), SPO2 was improved from 88.111.8 to 96.510.7 (P= 0.000), and the PCO2 was improved from 61.4±6.1 to 48.713 7 (P=0.002). Five patients were failing to respond to the NIV and shifted to mechanical ventilation. The NIV is a useful tool for treatment of respiratory failure in pediatrics, especially under the age of one year. Pneumonia was the commonest indication for the use of the NB!. More investigation is needed to fully evaluate the ramifications of increased use of this technology in the PICU.

scholarly journals Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain

Critical Care ◽  
2009 ◽  
Vol 13 (5) ◽  
pp. R148 ◽  
Author(s):  
Jordi Rello ◽  
Alejandro Rodríguez ◽  
Pedro Ibañez ◽  
Lorenzo Socias ◽  
Javier Cebrian ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Influenza A ◽  
Adult Patients ◽  
Severe Respiratory Failure ◽  
Influenza A H1n1

scholarly journals Acquired Immunodeficiency from Maternal Chemotherapy and Severe Primary Pneumocystis Infection in an Infant

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Adeline Yi Ling Lim ◽  
Adrian Christian Mattke ◽  
Julia Elizabeth Clark ◽  
Alberto Pinzon-Charry ◽  
Nelson Alphonso ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Opportunistic Pathogen ◽  
Severe Respiratory Failure ◽  
Combined Immunodeficiency ◽  
Patient Cohort ◽  
Immunosuppressed Patients ◽  
Acquired Immunodeficiency ◽  
Pneumocystis Infection ◽  
Vv Ecmo

Pneumocystis jirovecii is recognized as an opportunistic pathogen in immunosuppressed patients. We report a case of severe Pneumocystis pneumonia (PCP) in an infant with acquired combined immunodeficiency secondary to maternal chemotherapy exposure during the second and third trimesters of pregnancy. The infant required cardiorespiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. This case highlights the potential for severe acquired immunodeficiency in this patient cohort and further postnatal surveillance is highly recommended.

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