Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 7 Articles
Background: The management of complaints in the setting of intensive care may provide opportunities to understand patient and family experiences and needs. However, there are limited reports on the structured application of complaint analysis tools and comparisons between healthcare complaints in the critical care setting and other settings.\nMethods: From the complaint management database of a university-affiliated medical center in Taiwan, we retrospectively identified the records of healthcare complaints to the intensive care units (ICUs) from 2008 to 2016. Complaints to the general wards in the same period were randomly selected from the database with twice the number of that of the ICU complaints. We coded, typed, and compared the complaints from the two settings according to the Healthcare Complaint Analysis Tool.\nResults: We identified 343 complaints to the ICUs and randomly selected 686 complaints to the general wards during the 9-year study period. Most (94.7%) of the complaints to the ICUs came from the family members, whereas more complaints to the general wards came from the patients (44.2%). A total of 1529 problems (441 from ICU and 818 from general wards) were identified. Compared with the general ward complaints, in the ICU there were more complaints with multiple problems (25.1% vs. 16.9%, p = 0.002),complaints were referred more frequently to the nurses (28.1% vs. 17.5%, p < 0.001), and they focused more commonly on the care on the ICU/ward (60.5% vs. 54.2%, p = 0.029). The proportions of the three domains (clinical, management, and relationship) of complaints were similar between the ICU and general ward complaints (p = 0.121). However, in the management domain, the problems from ICU complaints focused more on the environment than on the institutional processes (90.9% vs. 74.5%, p < 0.001), whereas in the relationship domain, the problems focused more on communication (17.9% vs. 8.0%) and less on listening (34.6% vs. 46.5%) (p = 0.002) than the general ward complaints....
Background: In most countries, patients receiving mechanical ventilation (MV) are treated in intensive care units\n(ICUs). However, in some countries, including Japan, many patients on MV are not treated in ICUs. There are\ninsufficient epidemiological data on these patients. Here, we sought to describe the epidemiology of patients\non MV in Japan by comparing and contrasting patients on MV treated in ICUs and in non-ICU settings. A\npreliminary comparison of patient outcomes between ICU and non-ICU patients was a secondary objective.\nMethods: Data on adult patients receiving MV for at least 3 days in ICUs or non-ICU settings from April 2010\nthrough March 2012 were obtained from the Quality Indicator/Improvement Project, a voluntary data-administration\nproject covering more than 400 acute-care hospitals in Japan. We excluded patients with cancer-related diagnoses.\nPatient demographic data and the critical care provided were compared between groups.\nResults: Over the study period, 17,775 patients on MV were treated only in non-ICU settings, whereas 20,516 patients\nwere treated at least once in ICUs (46.4% vs. 53.6%). Average age was higher in non-ICU patients than in ICU patients\n(72.8 vs. 70.2, P < 0.001). Mean number of ventilation days was greater in non-ICU patients (11.7 vs. 9.5, P < 0.001).\nHospital mortality was higher in non-ICU patients (41.4% vs. 38.8%, P < 0.001). Standard critical care (e.g., arterial\nline placement, enteral nutrition, and stress-ulcer prevention) was provided significantly less often in non-ICU\npatients. Multivariate analysis showed that ICU admission significantly decreased hospital mortality (adjusted odds\nratio 0.713, 95% CI 0.676 to 0.753).\nConclusions: A large proportion of Japanese patients on MV were treated in non-ICU settings. Analysis of administrative\ndata indicated preliminarily that hospital mortality rates in these patients were higher in non-ICU settings than in ICUs.\nProspective analyses comparing non-ICU and ICU patients on MV by severity scoring are needed....
Background: A. baumannii is a common nosocomial pathogen known for its high transmission potential. A high\nrate of carbapenem-susceptible Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB)-complex in clinical\nspecimens led to the implementation of a pathogen-based surveillance on a 32-bed surgical intensive care unit\n(SICU) in a German tertiary care centre.\nMethods: Between April 2017 and March 2018, ACB-complex isolates with an epidemiological link to the SICU\nwere further assessed. Identification to the species level was carried out using a multiplex PCR targeting the gyrB\ngene, followed by RAPD, PFGE (ApaI) and whole genome sequencing (WGS, core genome MLST, SeqSphere+\nsoftware, Ridom). Additional infection prevention and control (IPC) measures were introduced as follows:\nepidemiological investigations, hand hygiene training, additional terminal cleaning and disinfection incl. UV-light,\nscreening for carbapenem-susceptible A. baumannii and environmental sampling. Hospital-acquired infections were\nclassified according to the CDC definitions.\nResults: Fourty four patients were colonized/infected with one or two (different) carbapenem-susceptible ACB-complex\nisolates. Fourty three out of 48 isolates were classified as hospital-acquired (detection on or after 3rd day of admission).\nNearly all isolates were identified as A. baumannii, only four as A. pittii. Twelve patients developed A. baumannii infections.\nGenotyping revealed two pulsotype clusters, which were confirmed to be cgMLST clonal cluster type 1770 (n = 8\npatients) and type 1769 (n = 12 patients) by WGS. All other isolates were distinct from each other. Nearly all\ntransmission events of the two clonal clusters were confirmed by conventional epidemiology. Transmissions stopped\nafter a period of several months. Environmental sampling revealed a relevant dissemination of A. baumannii, but only a\nfew isolates corresponded to clinical strains. Introduction of the additional screening revealed a significantly earlier\ndetection of carbapenem-susceptible A. baumannii during hospitalization.\nConclusions: A molecular and infection surveillance of ACB-complex based on identification to the species level,\nclassic epidemiology and genotyping revealed simultaneously occurring independent transmission events and clusters\nof hospital-acquired A. baumannii. This underlines the importance of such an extensive surveillance methodology in\nIPC programmes also for carbapenem-susceptible A. baumannii....
Background: Physical rehabilitation (PR) interventions in the intensive care unit (ICU) can improve patientsâ?? functional\noutcomes, yet systematic reviews identified discordant effects and poor reporting. We conducted a scoping review to\ndetermine the extent of ICU PR interventions and how they were reported and measured.\nMethods: We searched five databases from inception to December 2016 for prospective studies evaluating adult ICU\nPR interventions. Two independent reviewers screened titles, abstracts, and full texts for inclusion. We\nassessed completeness of reporting using the Consolidated Standards of Reporting Trials, Strengthening the\nReporting of Observational Studies in Epidemiology, or Standards for Quality Improvement Reporting Excellence\nguidelines, as appropriate. For planned PR interventions, we evaluated reporting with the Consensus on\nExercise Reporting Template (CERT) and assessed intervention and control groups separately. We calculated\ncompleteness of reporting scores for each study; scores represented the proportion of reported items. We\ncompared reporting between groups using Kruskal-Wallis with Bonferroni corrections and t tests,--- = 0.05.\nResults: We screened 61,774 unique citations, reviewed 1429 full-text publications, and included 117: 39 randomized\ntrials, 30 case series, 9 two-group comparison, 14 before-after, and 25 cohort. Interventions included neuromuscular\nelectrical stimulation (NMES) (14.5%), passive/active exercises (15.4%), cycling (6.8%), progressive mobility (32.5%), and\nmulticomponent (29.9%). The median (first,third quartiles) study reporting score was 75.9% (62.5, 86.7) with no\nsignificant differences between reporting guidelines. Of 87 planned intervention studies, the median CERT score was\n55.6%(44.7,75.0); cycling had the highest (85.0%(62.2,93.8)), and NMES and multicomponent the lowest (50.0% (39.5, 70.\n3) and 50.0% (41.5, 58.8), respectively) scores. Authors reported intervention groups better than controls (p < 0.001).\nConclusions: We identified important reporting deficiencies in ICU PR interventions, limiting clinical implementation\nand future trial development....
Currently the number of elderly in Indonesia tends to increase. Based on\n2014 Susenas data, the number of elderly in Indonesia reaches 20.24 million\npeople (8.03%). One of the most common physical disorders in the elderly is\ndisruption of the bodyâ??s balance and risk to falls. The risk of falling in the\nelderly can be prevented by doing physical exercise in the form of Salsa\ndance. Salsa dance has movements that can improve stability, flexibility, mobility\nand body balance. This study aims to analyze the effectiveness of Salsa\ndance on body balance in the elderly. The research method used\nquasi-experimental with the pre test-post test design control group. As many\nas 70 elderly who experienced balance disruption in the Puskemas Sarijadi\nhad participated in this study. The sample was taken by using consecutive\nsampling, then divided equally between the control group and the intervention\ngroup. The instrument used to measure elderly balance is Short Physical\nPerformance Battery (SPPB). Data analysis is carried out in two stages,\nnamely univariate analysis using the mean, standard deviation, maximum\nvalue and minimum value and percentage; then followed by bivariate analysis\nusing the Wilcoxon signed rank test and independent T test. The result shows\nthat there are differences in the balance of the elderly before and after the intervention\nin the treatment group, whereas in the control group there were\nno significant differences. Therefore, it can be concluded that Salsa dance can\nsignificantly improve elderly body balance, especially if done regularly. The\nincrease will appear significant after the intervention carried out for 10 and\n20 times. It is suggested that nurses utilize Salsa dance as an alternative in\ndealing with symptoms of body balance disorders in the elderly. This intervention\ncan be implemented along with other activities of the elderly in\ncommunity centre health services....
Carbapenemase Producing Enterobacteriaceae (CPE) has spread rapidly and presents a growing challenge in antimicrobial resistance (AMR) management internationally. Screening for CPE may involve a rectal swab, there are limited treatment options for affected patients, and colonised patients are cared for in isolation to protect others. These measures are sound infection prevention precautions; however, the acceptability of CPE screening and its consequences are currently unknown. The aim of this study was â??To determine factors influencing acceptability of CPE screening from the perspectives of nursing staff and the general public.â??...
Technique and indications for implantable cardioverter-defibrillator (ICD) placement have changed tremendously since the inception of this therapy in 1980. Initially, most of the patients who received ICD therapy either showed evidence of sustained ventricular tachycardia (VT) or were survivors of sudden cardiac arrest. Nurses play a crucial role in patient education and adaptation to having an implantable cardioverter-defibrillator. An evaluative research approach, pre-experimental one group pre-test and post-test research design was adopted. The study populations were staff nurses working in ICU. Convenient sampling technique was used to recruit 80 ICU staff nurses from Shekhawati Hospital and Research Centre, Jaipur. Ethical permission to conduct study was taken from hospital authority and confidentiality and anonymity was maintained throughout the study. Consent was taken from each subject prior to data collection. Self-structured tools with high reliability were used to collect the data. The collected data was analyzed by descriptive and inferential statistics. The analyzed shown that the total knowledge scores of the pre-test, out of 80 subjects 66.25% (53) had inadequate, 22.50% (18) had moderate and 11.25% (9) had adequate knowledge. However, post-test out of 80 subjects, 5% (4) had inadequate knowledge, 27.50% (22) had moderate and 67.50% (54) had adequate knowledge level regarding care of the patient with ICD among ICU staff nurses and out of 80 subjects 52.50% (42) had inadequate, 37.50% (30) had moderate and 10% (8) had adequate practice level regarding care of the patient with ICD in pre-test. However, after administration of PTP, post-test out of 80 subjects, 12.50% (10) had inadequate level, 27.50% (22) had moderate practice level and 60% (48) had adequate practice level regarding care of the patient with ICD among ICU staff nurses. The overall pre-test and post-test means were 14.15 and 23.66 with SD of 4.81 and 3.64, respectively and ‘t’ value 15.85 which was highly significant at P<0.05 level. The overall pre-test and post-test practice level means were 5.66 and 8.78 with SD of 2.07 and 1.88 respectively and ‘t’ value 12.81 which was highly significant at P<0.05 level. The study concluded that there was a significant increase in knowledge and level of practice after the Planned Teaching Programme (PTP). Hence it showed that PTP was effective....
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