Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 6 Articles
Background: Pregnant women should receive two vaccines during pregnancy due to\nmaternal-foetal complications and risks as well as the influenza and pertussis vaccinations. The goal\nwas to evaluate vaccination coverage against influenza and pertussis in pregnant women, following\nmidwife professional advice during the pregnancy follow-up; Methods: Prospective cohort study of\n1017 pregnancies during the vaccination campaign in 2015-2016. To estimate the degree of consistency\nbetween the coverage declared by mothers and that registered in the Nominal Vaccination Registry\n(NVR), we used the Cohenâ??s kappa index (k); Results: 95.4% were registered in the NVR. Vaccination\ncoverage recorded against influenza was 64.2% (95% CI: 61.2-67.2), and 89.8% (95% CI: 87.9-91.7)\nagainst pertussis. The coverage of the pregnant women interviewed was 61.7% (95% CI: 58.1-67.3))\nfor influenza and 92.3% (95% CI: 91.4-95.3) for pertussis. Subsequent interviews of 67.2% of the\nwomen produced a kappa agreement index between the data obtained from interviews and those\nrecorded in the NVR of 0.974 (IC95%: 98.0-99.6) for influenza, and 0.921 (IC95%: 98.1-99.7) for\npertussis. The women identified midwives as the main source of vaccination information and advice\n88.4% (IC95%: 85.8-90.9); Conclusions: The NVR is an effective platform for estimating immunisation\ncoverage in pregnant women. The degree of agreement between declared vaccinations and registered\nvaccinations was high for both vaccines....
Background: Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory\nresponses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an\nassociated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their\npartners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using\nappropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and\ncontrolling for contextual factors, is lacking.\nMethods: The present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the\nhealth-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-\nInterdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The\nPost-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their\npartners, within up to 6 months after the transfer from acute care ICU to post-acute ICU.\nResults: Clinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of\nthe partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress\nsymptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners\ncompared to female partners or female patients. In younger partners (greater than equal to 57 years), higher values of post-traumatic\nstress symptoms were associated with a decreased QoL in the patients.\nConclusions: Mental health screening and psychotherapeutic treatment options should be offered to both the\nchronically critically ill patients and their partners. Future research is required to address the special needs of\nyounger patient-partner dyads, following protracted ICU treatment....
Nurses must be enlightened that clinical reasoning, clinical decision making,\nand clinical judgement are the key elements in providing safe patient care. It\nmust be incorporated and applied all throughout the nursing process. The\nimpact of patientsâ?? positive outcomes relies on how nurses are effective in\nclinical reasoning and put into action once clinical decision making occurs.\nThus, nurses with poor clinical reasoning skills frequently fail to see and notice\npatient worsening condition, and misguided decision making arises that\nleads to ineffective patient care and adding patients suffering. Clinical judgment\non the other hand denotes on the outcome after the cycle of clinical\nreasoning. Within this context, nurses apply reflection about their actions\nfrom the clinical decision making they made. The process of applying knowledge,\nskills and expertise in the clinical field through clinical reasoning is the\nwork of art in the nursing profession in promoting patient safety in the\ncourse of delivering routine nursing interventions. Nurses must be guided\nwith their sound clinical reasoning to have an optimistic outcome and prevent\niatrogenic harm to patients. Nurses must be equipped with knowledge,\nskills, attitude and values but most importantly prepared to face the bigger\npicture of responsibility to care for every patient in the clinical field....
Background: Rapid response teams (RRTs) respond to hospitalized patients experiencing clinical deterioration and\nhelp determine subsequent management and disposition. We sought to evaluate and compare the prognostic\naccuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) for prediction of\nin-hospital mortality following RRT activation. We secondarily evaluated a subgroup of patients with suspected\ninfection.\nMethods: We retrospectively analyzed prospectively collected data (2012-2016) of consecutive RRT patients from two\nhospitals. The primary outcome was in-hospital mortality. We calculated the number needed to examine (NNE), which\nindicates the number of patients that need to be evaluated in order to detect one future death.\nResults: Five thousand four hundred ninety-one patients were included, of whom 1837 (33.5%) died in-hospital. Mean\nage was 67.4 years, and 51.6% were male. A HEWS above the low-risk threshold (less than equal to 5) had a sensitivity of 75.9% (95%\nconfidence interval (CI) 73.9-77.9) and specificity of 67.6% (95% CI 66.1-69.1) for mortality, with a NNE of 1.84. A NEWS2\nabove the low-risk threshold (less than equal to 5) had a sensitivity of 84.5% (95% CI 82.8-86.2), and specificity of 49.0% (95% CI: 47.4-\n50.7), with a NNE of 2.20. The area under the receiver operating characteristic curve (AUROC) was 0.76 (95% CI 0.75-0.\n77) for HEWS and 0.72 (95% CI: 0.71-0.74) for NEWS2. Among suspected infection patients (n = 1708), AUROC for HEWS\nwas 0.79 (95% CI 0.76-0.81) and for NEWS2, 0.75 (95% CI 0.73-0.78).\nConclusions: The HEWS has comparable clinical accuracy to NEWS2 for prediction of in-hospital mortality among RRT\npatients....
Background. The fact that the majority of patients come late creates management difficulties as these first hours are important to\navoid secondary insults to the brain and preserve the ischemic penumbra. Although thrombolytic treatments are currently not\navailable in our hospital, significant delays during the prehospital or in-hospital phases of care createmanagement difficulties and\nwould make such advanced treatments impossible in the future in Ethiopia. Methods. Prospective observational study was carried\nat stroke unit of Jimma University Medical Center for 4 consecutive months from March 10 to July 10, 2017. Data was cleaned\nand entered to Epidata version 3.1 and then exported and analyzed using SPSS version 20.0. Results. A total of 116 eligible stroke\npatients were recruited during the study period with mean age of��.....
Background: Most of the previous studies focused on central line-associated bloodstream infection (CLABSI), while\nnon-central line-associated bloodstream infection (N-CLABSI) was poorly studied. This study was performed to\ninvestigate the clinical impacts and risk factors for N-CLABSI in intensive care unit (ICU) patients.\nMethods: An observational study was conducted in an adult general ICU. The electronic medical records from 2013\nto 2017 of all patients agedless than equal to 18 years admitted to the ICU > 2 days were analyzed retrospectively. Patients with NCLABSI\nand without N-CLABSI or with CLABSI were compared for clinical features and outcomes. Predicted death in\nICU included death in ICU and discharging from ICU against medical advice because of critical conditions and the\ndesire to pass away at home. Propensity score (PS) matching was used to ensure that both two groups had similar\nbaseline characteristics. Multivariate regression models were used to confirm whether N-CLABSI was an\nindependent risk factor for each of the outcomes and to analyze the risk factors for N-CLABSI in ICU patients.\nResults: Of 5046 patients included, 155 developed 168 ICU-acquired N-CLABSI episodes (2.1 episodes per 1000\npatient-days) in the ICU, accounted for the majority of nosocomial bloodstream infections (NBSIs; 71.8%). After PS\nmatching, patients with N-CLABSI had prolonged length of stay (LOS) in ICU (median 15 days, p < 0.001) and LOS\nin hospital (median 13 days, p < 0.001), excess hospitalization costs (median, dollar 27,668 [in US dollar 2017, 1:6.\n75], p < 0.001), and increased mortality in ICU (8.8%, p = 0.013) and predicted mortality in ICU (22.7%, p< 0.\n001), compared with those without N-CLABSI. There were no significant differences in all the outcomes\nbetween\nN-CLABSI and CLABSI. N-CLABSI was an independent risk factor for each of the outcomes. Gastrointestinal\nbleeding (adjusted odds ratio [aOR] 2.30), trauma (aOR 2.52), pancreatitis (aOR 3.45), surgical operation (aOR\n1.82), intravascular catheters (aOR 2.93), sepsis (aOR 1.69), pneumonia (aOR 1.53), intraabdominal infection (IAI,\naOR 8.37), or healthcare-associated infections other than NBSI, pneumonia, and IAI (aOR 3.89) were risk factors\nfor N-CLABSI in ICU patients....
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