Current Issue : July - September Volume : 2020 Issue Number : 3 Articles : 7 Articles
Abstract\nBackground: Novice nurses need to be better prepared to provide care in acute situations. There is currently no\nvalidated scale specifically measuring nursesâ?? perception of their ability to provide care in acute situations. The aim\nof this study was to develop and examine the psychometric properties of a scale that measures novice nurses selfreported\nperception of ability to provide care in acute situations.\nMethod: Development and test of the psychometric properties of the Perception to Care in Acute Situations\n(PCAS) scale. Items were generated from interviews with novice nurses (n = 17) and validated using opinions of an\nexpert panel and cognitive interviews with the target group.\nTwo hundred nine novice nurses tested the final scale. Exploratory factor analysis (EFA) was used to test construct\nvalidity, item reduction and underlying dimensions between the measured variables and the latent construct.\nResult: The PCAS scale contains 17 items grouped into three factors. EFA demonstrated a clean three factor logic\nconstruct solution with no cross-loadings, high correlation for the total scale in both Cronbachâ??s alfa 0.90 and\nordinal alpha 0.92.\nConclusions: The PCAS scale has proven to have acceptable validity. The factors,â? confidence in provision of careâ?,\nâ??communicationâ? and â??patient perspectiveâ? are likely to be important aspects of providing care in acute situations.\nAdditional testing of the PCAS is needed to conclude if it is sensitive enough to evaluate interventions aimed at\nimproving novice nurses competence and suitable as a guide for reflection for novice nurses.\nKeywords: Nursing, Education, Educational measurement, Psychometrics, Self report, Acute...
Background. Modern intensive care methods led to an increased survival of critically ill patients over the last decades. But an\nunreflected application of modern intensive care measures might lead to prolonged treatment for incurable diseases, and an\ninadaequate or too aggressive therapy can prolong the dying process of patients. In this study, we analysed end-of-life decisions\nregarding withholding and withdrawal of intensive care measures in a German intensive care unit (ICU) of a communal tertiary\nhospital. Methods. Patient datasets of all adult patients dying in an ICU or an intermediate care unit (IMC) in a tertiary communal\nhospital (Klinikum Hanau, Germany) between 01.01.2011 and 31.12.2012 were analysed for withholding and withdrawal of intensive\ncare measures. Results. During the two-year period, 1317 adult patients died in Klinikum Hanau. Of these, 489 (37%) died either in an\nICU/IMC unit. The majority of those deceased patients (n = 427, 87%) was 60 years or older. In 306 (62%) of 489 patients, at least one\nlife-sustaining measure was withheld or withdrawn. In 297 (61%) of 489 patients dying in ICU/IMC, any type of therapy was\nwithheld, and in 139 patients (28%), any type of therapy was withdrawn. Mostly, cardiopulmonary resuscitation (n = 222), invasive\n(n = 121) and noninvasive (n = 40) ventilation followed by renal replacement therapy (n = 71) and catecholamine therapy (n = 66)\nwere withheld. More invasive measures as ventilation or renal replacement therapy were withdrawn in 18 and 22 patients only. After\nwithholding/withdrawal of therapy, most patients died within two days. More than 20% of patients dying in ICU/IMC did not have\nan analgesic medication. Conclusions. About one-third of patients dying in the hospital died in ICU/IMC. At least one life-sustaining\ntherapy was limited/withdrawn in more than 60% of those patients. Withholding of a therapy was more common than active therapy\nwithdrawal. Ventilation and renal replacement therapy were withdrawn in less than 5% of patients, respectively....
Background: Although studies on the effectiveness of the use of ICU diaries on psychiatric disorders and quality of\nlife have been published, the results still seem to be controversial. The study aimed to determine the effects of\nusing an ICU diary on psychiatric disorders, sleep quality, and quality of life (QoL) in adult ICU survivors in China.\nMethods: One hundred and twenty-six patients who underwent a scheduled cardiac surgery and were expected\nto stay.....................
Historically, fungal infections have not been considered an\nimportant influenza complication. In 2018, a retrospective\nmulticenter cohort study in Belgium and the Netherlands\nidentified aspergillosis in 19% of patients with severe influenza.\nAs influenza seemed independently associated with\nIPA, the term influenza-associated pulmonary aspergillosis\n(IAPA) was introduced [1, 2]. In contrast, a single-center\nretrospective Canadian study reported an incidence of 7.2%\n[3]. Incidence seemingly varies between geographical regions\nand centers, but awareness among physicians may also vary.\nDiagnosis of IAPA is still challenging. Since culture has low\nsensitivity, non-culture-based diagnostic methods like galactomannan\n(GM) should be used [4]....
Objectives: The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care\ndemand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed\nthe prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This\nstudy analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after\nsurgery.\nMethods: In this multicenter, respective cohort study, 124 patients who required PMV after surgery in the ICUs of\nfive tertiary hospitals in Beijing between January 2007 and June 2016 were enrolled. The primary outcome was the\nduration of survival within 1 year. Predictors of 1-year mortality were identified with a multivariable Cox\nproportional hazard model. The predictive effect of the ProVent score was also validated.\nResults: Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From..................
Background: The aim of this study is to validate a previously published consensus-based quality indicator set for\nthe management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study\nits potential for quality measurement and improvement.\nMethods: Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in\nthe CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators\nand as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the\nvariables. Discriminability was determined by the between-centre variation, estimated with a random effect regression\nmodel adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome\nindicators was determined by the median number of events per centre, using a cut-off of 10.\nResults: A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved\nfeasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators,\nranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre\nvariation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical\nuncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre.\nConclusions: Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality\nimprovement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and\ncontinuous reevaluation of quality indicators.\nTrial registration: The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August\n06, 2014, with Resource Identification Portal (RRID: SCR_015582).\nKeywords: Quality indicators, Benchmarking, Traumatic brain injuries, Intensive care units, Quality of health care...
Background: Whereas ICU-acquired weakness may delay extubation in mechanically ventilated patients, its\ninfluence on extubation failure is poorly known. This study aimed at assessing the role of ICU-acquired weakness on\nextubation failure and the relation between limb weakness and cough strength.\nMethods: A secondary analysis of two previous prospective studies including patients at high risk of reintubation\nafter a planned extubation, i.e., age greater than 65 years, with underlying cardiac or respiratory disease, or\nintubated for more than 7 days prior to extubation. Patients intubated less than 24 h and those with a do-notreintubate\norder were not included. Limb and cough strength were assessed by a physiotherapist just before\nextubation. ICU-acquired weakness was clinically diagnosed as limb weakness defined as Medical Research Council\n(MRC) score < 48 points and severe weakness as MRC sum-score < 36. Cough strength was assessed using a semiquantitative\n5-Likert scale. Extubation failure was defined as reintubation or death within the first 7 days following\nextubation.\nResults: Among 344 patients at high risk of reintubation, 16% experienced extubation failure (56/344). They had\ngreater severity and lower MRC sum-score.................
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