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Required Intervention (required + intervention)
Selected AbstractsA Computerized Nursing Process Support System in BrazilINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Maria da Graça Oliveira Crossetti BACKGROUND Hospital de Clinicas de Porto Alegre introduced the nursing process model as the basis for nursing practice at the hospital more than 20 years ago. A computerized nursing order system based on nursing diagnoses was introduced. The strategies used in the development of the system included establishment of Nursing Diagnosis Work Groups in 1998; systematic analysis of nursing processes based on the work of existing studies, the NANDA taxonomy in 1999; development and implementation of a data collection instrument to analyze the nursing diagnosis process; training of all nursing staff during 1999,2000; meetings between analysts and nursing staff to articulate the nursing process needs the system would be required to support; pilot implementation of the computerized nursing process system in the ICU in February 2000; and hospital-wide implementation in December 2000. The system supports nursing diagnoses and orders. It was developed in-house by the information systems group at the hospital and is implemented as an Oracle database accessed in client server mode over a Windows NT-based Ethernet network. The system is part of the hospital's larger clinical information management system. MAIN CONTENT POINTS The patient care module includes medical orders and nursing orders. On entering the nursing orders module, the user selects a patient and the system presents a list all current orders completed and pending. These orders can be examined, updated, and reprinted, and new daily nursing orders can also be input at this time. The "new order" screen provides the user with any previous orders to ensure consistency in nursing care. New nursing orders are prepared based on the patient history, physical exam, and daily evaluations. Required interventions are identified based on changes in the patient's "basic human needs." This process can be realized through two distinct paths through the nursing care module: one associated with diagnoses and the other with signs and symptoms. A nurse with more clinical experience and knowledge of diagnostic reasoning will opt to develop orders based on diagnoses. After the diagnosis and associated etiology is input, the system generates a list of possible interventions for selection. The duration and frequency of the intervention can then be specified and the order individualized to a patient's particular needs. Less experienced nurses and students will develop nursing orders based on a patient's signs and symptoms. The system generates a list of diagnoses, etiology, and associated basic human needs in response to the signs and symptoms input. The nurse selects the appropriate diagnoses and etiology and the system generates the list of nursing intervention options. Nurses following either path are required to confirm their orders. They then have the option of developing other orders for the same patient until all that patient's basic human needs have been addressed. The orders can be printed but also remain in the system for nursing staff to implement. CONCLUSIONS The application of systematic, evidence-based methods in nursing care results in improved quality of service that conforms to individual patients' basic human needs. [source] Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention?JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2010PT Foley§ Summary This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding. [source] Routine endoscopic retrograde cholangiography in the detection of early biliary complications after liver transplantationLIVER TRANSPLANTATION, Issue 5 2002Sudeep R. Shah The value of routinely performing endoscopic retrograde cholangiography (ERC) to detect biliary complications in patients undergoing orthotopic liver transplantation (OLT) with duct-to-duct anastomosis without a T-tube is not known. Eighty-nine of 171 liver transplant recipients (61 men; mean age, 49.9 years) underwent ERC 14.5 ± 4.5 (SD) days after surgery between January 1997 and August 1999. Findings of ERC and need for intervention for biliary complications were noted. ERC was successful in 71of 89 patients (80%). Nineteen patients (21%) required intervention for biliary complications (stricture, 13 patients; bile leak, 6 patients). Protocol ERC detected eight of these complications (42%). In 4 patients, ERC failed, and 7 patients with a normal ERC result subsequently required intervention (2 patients in the same admission, and 5 patients after discharge). Sensitivity, specificity, and positive and negative predictive values for successful ERC in detecting early biliary complications were 80%, 98%, 89%, and 97%, whereas those for predicting the overall rate of biliary complications were 53%, 98%, 89%, and 89%, respectively. Although highly specific and moderately sensitive in detecting early biliary complications, ERC performed routinely has low sensitivity in predicting the overall risk for biliary complications in patients undergoing OLT with unsplinted duct-to-duct anastomosis. [source] MOSHER AWARD HONORABLE MENTION,THE LARYNGOSCOPE, Issue 4 2000Natural History of Acoustic Neuromas Abstract Objectives/Hypothesis 1) Develop a computerized technique to accurately compare acoustic neuroma size on routine computed tomography and magnetic resonance imaging (MRI) scans; 2) use this technique to determine the growth pattern in a large series of patients with acoustic neuroma who were conservatively managed; 3) describe the natural history of patients with acoustic neuromas who did not receive surgical intervention and those who underwent subtotal resection; 4) correlate the size and growth rate of acoustic neuromas to clinical presentation and auditory and vestibular testing; and 5) recommend guidelines for the management of patients with acoustic neuromas. Study Design A retrospective study from 1974 to 1999 of patients with unilateral acoustic neuromas who had conservative treatment by serial imaging studies (80 patients) or subtotal resection (49 patients). Methods All patient charts were evaluated for presenting symptoms, reasons for the type of management given, and clinical outcome. Charts were also reviewed with respect to serial audiological assessment, electronystagmography, and brainstem auditory evoked response. Imaging studies were analyzed using a computer technique so that serial studies could be compared to determine growth rates. Results Rigorous computer analysis of tumor size and growth rate was statistically the same as the radiologist's description of the tumor size and growth rate. Of 70 patients who were older than 65 years of age old at the time their tumor was discovered, 4 (5.7%) required intervention and 18 (26%) were dead of unrelated causes. These patients had a mean follow-up of 4.8 years (range, 0.01,17.2 y). Overall, growth rate for nonsurgical patients was 0.91 mm per year. Nonsurgical tumors did not grow or regressed in 42.3%. Overall postoperative growth rate for surgical subtotal resection patients was 0.35 mm per year. Surgical tumors did not grow or regressed after subtotal resection of acoustic neuroma in 68.5% of patients. Three patients (6.1%) required revision surgery because of tumor growth or the development of symptoms. Neither auditory nor vestibular testing was a reliable measure for determining tumor growth. Conclusion Measurement of the maximal tumor diameter on MRI scans is a reliable method for following acoustic neuroma growth. There is no need to perform a rigorous analysis of tumor size to determine whether the tumor is growing significantly. The vast majority of patients older than 65 years with acoustic neuromas do not require intervention. The indications for intervention should be based on a combination of rapid tumor growth with the development of symptoms. [source] Teaching Mass Casualty Triage Skills Using Immersive Three-dimensional Virtual RealityACADEMIC EMERGENCY MEDICINE, Issue 11 2008Dale S. Vincent MD Abstract Objectives:, Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy. Methods:, Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training. Results:, Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p < 0.001). Time to complete each scenario decreased significantly from A (8:10 minutes) to B (5:14 minutes; p < 0.001) and from B to C (3:58 minutes; p < 0.001). Self-efficacy improved significantly in the areas of prioritizing treatment, prioritizing resources, identifying high-risk patients, and beliefs about learning to be an effective first responder. Conclusions:, Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, fully immersed VR triage experience. [source] Nephron-sparing surgery: a call for greater application of established techniquesBJU INTERNATIONAL, Issue 10 2008James G. Young OBJECTIVES To examine the results of open partial nephrectomy (OPN) over a 15-year period in a large UK teaching hospital and to compare results with other series including minimally invasive techniques, as nephron-sparing techniques are still under-utilized in the surgical treatment of renal carcinoma. A standardized technique is described that we think minimizes the risk of postoperative urinoma. PATIENTS AND METHODS We retrospectively reviewed a series of 141 patients who underwent OPN performed over a 15-year period in one centre by the senior author (D.M.A.W.). A notable feature of this series compared with others is the high proportion of patients undergoing other major synchronous surgery. RESULTS In all, 141 patients underwent 147 OPNs, with six undergoing bilateral procedures, of which 82 were for imperative indications (single kidney, bilateral synchronous tumours, or pre-existing renal impairment). There were three perioperative deaths, two in patients undergoing other synchronous major surgery. In all, 38 patients had postoperative complications: 28 patients required blood transfusion (four required intervention for their bleeding), five required acute dialysis and three late dialysis. There was a 90% cancer-specific survival rate at a median follow-up of 2 years. CONCLUSIONS This series confirms the trend towards improved outcomes and decreased complications in OPN at a time when its place is challenged by minimally invasive techniques. [source] Review of patient safety incidents submitted from Critical Care Units in England & Wales to the UK National Patient Safety Agency*ANAESTHESIA, Issue 11 2009A. N. Thomas Summary We reviewed and classified all patient safety incidents submitted from critical care units in England and Wales to the National Patient Safety Agency for the first quarter of 2008. A total of 6649 incidents were submitted from 141 organisations (median (range) 23 (1,268 incidents)); 786 were unrelated to the critical care episode and 248 were repeat entries. Of the remaining 5615 incidents, 1726 occurred in neonates or babies, 1298 were associated with temporary harm, 15 with permanent harm and 59 required interventions to maintain life or may have contributed to the patient's death. The most common main incident groups were medication (1450 incidents), infrastructure and staffing (1289 incidents) and implementation of care (1047 incidents). There were 2789 incidents classified to more than one main group. The incident analysis highlights ways to improve patient safety and to improve the classification of incidents. [source] | ||||||||||