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Intensive-care Unit (intensive-care + unit)
Selected AbstractsA Quasi-Experimental Trial on Individualized, Developmentally Supportive Family-Centered CareJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2006Jacqueline F. Byers Objective:, To evaluate the impact of individualized, developmentally supportive family-centered care on infant physiological variables, growth, behavioral stress cues, return to sleep state, medical and developmental progress, complications, resource utilization, parental perception of the neonatal intensive-care unit experience, and overall parental satisfaction. Design:, Quasi-experimental, repeated measures design. Setting:, Developmental and a control nursery in a 78-bed, level II/III neonatal intensive-care unit. Participants:, A convenience sample of 114 premature infants and their parents. Interventions:, Control group infants received the routine neonatal intensive-care unit standard of care. Experimental infants received routine care plus the addition of individualized, developmentally supportive family-centered interventions. Main Outcome measures:, Between groups, there were no statistically significant differences in demographic factors, days to medical or developmental milestones, length of stay, or direct cost/case. Repeated measures analysis of variance determined that at every point of data collection, the average number of baseline, activity, and postactivity stress cues were lower in the developmentally supportive group. Infants in the developmental group had 8% less sedatives/narcotics and 15% less vasopressors costs than the control group. There were no differences in complication rates, parental perceptions of the neonatal intensive-care unit experience, or parental satisfaction between groups. Conclusions:, Preterm infants who received developmentally supportive family-centered care demonstrated fewer behavioral stress cues and comparable short-term outcomes and resource utilization than infants who received routine care. JOGNN, 35, 105-115; 2006. DOI: 10.1111/J.1552-6909.2006.00002.x [source] Evaluation of a severity score to predict the prognosis of Fournier's gangreneBJU INTERNATIONAL, Issue 3 2010Saturnino Luján Marco Study Type , Prognosis (case series) Level of Evidence 4 OBJECTIVE To determine the validity of a Fournier's gangrene severity index (FGSI), developed to assign a numerical score describing the severity of FG, and evaluate factors in the survival of patients with FG. PATIENTS AND METHODS We retrospectively reviewed 51 patients diagnosed with FG between 1994 and 2006. Data were collected on their medical history, which included vital signs (temperature, heart and respiratory rates) and metabolic variables (sodium, potassium, creatinine, bicarbonate levels, haematocrit, and white blood cell count). We computed a score relating to the severity of the disease at the time, and compared it to other features according to whether the patient survived or died. The different prognostic factors were assessed by univariate analysis with the Mann,Whitney U and Kendall A-B tests. RESULTS Of the evaluated 51 inpatients, eight died (16%) and 43 survived (84%). The median (range) age was 63 (17,85) years and the median time from the onset of the symptoms until the admission to the emergency room was 7.8 (1,60) days. The mean hospital stay was 33 (2,90) days and 17 patients were admitted to the intensive-care unit for a mean of 4.5 days. There was no statistically significant difference between the groups. Body surfaces involved were the scrotum in five patients (10%), the penis and scrotum in 11 (22%), the scrotum and perineum in 30 (59%) and the abdominal wall in five (10%). There was no statistically significant difference in the distribution in those who survived or died (P = 0.131). The median age of 60 (17,81) years in the survivors was significantly lower than that of 73.5 (50,85) years in those who died (P = 0.02). There was no significant difference (P = 0.06) between the number of repeated debridements in the survivors (3.23) and those who died (5.25). The mean (range) FGSI score for survivors was 6.7 (0,14), vs 8.7 (6,13) for those who died (P = 0.12). The only laboratory variables associated with death were serum bicarbonate (P = 0.04) and serum sodium (P = 0.02) levels. CONCLUSIONS FG is an unpredictable disease process with wide variability in its presentation. In our experience, the FGSI gives no indication of the likelihood of survival, but the risk factors for predicting the severity of FG seem to be greater in older patients and those with high sodium and low bicarbonate levels. [source] Real-time polymerase chain-reaction detection of pathogens is feasible to supplement the diagnostic sequence for urinary tract infectionsBJU INTERNATIONAL, Issue 1 2010Lutz E. Lehmann OBJECTIVE To evaluate, in a prospective pilot study, the feasibility of identifying pathogens in urine using real-time polymerase chain reaction (PCR), and to compare the results with the conventional urine culture-based procedures. PATIENTS AND METHODS Severe urinary tract infections (UTIs) are frequent in critically ill patients in the intensive-care unit (ICU) and in outpatients, and thus the reliable and fast identification of the bacteria is mandatory, but routine urine culture is time-consuming and the therapeutic regimen is often calculated and not culture-based. The study included 301 prospectively collected urine samples from 189 patients with suspected UTI, based in a university hospital in 2005, and included outpatients and those in the ICU. Urine culture with Cled-, MacConkey- and malt extract agar of all samples was followed by microbiological identification of the pathogens in 98 samples with visible growth. In parallel, all samples were assessed using qualitative real-time PCR-based DNA detection and identification by labelled hybridization probes. RESULTS In all, 15 dipstick culture-negative samples showed positive pathogen DNA identification by PCR. By contrast, 17 PCR-negative samples showed detectable pathogens by culture, of which 10 were not detectable on PCR because the identified pathogens were not represented in the probe panel. The sensitivity and specificity for detecting contaminated samples was 0.90 and 0.87, respectively. Overall, 95% of the mono-infection pathogens and 57% of the multiple-infection pathogens were detected concordantly with both methods. CONCLUSION In this prospective pilot study PCR-based identification of pathogens was feasible for supplementing conventional culture methods for the diagnosis of UTI. The main advantage is the time saved in identifying the pathogens. The limited pathogen detection in multiple-infection-samples by PCR might be explained by competitive PCR amplification conditions. [source] Learning Curve for Translaryngeal Tracheotomy in Head and Neck SurgeryTHE LARYNGOSCOPE, Issue 4 2001Gioacchino Giugliano MD Abstract Objectives Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive-care units for its simplicity of execution, low morbidity, rapid wound closure after cannula removal, good esthetic results, and lack of long-term sequelae. The aim of this study was to evaluate the feasibility and use of adopting TLT in patients with cancer undergoing major head and neck surgery. Study Design Prospective analysis of learning curve and incidence of complications in 41 patients with cancer who underwent TLT at the Division of Head and Neck Surgery of the European Institute of Oncology from November 1997 to June 1999. Methods Patient characteristics, pathology, anatomic characteristics of the neck, and surgical short-term and long-term complications were noted. The patients were divided into consecutive groups of six or seven patients, and time trends in occurrence of complications and time to execute the procedure were assessed. Results TLT performance time decreased from 50 minutes in the first seven patients to 24 minutes in the last group. The technique was easy to perform and safe, with only two minor complications during surgery. However, minor complications occurred in three and major complications in 17 patients in the days immediately following surgery, almost entirely attributable to lack of counter-cannu1a and stylet. Conclusions In view of the high proportion of major complications, TLT using the presently available kit is unsuitable for major head and neck surgery. However, the considerable advantages of the technique would recommend it as a valid alternative to surgical tracheotomy if the kit included a counter-cannu1a and stylet. [source] | ||||||||||