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Despite the increasing number of women within medical professions, gender equality in career advancement and leadership positions still remains a challenge due to numerous barriers including unbalanced domestic responsibilities, discrimination, and rigidity in career structures. Here, we discuss ways to achieve work-life balance and family planning as well as some of the challenges women face in medicine and nursing careers and outline strategies for individuals and organizations to overcome them.
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Movilidad Laboral , Liderazgo , Humanos , FemeninoRESUMEN
Acute cardiac emergencies are life threatening. The initial responses to acute cardiac emergencies must be rapid, efficient, skillful, and well-planned. The goal of this article is to provide information that can be used to facilitate the prompt recognition and treatment of the most common acute cardiac emergencies.
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Urgencias Médicas , HumanosRESUMEN
OBJECTIVE: To report the impact of hospital-wide interventions on central line-associated bloodstream infection (CLABSI) rates in a 24-bed trauma-surgical intensive care unit. DESIGN: Data were gathered retrospectively from January 1, 2001, through June 30, 2009. Interventions to reduce CLABSI rates during this period included standardization of line insertion and maintenance processes, development of a mandatory education program incorporating practical line insertion simulation sessions, frequent audits, and intensive care unit staffing modifications. We used the χ(2) test and analysis of variance to analyze the data where appropriate. SETTING: Urban tertiary referral center providing level I trauma services. PATIENTS: Eight thousand four hundred eighty-one trauma-surgical intensive care unit admissions, of which 76% were owing to trauma. RESULTS: During this period, the incidence of CLABSI declined from 6.1 to 0.3 per 1000 line-days. No CLABSIs occurred for 8 of the last 10 quarters (January 2007 to June 2009). Internal jugular sites were associated with a higher CLABSI rate than subclavian sites (P = .03). The central line utilization ratio remained high for most of the study period. When compared with the 2006-2007 Centers for Disease Control and Prevention data, the trauma-surgical intensive care unit was at the 10th percentile in CLABSIs and at the 75th to 90th percentile in central line utilization ratios. CONCLUSIONS: The significant decline in the incidence of CLABSIs, which reflected the national trend, could be attributed to multiple interventions. The high central line utilization ratio compared with nationally available data represents a potential target for further improvement.
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Bacteriemia/epidemiología , Cateterismo Venoso Central/efectos adversos , Control de Infecciones/tendencias , Unidades de Cuidados Intensivos , Adulto , Anciano , Análisis de Varianza , Bacteriemia/microbiología , Bacteriemia/prevención & control , Catéteres de Permanencia/efectos adversos , Cuidados Críticos , Infección Hospitalaria , Contaminación de Equipos/prevención & control , Femenino , Humanos , Incidencia , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Centros Traumatológicos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
The prevention of ventilator-associated pneumonia (VAP) has been a challenge within many healthcare organizations. The initial efforts for VAP prevention focused on compliance with "ventilator bundles." VAP rates initially improved with implementation of the bundles but then reached a plateau. The trauma surgical intensive care unit (ICU) was interested in investigating measures to further improve the prevention of VAP after bundle implementation. A multidisciplinary team was formed to investigate innovative strategies to prevent VAP. The group identified their initial focus as head of bed (HOB) elevation intervention within and outside of the ICU through HOB audits and a transport checklist. Through these efforts, the VAP rate within the trauma surgical ICU dropped to the lowest level in 4 years.
