A Communication Skills Training Workshop to Improve ICU Team Relational Coordination about Goals of Care: A Pilot Study.

Background: Families of critically ill patients and their healthcare team must make life and death decisions together. Ideally, intensive care unit team members collaborate in the support of patients and families as goals of care are clarified and care plans are created. Few interventions exist to improve collaboration around this process. Team-based communication skills training about goals-of-care conversations represents one promising intervention. Objective: The purpose of this study was to examine the impact of a communication skills training workshop on coordination and collaboration among ICU team members. Design: Participants from a single institution completed surveys immediately before and six months after completion of the workshop. All participants, including nurses, physicians, social workers, and chaplains, completed a goals-of-care Relational Coordination survey. Nurses and physicians completed a Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAPNC) survey. Results: Thirty-six participants were enrolled in three workshops. Seventeen and fifteen participants completed the relational coordination survey and JSAPNC respectively at both time points. The mean intergroup relational coordination index increased from 2.94 pre-intervention to 3.19 6-month post (P = .002, d= .89). Nurse relational coordination index ratings of all other groups increased from 2.84 pre-intervention to 3.08 6-month post (p = .004, d=1.23). Mean total scores on the JSAPNC survey did not change significantly from pre-intervention (53.8) to 6-month post (54.2, P = .45). Conclusion: Team-based communication skills training may improve ICU team relational coordination surrounding goals of care.

Quantitative analysis of blend uniformity within a Three-Chamber feed frame using simultaneously Raman and Near-Infrared spectroscopy.

This study reports the use of Raman and Near-infrared (NIR) spectroscopy to simultaneously monitor the drug concentration in flowing powder blends within a three-chamber feed frame. The Raman probe was located at the top of the dosing chamber, while the NIR probe was located at the top of the filling chamber. The Raman and NIR spectra were continuously acquired while the powder blends flowed through the feed frame. Calibration models were developed with spectra from a total of five calibration blends ranging in caffeine concentration among 3.50 and 6.50% w/w. These models were optimized to predict three test set blends of 4.00, 5.00, and 6.00% w/w caffeine. The results showed a high predictive ability of the models based on root mean square error of predictions of 0.174 and 0.235% w/w for NIR and Raman spectroscopic models, respectively. Concentration profiles with higher variability were observed for the Raman spectroscopy predictions. An estimate of the mass analyzed by each spectrum showed that a NIR spectrum analyzes approximately 4.5 times the mass analyzed by a Raman spectrum; despite these differences in the mass analyzed, blend uniformity results are equivalent between techniques. Variographic analysis demonstrated that both techniques have significantly low sampling errors for the real-time monitoring process of drug concentration within the feed frame.

Scaling effect in COVID-19 spreading: The role of heterogeneity in a hybrid ODE-network model with restrictions on the inter-cities flow.

The new Covid-19 pandemic has left traces of suffering and devastation to individuals of almost all countries worldwide and severe impact on the global economy. Understanding the clinical characteristics, interactions with the environment, and the variables that favor or hinder its dissemination help the public authorities in the fight and prevention, leading for a rapid response in society. Using models to estimate contamination scenarios in real time plays an important role. Population compartments models based on ordinary differential equations (ODE) for a given region assume two homogeneous premises, the contact mechanisms and diffusion rates, disregarding heterogeneous factors as different contact rates for each municipality and the flow of contaminated people among them. This work considers a hybrid model for covid-19, based on local SIR models and the population flow network among municipalities, responsible for a complex lag dynamic in their contagion curves. Based on actual infection data, local contact rates ( ß ) are evaluated. The epidemic evolution at each municipality depends on the local SIR parameters and on the inter-municipality transport flow. When heterogeneity of ß values and flow network are included, forecasts differ from those of the homogeneous ODE model. This effect is more relevant when more municipalities are considered, hinting that the latter overestimates new cases. In addition, mitigation scenarios are assessed to evaluate the effect of earlier interventions reducing the inter-municipality flux. Restricting the flow between municipalities in the initial stage of the epidemic is fundamental for flattening the contamination curve, highlighting advantages of a contamination lag between the capital curve and those of other municipalities in the territories.

Inpatient Management of Diabetes Mellitus among Noncritically Ill Patients at University Hospital of Puerto Rico.

OBJECTIVE: To describe the state of glycemic control in noncritically ill diabetic patients admitted to the Puerto Rico University Hospital and adherence to current standard of care guidelines for the treatment of diabetes. METHODS: This was a retrospective study of patients admitted to a general medicine ward with diabetes mellitus as a secondary diagnosis. Clinical data for the first 5 days and the last 24 hours of hospitalization were analyzed. RESULTS: A total of 147 noncritically ill diabetic patients were evaluated. The rates of hyperglycemia (blood glucose ≥180 mg/dL) and hypoglycemia (blood glucose <70 mg/dL) were 56.7 and 2.8%, respectively. Nearly 60% of patients were hyperglycemic during the first 24 hours of hospitalization (mean random blood glucose, 226.5 mg/dL), and 54.2% were hyperglycemic during the last 24 hours of hospitalization (mean random blood glucose, 196.51 mg/dL). The mean random last glucose value before discharge was 189.6 mg/dL. Most patients were treated with subcutaneous insulin, with basal insulin alone (60%) used as the most common regimen. The proportion of patients classified as uncontrolled receiving basal-bolus therapy increased from 54.3% on day 1 to 60% on day 5, with 40% continuing to receive only basal insulin. Most of the uncontrolled patients had their insulin dose increased (70.1%); however, a substantial proportion had no change (23.7%) or even a decrease (6.2%) in their insulin dose. CONCLUSION: The management of hospitalized diabetic patients is suboptimal, probably due to clinical inertia, manifested by absence of appropriate modification of insulin regimen and intensification of dose in uncontrolled diabetic patients. A comprehensive educational diabetes management program, along with standardized insulin orders, should be implemented to improve the care of these patients.

Clinical findings in patients submitte to cardiac catheterization and coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean: a pilot study

OBJECTIVE: This study examined the demographic characteristics, cardiac risk factors, angiographic findings, and complications of patients undergoing coronary angiography. BACKGROUND: There is growing evidence of coronary angiography safety, however, limited data is available concerning the value of this procedure in the Puerto Rican population. METHODS: We retrospectively reviewed the medical records of 322 patients submitted to this procedure at the Cardiovascular Center of Puerto Rico and the Caribbean over a three-month period during 1995. Comparisons of means were based on Student's t-test; comparisons of proportions were based on Pearson's Chi-Square test. RESULTS: Mean age was 60.4 +/- 10.6 years (Range: 20-86); 57.1 per cent were males. Stable angina (p < 0.001) and atypical chest pain (p = 0.014) were more frequent in females. Smoking history (p < 0.0001), left ventricular dysfunction (p = 0.003), angina post-myocardial infarction (p < 0.001), and myocardial infarction (p < 0.025) were more frequent in males. The most frequent angiographic findings were two-vessel disease (24.2 per cent), normal coronary angiogram (21.2 per cent), and non-obstructive disease (16.9 per cent). In patients with angiographic evidence of coronary artery disease, hypertension (69.8 per cent), diabetes mellitus (41.3 per cent), and hypercholesterolemia (37 per cent) were the predominant risk factors. Thirty-four percent of patients had left ventricular dysfunction. The majority of patients (86 per cent) met American College of Cardiology/American Heart Association Class I.