Interfacility Referral Communication for PICU Transfer.

OBJECTIVES: For patients requiring transfer to a higher level of care, excellent interfacility communication is essential. Our objective was to characterize verbal handoffs for urgent interfacility transfers of children to the PICU and compare these characteristics with known elements of high-quality intrahospital shift-to-shift handoffs. DESIGN: Mixed methods retrospective study of audio-recorded referral calls between referring clinicians and receiving PICU physicians for urgent interfacility PICU transfers. SETTING: Academic tertiary referral PICU. PATIENTS: Children 0-18 years old admitted to a single PICU following interfacility transfer over a 4-month period (October 2019 to January 2020). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We reviewed interfacility referral phone calls for 49 patients. Referral calls between clinicians lasted a median of 9.7 minutes (interquartile range, 6.8-14.5 min). Most referring clinicians provided information on history (96%), physical examination (94%), test results (94%), and interventions (98%). Fewer clinicians provided assessments of illness severity (87%) or code status (19%). Seventy-seven percent of referring clinicians and 6% of receiving PICU physicians stated the working diagnosis. Only 9% of PICU physicians summarized information received. Interfacility handoffs usually involved: 1) indirect references to illness severity and diagnosis rather than explicit discussions, 2) justifications for PICU admission, 3) statements communicating and addressing uncertainty, and 4) statements indicating the referring hospital's reliance on PICU resources. Interfacility referral communication was similar to intrahospital shift-to-shift handoffs with some key differences: 1) use of contextual information for appropriate PICU triage, 2) difference in expertise between communicating clinicians, and 3) reliance of referring clinicians and PICU physicians on each other for accurate information and medical/transport guidance. CONCLUSIONS: Interfacility PICU referral communication shared characteristics with intrahospital shift-to-shift handoffs; however, communication did not adhere to known elements of high-quality handovers. Structured tools specific to PICU interfacility referral communication must be developed and investigated for effectiveness in improving communication and patient outcomes.

Complete Genome Characterization of Reticuloendotheliosis Virus Detected in Chickens with Multiple Viral Coinfections.

Reticuloendotheliosis virus (REV) is a retroviral pathogen capable of infecting several avian hosts and is associated with immunosuppression, anemia, proventriculitis, neoplasia, and runting-stunting syndrome. Its genome contains the three major genes, gag, pol, and env, and two flanking long terminal repeat (LTR) regions. Complete genome sequences of REV are limited in terms of geographical origin. The aim of this study was to characterize the complete genome of REV detected in Brazilian chickens with multiple viral coinfections and analyze the polymorphisms in the deduced amino acids sequences corresponding to its encoded proteins. We tested the presence and completeness of REV as well as other viral pathogens in samples from Brazilian poultry farms by qPCR. The complete genomes of two REV strains were sequenced by overlapping fragments through the dideoxy method. Phylogenetic analysis, pairwise identity matrix, polymorphism identification and protein modeling were performed along the entire genome. We detected REV in 65% (26/40) of the tested samples. Concomitant viral infections were detected in 82.5% (33/40) of the samples and in 90% (9/10) of the farms. Multiple infections included up to seven viruses. Phylogenetic analysis classified both Brazilian strains into REV subtype 3, and the pairwise comparison indicated that strains from the USA and fowlpox virus (FWPV)-related strains were the most identical. The subdomain p18 in gag, the reverse transcriptase/ribonuclease H in pol, and the surface (SU) in the env protein were the most polymorphic in genomic comparisons. The relevant motifs for each protein were highly conserved, with fewer polymorphisms in the fusion peptide, immunosuppression domain, and disulfide bonds on the surface (SU) and transmembrane (TM) of env. This is the first study to include complete genomes of REV in Brazil and South America detected in farms with multiple viral coinfections. Our findings suggest an involvement of REV as an immunosuppressor and active agent in the emergence and progression of multiple infectious diseases. We also found a possible etiological relationship between Brazilian strains and the USA and FWPV recombinant strains. This information highlights the need for epidemiological vigilance regarding REV in association with another pathogens.

Catheter related thrombosis in hospitalized infants: A neural network approach to predict risk factors.

INTRODUCTION: We sought to investigate the predictors of catheter-related thrombosis (CRT) in a cohort of critically ill hospitalized infants and using a novel approach (the artificial neural network - ANN) in combination with conventional statistics to identify/confirm those predictors. METHODS: We performed a retrospective analysis of all infants with a central or peripherally inserted central venous catheter (CVC/PICC) between 2015 and 2018. ANN was generated to investigate the predictors of CRT. The predictive variables examined in the ANN were age, gender, weight, co-morbid conditions, line type, use of ultrasound (USG), emergent line placement, location of line tip, any major surgical procedures, use of mechanical ventilation, exposure to cardio-pulmonary bypass (CPB), past-history of CVC/PICC, or thrombosis. Binary logistic regression was performed to calculate odds ratios (ORs) and determine which factors were significant in predicting CRT. RESULTS: Of total of 613 infants, 59.9% of patients had a history of previous CVC or PICC and 12.2% had a history of thrombus as documented by USG in the past three months. CPB exposure was present in 48.1%. The incidence of CRT was 10.7%. Independent predictors of CRT were the line tip in IVC (OR: 2.37, 1.08-5.21, P = 0.032), history of thrombosis (OR: 2.40, 1.16-4.96, P = 0.019), previous CVC/PICC (OR: 2.80, 1.24-6.33, P = 0.014) and exposure to CPB (OR: 2.749, 1.08-6.98, P = 0.034). A sensitivity analysis was performed to determine the normalized importance of each variable used to create the ANN. The most important variables were age (with normalized importance of 100%), history of thrombosis, weight, and exposure to CPB (normalized importance of 68.2%). CONCLUSIONS: Nearly 1 in 10 infants developed CRT. We found that catheter tip in IVC, exposure to CPB, history of vein thrombosis and history of CVC/PICC placement in the past 3 months are independently associated with a higher risk of CRT in infants by using conventional and neural network methods.

Simple and reliable determination of the modified rankin scale score in neurosurgical and neurological patients: the mRS-9Q.

BACKGROUND: The modified Rankin Scale (mRS) is a 6-level outcome scale used to assess level of function in neurological disease. OBJECTIVE: We examined the interobserver reliability and intraobserver reliability of the mRS-9Q, a 9-question "yes/no" survey that measures the mRS score in neurosurgical and neurological patients. METHODS: The mRS-9Q was administered in person or by telephone, and a Web-based tool was used to calculate the mRS score and to perform error checking. Part 1 compared the mRS-9Q with an mRS structured interview (n = 80). Part 2 compared mRS-9Q administration by telephone and by hard copy (n = 80). Part 3 compared mRS-9Q administration by an expert interviewer with administration by a nonexpert (n = 83). Part 4 examined reproducibility of the mRS-9Q over a 2-week period (n = 84). RESULTS: Agreement was very good in all study parts. In Part 1 (mRS-9Q vs mRS with structured interview), κ = 0.80 and κw = 0.96. In Part 2 (mRS-9Q telephone vs hard copy), κ = 0.83 and κw = 0.95. In Part 3 (mRS-9Q expert vs nonexpert), κ = 0.73 and κw = 0.93. In Part 4 (mRS-9Q reproducibility), κ = 0.76 and κw = 0.93. CONCLUSION: The mRS-9Q is a simple, easy-to-administer survey with a custom Web-based mRS calculation and error-checking tool. The mRS-9Q can reliably determine the mRS by hard copy survey or by telephone and can be administered by experts or nonmedical study personnel. The mRS-9Q can be used to measure functional outcome in a broad population of patients with neurosurgical and neurological diseases.

EMG biofeedback technique improves muscular activity in patietns with hypoglossal-facial anastomosis

En el presente estudio se evaluó la actividad electromiográfica (EMG) facial en tres pacientes (un hombre y dos mujeres) sometidos a una anastomosis nerviosa hipogloso-facial, con parálisis facial posquirúrgica y a quienes se aplicó un programa de entrenamiento con biorretroalimentación. Los pacientes se sentaron frente a un electromiógrafo Autogenic 1 700, de manera que la señal analógica visual de retroalimentación fue un parámetro de la actividad muscular del lado afectado de su cara. Se colocaron electrodos superficiales en grupos musculares especificos teniéndose cuidado de colocarlos en los mismos sitios en los tres pacientes y en todas las sesiones. El entrenamiento costó de dos fases. En la primera: los pacientes realizaron los movimientos de: sonreír, fruncir la nariz y de profusión de los labios con su máximo esfuerzo, mientras mantenían su lengua relajada. En la segunda: activaron su lengua intentando mantener los músculos faciales relajados. Los resultados mostraron un incremento significativo de la actividad muscular del lado afectado de la cara al realizar los movimientos faciales sin la activación de la lengua, y una relajación importante en toda la cara al activar la lengua. Los pacientes también mostraron una mejoría moderada en el aspecto clínico. En menos de nueve semanas de entrenamiento usando la aproximación de biorretroalimentación, se observaron los primeros cambios significativos, lo que sugiere una transferencia exitosa de actividad neuronal en la anastomosis hipogloso-facial, de acurdo con otros reportes

Estadísticas de la Unidad de terapia intensiva de adultos del Hsopital Militar " Dr. Carlos Arvelo" 1982-1993 / Statistics of the intensive care Unit of adults from the Hospital Militar \"Dr. Carlos Arvelo\" 1982-1993

La UCI del Hospital Militar "Dr. Carlos Arvelo" fue fundada en el año de 1971 y funciona como una unidad polivalente. El presente estudio se realizó con la finalidad de evaluar la experiencia y los resultados del trabajo realizado en nuestra UCI. De 2952 pacientes ingresados durante 12 años (1982-1993), el sexo masculio fue el predominante (64,5 por ciento), la edad promedio fue de 47,6 años y el promedio de estadía de 11.7 días, la mortalidad fue del 22,4 por ciento. Entre las principales causas de ingreso encontramos: cardiopatía isquémica (17,6 por ciento); post-operatotio de cirugía abdominal (13,5 por ciento; post-operatorio de neurocirugía (13,3 por ciento); post-operatorio de cirugía cardiovascular (13,3 por ciento); e insuficiencia respiratoria aguda (9,8 por ciento)

Sensibilidad bacteriana en una unidad de terapia intensiva / Bacterian sensibility in critical care united

El presente estudio se realizó de manera prospectiva entre los meses de marzo a junio de 1992. Se tomaron cultivos a todos los pacientes ingresados a la UTI, en ese lapso. De un total de 775 cultivos realizados, 233 (30 por ciento) fueron reportados como positivos, de estos el 79,3 por ciento correspondió a gérmenes gram-negativos y el 20,6 por ciento a gérmenes gram-positivos. La mayor sensibilidad de los gérmenes gram-negativos correspondió a la combinación cefoperazona/sulbactan y quinolonas. En el caso de los gram-positivos, correspondió a la vancomicina, ampicilina-sulbactam y cefoperazona-sulbactam