Seasonal responses of macroinvertebrate assemblages to magnesium in a seasonally flowing stream.

Macroinvertebrates can be highly sensitive to elevated salinity in freshwater environments, and are known to respond to saline discharges. Magnesium (Mg) is a mine-related contaminant and is a potential environmental risk to a seasonally-flowing, receiving water stream in Kakadu National Park, located in the wet-dry tropics of Australia. The macroinvertebrate assemblage in the stream in the was characterised at four hydrographic phases, from early wet season flow to early dry season pools at flow cessation. On each of the four occasions representing the respective phases, individuals from the most abundant macroinvertebrate species present were collected and acutely exposed to a range (up to 19) of Mg concentrations under laboratory conditions. Sensitivity of taxa to Mg ranged between 39 mg/L Mg (Caenidae: Tasmanocoenis spp.) and 4400 mg/L Mg (Dytiscidae: Clypeodytes feryi), based on the 50% Lethal Concentration (LC50). Characterisation of the macroinvertebrate assemblage at each hydrographic phase indicated the seasons when Mg-sensitive species were present. Whilst no statistical differences in measures of seasonal sensitivity were found, the macroinvertebrate assemblages present during the early flow period had higher Mg-sensitivity than the assemblages present during other hydrographic phases. This could be attributed to the greater relative proportions of Mg-sensitive taxa (e.g. Ephemeroptera) present at early flow compared to greater relative proportions of more Mg-tolerant taxa (C. feryi and Hydacarina spp.) present during later hydrograph phases, especially periods of lower, or no, flow.

The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration.

OBJECTIVE: To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. METHODS: The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). RESULTS: Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (P < .05). The incidence of adverse events was unchanged. DISCUSSION: Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. IMPLICATIONS FOR PRACTICE: Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

A visit to the intensive cares unit: a family-centered culture change to facilitate pediatric visitation in an adult intensive care unit.

To guide family adjustment, an effort was made to facilitate pediatric visitation in an adult intensive care unit (ICU). Goals were to improve customer satisfaction and to raise staff comfort level with child visitation. After implementing an open visitation policy, concerns around pediatric visitation in the ICU remained. Fears centered on risks to both patient and child. Literature was reviewed before a book was written entitled A Visit to the ICU. It contained information about what a child visiting the ICU would see, hear, and feel when visiting a loved one. The book provided reassurance for caregivers and children, informing them about what to expect when visiting. The goal of the book was to provide caregivers with a framework for age-appropriate education. Staff education was provided on developmental stages, including a child's understandings of illness and death. Nursing interventions were reviewed and resources provided. A survey demonstrated that the book increased staff comfort level with children visiting the unit, was a positive tool for patients and families, and eased fears among children while helping to facilitate coping mechanisms. The article will describe the practice change of pediatric visitation in an ICU and how it could be applied to other critical care settings.