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1.
Crit Care Explor ; 4(1): e0615, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35036924

RESUMO

To determine if implementation of a standardized effective request process (ERP) can increase organ donation authorization rates. DESIGN: A retrospective, observational study was performed using data acquired from the Midwest Transplant Network. chi-square test was used to analyze categorical data, with p value of less than 0.05 deemed significant. SETTING: The Midwest Transplant Network located in Westwood, KS from January 1, 2013 to June 30, 2017. PATIENTS: A total of 1,391 consecutive patients were identified as potential donors based on medical evaluation of the patient's neurologic status, organ function, and established age criteria. INTERVENTIONS: An ERP was used when discussing donation with 733 patients (53%), compared with no ERP usage with 658 patients (47%). MEASUREMENTS AND MAIN RESULTS: A significant increase (30%) in donation rates was observed when an ERP was used. A comparative decrease in donation rates was observed whenever a breakdown in any of the four identified steps occurred. LIMITATIONS: The data analyzed was gathered retrospectively. Due to the retrospective nature of our study, there is no way to determine delay in authorization times versus no delay. Although most population data information about the authorized donors was known, this information was limited in patients who declined. CONCLUSIONS: With proper preparation and planning, the implementation of a standardized ERP may improve organ donation rates and increase the number of life-saving organs for transplant.

4.
Pediatr Radiol ; 50(3): 329-337, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31473787

RESUMO

BACKGROUND: Ultrasound (US) has been used in the adult trauma population with reported moderate to high sensitivities, but data are scarce in the pediatric trauma population. OBJECTIVE: The purpose of this study was to specifically examine the sensitivity and specificity of one lung US methodology (single-point anterior exam) in the pediatric trauma population when compared to chest radiography or CT. MATERIALS AND METHODS: We conducted a retrospective review of pediatric trauma patients who received lung US as an extension of the focused assessment with sonography for trauma (FAST) exam. We compared lung US findings with chest radiography and CT scans. RESULTS: Two hundred twenty-six pediatric trauma patients underwent lung US exam with confirmatory exams; 11 pneumothoraces (4.8%) were observed. Of those 11, 6 were evaluated as false negatives on the lung US. Analyses resulted in 45.5% sensitivity, 98.6% specificity and 96.0% accuracy. Pneumothoraces undetected by lung US were small and apical and were likely not observed because of their size and location. None of the false negatives required intervention. All true positives were associated with lung contusions. CONCLUSION: Pneumothorax is less common in the pediatric than the adult trauma population, and when encountered in children pneumothorax is often occult and might be associated with lung contusions. Existing evidence supports the usefulness of chest US in detecting pneumothorax in adults and suggests that it can be translated to injured children. However, our findings suggest that the sensitivity of lung US as a single-point anterior exam extension of the FAST exam might not be as reliable in the pediatric trauma population as in adults. Other methodologies using lung US might improve sensitivity.


Assuntos
Pneumotórax/diagnóstico por imagem , Ultrassonografia/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Pulmão/diagnóstico por imagem , Masculino , Sistema de Registros , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Centros de Traumatologia
5.
Am J Emerg Med ; 38(4): 806-809, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31864879

RESUMO

BACKGROUND: Dosing of four factor prothrombin complex concentrate (4PCC) for warfarin reversal remains controversial. Recently, the American College of Cardiology (ACC) recommended a low-dose PCC regimen as an option for warfarin reversal in acute major bleeding. We performed a retrospective study evaluating if a modified version of the ACC guideline recommendations was effective for warfarin reversal in acute major bleeds when compared to traditional variable dosing. METHODS: This was a retrospective cohort study of patients who received 4PCC for warfarin reversal in a 12 month period. We included patients that were ≥18 years of age, received 4PCC for warfarin reversal, and had an initial International Normalized Ratio (INR) of >2. Our primary outcome was the number of patients who had a post-4PCC infusion INR of <1.6. RESULTS: A total of 60 patients were included in the final analysis with 30 patients stratified to the traditional dosing and low-dose groups, respectively. Patient demographics were similar between both groups. We found no difference in the number of patients who had a post-4PCC infusion INR <1.6 between the traditional dosing and low dosing group (90.0% vs. 86.7%; p = 0.68). Additionally, we found no difference between post-infusion median INRs in each group (1.35 vs. 1.30; p = 0.16). Approximately 1000 units per patient were spared when utilizing the low-dose regimen. CONCLUSION: A modified version of the ACC's low-dose 4PCC option for warfarin reversal achieves similar outcomes for lowering INR values compared to traditional variable dosing regimens.


Assuntos
Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea/administração & dosagem , Varfarina/antagonistas & inibidores , Idoso , Idoso de 80 Anos ou mais , Fatores de Coagulação Sanguínea/uso terapêutico , Feminino , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Varfarina/efeitos adversos
6.
Crit Care Med ; 47(8): 1058-1064, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31135499

RESUMO

OBJECTIVES: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest. DESIGN: Retrospective observational study. SETTING: The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008. SUBJECTS: Potential deceased lung donors. INTERVENTIONS: A 360° rotational protocol. Presence of immediate lung function in recipients, change in PaO2:FIO2 ratio during donor management, initial and final PaO2:FIO2 ratio, and proportion of lungs donated were measured. Outcomes were compared between rotated and nonrotated donors. MEASUREMENTS AND MAIN RESULTS: A total of 693 donors were analyzed. The proportion of lung donations increased by 10%. The difference between initial PaO2:FIO2 ratio and final PaO2:FIO2 ratio was significantly different between rotated and nonrotated donors (36 ± 116 vs 104 ± 148; p < 0.001). Lungs transplanted from rotated donors had better immediate function than those from nonrotated donors (99.5% vs 68%; p < 0.001). CONCLUSIONS: There was a statistically significant increase in lung donations after implementing rotational positioning of deceased donors. Rotational positioning significantly increased the average difference in PaO2:FIO2 ratios. There was also superior lung function in the rotated group. The authors recommend that organ procurement organizations consider adopting a rotational positioning protocol for donors to increase the lungs available for transplantation.


Assuntos
Seleção do Doador/métodos , Transplante de Pulmão , Pulmão/fisiopatologia , Coleta de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Morte Encefálica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doadores de Tecidos
7.
J Healthc Qual ; 35(1): 60-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22093135

RESUMO

INTRODUCTION: Sepsis is recognized as an often-lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis-focused RT and standard care. METHODS: This retrospective chart review categorized septic patients based on treatment by a sepsis response team (SRT) versus standard care (non-SRT). Guideline compliance was based upon the Surviving Sepsis evaluation and treatment guidelines. RESULTS: Patient records for 123 identified septic patients post first-year implementation were evaluated. Overall, compliance rates were low and there were variations in compliance between the treatment providers. The SRT was more compliant than the non-SRT. SRT noncompliance was more often due to failure to achieve therapeutic goals within the recommended time. Mortality benefit was not statistically significant between groups; however mortality was higher in the non-SRT group. CONCLUSION: Noncompliance is more complex than simple failure to initiate, especially in time-dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis-focused therapies over standard care.


Assuntos
Prática Clínica Baseada em Evidências/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Sepse/terapia , Padrão de Cuidado/estatística & dados numéricos , Idoso , Distribuição de Qui-Quadrado , Prática Clínica Baseada em Evidências/normas , Feminino , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Sepse/mortalidade , Índice de Gravidade de Doença , Padrão de Cuidado/normas , Centros de Atenção Terciária , Fatores de Tempo , Centros de Traumatologia
8.
J Am Osteopath Assoc ; 109(5): 263-7; quiz 280-1, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19451259

RESUMO

CONTEXT: Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities. OBJECTIVES: To determine whether placement of hand hygiene foam dispensers in more conspicuous positions and closer proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume. METHODS: This prospective, observational study conducted in an intensive care unit was composed of three observation periods. A control period with standard agent dispenser location (8 dispensers) was followed by two experimental periods: (1) "conspicuous and immediate proximity to patient" placement (16 dispensers) and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers). RESULTS: Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a statistically significant increase in daily consumption after conspicuous and proximate positioning of dispensers (P<.001). However, increasing the number of dispensers did not increase agent use (P=.196). CONCLUSION: More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie, immediate proximity to patients) resulted in statistically and clinically significant increases in product usage. An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on usage by volume for these highly effective products should be considered when planning and implementing intensive care unit infection-control policies.


Assuntos
Álcoois/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Infecção Hospitalar/prevenção & controle , Desinfecção/estatística & dados numéricos , Desinfecção das Mãos , Unidades de Terapia Intensiva , Atitude do Pessoal de Saúde , Desinfecção/métodos , Fidelidade a Diretrizes , Desinfecção das Mãos/métodos , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Estudos Prospectivos , Marketing Social , Estados Unidos
9.
Am J Crit Care ; 17(4): 357-63, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18593835

RESUMO

BACKGROUND: The role of advanced registered nurse practitioners and physician assistants in emergency departments, trauma centers, and critical care is becoming more widely accepted. These personnel, collectively known as advanced practice providers, expand physicians' capabilities and are being increasingly recruited to provide care and perform invasive procedures that were previously performed exclusively by physicians. OBJECTIVES: To determine whether the quality of tube thoracostomies performed by advanced practice providers is comparable to that performed by trauma surgeons and to ascertain whether the complication rates attributable to tube thoracostomies differ on the basis of who performed the procedure. METHODS: Retrospective blinded reviews of patients' charts and radiographs were conducted to determine differences in quality indicators, complications, and outcomes of tube thoracostomies by practitioner type: trauma surgeons vs advanced practice providers. RESULTS: Differences between practitioner type in insertion complications, complications requiring additional interventions, hospital length of stay, and morbidity were not significant. The only significant difference was a complication related to placement of the tube: when the tube extended caudad, toward the feet, from the insertion site. Interrater reliability ranged from good to very good. CONCLUSIONS: Use of advanced practice providers provides consistent and quality tube thoracostomies. Employment of these practitioners may be a safe and reasonable solution for staffing trauma centers.


Assuntos
Pessoal Técnico de Saúde , Unidades de Terapia Intensiva , Médicos , Qualidade da Assistência à Saúde/organização & administração , Toracostomia/métodos , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Variações Dependentes do Observador , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Resultado do Tratamento
10.
Am J Surg ; 194(3): 409-12, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17693293

RESUMO

Complications of percutaneous tracheostomy include bleeding, loss of airway control, inadvertent injury to surrounding structures, and equipment damage, all of which can be attributed to poor visualization and inaccurate orientation. Initially, we performed percutaneous tracheostomy in the intensive care unit setting using the single-dilator technique with video bronchoscopy without external transillumination. During our first 30 procedures, the video bronchoscope was damaged in four instances, requiring costly repairs each time. To decrease the potential for uncertainty, loss of airway control, and equipment damage, the investigators developed a technique incorporating an external laser light source to transilluminate the trachea to accurately identify the correct and appropriate orientation. Since integration of the external transillumination technique, no additional video bronchoscopes have been damaged in 100 subsequent procedures. We conclude transillumination using an external laser light source is useful in identifying the tracheostomy insertion site. This tool decreases instrument damage and improves surgeon confidence during percutaneous tracheostomy placement.


Assuntos
Traqueostomia/métodos , Transiluminação , Humanos , Lasers , Traqueia/anatomia & histologia , Traqueostomia/normas , Transiluminação/métodos
11.
J Surg Res ; 139(2): 280-5, 2007 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-17161433

RESUMO

BACKGROUND: Intra-abdominal pressure (IAP) obtained by bladder pressure measurement is used to detect impending abdominal compartment syndrome (ACS), but, while it is recommended to use a supine position, the literature describes IAP measurement in varying positions. This study evaluated the impact of body position at differing head-of-bed (HOB) elevations on bladder pressure when planned to be used as a surrogate IAP measurement. MATERIALS AND METHODS: Forty-five trauma patients admitted to a surgical intensive care unit underwent bladder pressure measurements at 0, 15, 30, 45 degrees HOB position and 30 degrees HOB position plus 15 degrees of reverse Trendelenburg tilt; these measurements were performed in counterbalanced fashion and assessed by built-in angle indicators on the bed rails of each bed. Study participants were connected to an IAP monitoring kit via their indwelling Foley catheter. RESULTS: A total of 675 bladder pressure measurements were obtained with 135 measurements at each of five HOB elevations (0 degrees , 15 degrees , 30 degrees , 45 degrees , 30 degrees +15 degrees tilt). Statistically significant differences occurred between all HOB elevations. Statistically significance differences also occurred at different BMI statuses. CONCLUSIONS: Elevating HOB significantly increases bladder pressure measurement. Bladder pressure measurements in nonsupine positions may not provide valid interpretation for IAP, and more so in cases of increased body mass index.


Assuntos
Abdome/fisiologia , Decúbito Dorsal/fisiologia , Bexiga Urinária/fisiologia , Leitos , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão
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