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3.
Enferm Intensiva ; 31(2): 82-89, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32360022

RESUMO

In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Humanos , Espanha/epidemiologia
7.
Enferm. intensiva (Ed. impr.) ; 31(1): 19-34, ene.-mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187364

RESUMO

Objetivos: El objetivo fue explorar la experiencia de médicos y técnicos en cuidados auxiliares de enfermería (TCAE) respecto al manejo de contenciones mecánicas en unidades de cuidados críticos. Método: Estudio fenomenológico multicéntrico que incluyó 14 unidades de cuidados críticos (UCC) de Madrid (España). Las UCC fueron estratificadas en función del uso de contenciones mecánicas: «uso frecuente» versus «uso escaso». Se realizaron 3 grupos de discusión: el primero compuesto por TCAE procedentes de UCC con uso frecuente de contenciones mecánicas, el segundo grupo por TCAE de UCC de uso escaso de contenciones mecánicas y el último grupo por médicos de ambos subtipos de UCC. Método de muestreo: por propósito. Análisis de datos: análisis temático de contenido. Se alcanzó la saturación de los datos. Resultados: Emergen 4 temas principales: 1) concepto de seguridad y riesgo (seguridad del paciente versus seguridad del profesional); 2) tipos de contenciones; 3) responsabilidades profesionales (prescripción, registro y roles profesionales); y 4) paradigma «contención cero». La conceptualización sobre el uso de contenciones mecánicas muestra diferencias en algunos de los temas principales dependiendo del tipo de UCC en cuanto a políticas, uso y manejo de contenciones mecánicas (uso frecuente versus uso escaso). Conclusiones: La reducción real del uso de contenciones mecánicas en UCC debe partir de un punto clave: la aceptación de la complejidad del fenómeno. El uso de contenciones mecánicas observado en las diferentes UCC está influenciado por factores individuales, grupales y organizativos. Estos factores determinan las interpretaciones que médicos y TCAE realizan sobre seguridad y riesgo, el centro del cuidado (cuidado centrado en el paciente o en el profesional), el concepto de contención, las responsabilidades e intervenciones profesionales y las interacciones del equipo y el liderazgo


Objectives: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. Method; A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. Data analysis: thematic content analysis. Data saturation was achieved. Results: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). Conclusions; The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership


Assuntos
Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Assistentes de Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Auxiliares de Emergência , Comunicação Interdisciplinar , Serviços Médicos de Emergência , Cuidados Críticos/organização & administração , Grupos Focais
11.
Curr Opin Anaesthesiol ; 33(2): 162-169, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32022730

RESUMO

PURPOSE OF REVIEW: The availability of large datasets and computational power has prompted a revolution in Intensive Care. Data represent a great opportunity for clinical practice, benchmarking, and research. Machine learning algorithms can help predict events in a way the human brain can simply not process. This possibility comes with benefits and risks for the clinician, as finding associations does not mean proving causality. RECENT FINDINGS: Current applications of Data Science still focus on data documentation and visualization, and on basic rules to identify critical lab values. Recently, algorithms have been put in place for prediction of outcomes such as length of stay, mortality, and development of complications. These results have begun being implemented for more efficient allocation of resources and in benchmarking processes, to allow identification of successful practices and margins for improvement. In parallel, machine learning models are increasingly being applied in research to expand medical knowledge. SUMMARY: Data have always been part of the work of intensivists, but the current availability has not been completely exploited. The intensive care community has to embrace and guide the data science revolution in order to decline it in favor of patients' care.


Assuntos
Big Data , Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva/organização & administração , Benchmarking , Humanos , Aprendizado de Máquina
12.
Am J Kidney Dis ; 75(3): 435-452, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31982214

RESUMO

The intensive care unit (ICU) is a common source of high-acuity nephrology consultations. Although advanced chronic kidney disease is associated with increased ICU mortality, the prognosis of acute kidney injury (AKI) requiring renal replacement therapy is far worse, with short-term mortality rates that often exceed 50%. As such, it is essential that practicing nephrologists be comfortable caring for critically ill patients. This Core Curriculum article emphasizes the developments of the last decade since the last Core Curriculum installment on this topic in 2009. We focus on some of the most common causes of AKI in the critical care setting and use these AKI causes to delve into specific topics most relevant to critical care nephrology, including acute respiratory distress syndrome, extracorporeal membrane oxygenation, evolving concepts in fluid management, and shock. We conclude by reviewing the basics of palliative care nephrology and dialysis decision making in the ICU.


Assuntos
Lesão Renal Aguda/terapia , Cuidados Críticos/organização & administração , Currículo , Nefrologia/métodos , Terapia de Substituição Renal/métodos , Lesão Renal Aguda/epidemiologia , Saúde Global , Humanos , Incidência
13.
PLoS One ; 15(1): e0226800, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914163

RESUMO

Critical care staff are frequently required to respond to stressful scenarios. The way staff counter organisational challenge may be influenced by their underlying personality type, preferred style of cognitive processing and previous clinical experience. Our objective was to explore the personality types of a sample of critical care workers, and the potential relationship of this with cognitive processing. This was achieved through a qualitative interview study in which participants were presented with difficult but realistic scenarios pertaining to staffing. Data on individual's personality were captured using the '16 Personality Factor' assessment, a tool that produces scores for 16 different elements of an individual's personality. The existence of perfectionist and pragmatic cognitive processing styles were identified as one theme emerging from a prior analysis of these interview transcripts. We aimed to validate this, explore our ability to categorise individuals into groups based upon their cognitive processing. We identified that some individuals strongly tended to either a perfectionist or pragmatic style of cognitive processing for the majority of their decisions; however most adapted their style of processing according to the nature of the decision. Overall participants generally demonstrated average scores for all 16 personality factors tested. However, we observed that some factors tended to higher scores than others, indicating a pattern within the personalities of our sample cohort. Whilst a small sample size, our data suggests that individuals working within the same critical care environment may have clear differences in their approach to problem solving as a consequence of both their personality type and preferred style of cognitive processing. Thus there may be individuals within this environment who would benefit from increased support to minimise their risk of cognitive dissonance and stress in times of challenge.


Assuntos
Competência Clínica/normas , Dissonância Cognitiva , Cuidados Críticos/organização & administração , Pessoal de Saúde/psicologia , Personalidade , Atitude do Pessoal de Saúde , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pesquisa Qualitativa
14.
Artigo em Espanhol | IBECS | ID: ibc-187189

RESUMO

El 11 de marzo de 2020 el director general de la Organización Mundial de la Salud (OMS) declaró la enfermedad causada por el SARS-CoV-2 (COVID-19) como una pandemia. La propagación y evolución de la pandemia está poniendo a prueba los sistemas sanitarios de decenas de países y ha dado lugar a una miríada de artículos de opinión, planes de contingencia, series de casos e incipientes ensayos. Abarcar toda esta literatura es complejo. De forma breve y sintética, en la línea de las anteriores recomendaciones de los Grupos de Trabajo, la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) ha elaborado esta serie de recomendaciones básicas para la asistencia a pacientes en el contexto de la pandemia


On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Pneumonia Viral , Pessoal de Saúde/normas , Transferência de Pacientes/normas , Cuidados Críticos/normas , Espanha/epidemiologia , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Segurança do Paciente , Pandemias , Cuidados Críticos/organização & administração
16.
BMC Health Serv Res ; 19(1): 797, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690304

RESUMO

BACKGROUND: Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7-638.e11, 2017). The 'Systematic Approach to improving care for Frail older patients' (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives. METHODS: The co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158-67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership. RESULTS: Five priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting. CONCLUSIONS: The co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.


Assuntos
Cuidados Críticos/organização & administração , Procedimentos Clínicos/organização & administração , Fragilidade/terapia , Melhoria de Qualidade/organização & administração , Idoso , Idoso de 80 Anos ou mais , Participação da Comunidade , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pesquisa sobre Serviços de Saúde , Humanos , Participação do Paciente
17.
BMC Health Serv Res ; 19(1): 766, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665004

RESUMO

BACKGROUND: To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. METHODS: We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme's outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme's implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme's outcomes can be explained by the level of implementation. DISCUSSION: This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.


Assuntos
Doença Aguda/terapia , Cuidados Críticos/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Hospitais , Humanos , Irlanda , Programas Nacionais de Saúde , Avaliação de Programas e Projetos de Saúde
19.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31366685

RESUMO

Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.


Assuntos
Cardiopatias/terapia , Unidades de Terapia Intensiva/organização & administração , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Criança , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Lactente
20.
Crit Care Clin ; 35(4): 535-550, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445603

RESUMO

The "daily disasters" within the ebb and flow of routine critical care provide a foundation of preparedness for the less-frequent, larger events that affect most health care organizations at some time. Although large disasters can overwhelm, those who strengthen processes and habits through daily practice will be the best prepared to manage them.


Assuntos
Cuidados Críticos , Planejamento em Desastres , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva , Cuidados Críticos/organização & administração , Planejamento em Desastres/organização & administração , Desastres , Serviço Hospitalar de Emergência/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Incidentes com Feridos em Massa , Capacidade de Resposta ante Emergências/organização & administração , Triagem
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