Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 31.806
Filtrar
1.
Braz. j. biol ; 84: e255605, 2024. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1355882

RESUMO

Abstract Combining ability analysis provides useful information for the selection of parents, also information regarding the nature and magnitude of involved gene actions. Crops improvement involves strategies for enhancing yield potentiality and quality components. Targeting the improvement of respective characters in bitter gourd, combining ability and genetic parameters for 19 characters were estimated from a 6×6 full diallel analysis technique. The results revealed that the variances due to general combining ability (GCA) and specific combining ability (SCA) were highly significant for most of the important characters. It indicated the importance of both additive and non-additive gene actions. GCA variances were higher in magnitude than SCA variances for all the characters studied indicating the predominance of the additive gene effects in their inheritance. The parent P2 (BG 009) appeared as the best general combiner for earliness; P1 (BG 006) for number of fruits, average single fruit weight and fruit yield; P4 (BG 027) for node number of first female flower and days to seed fruit maturity; P3 (BG 011) for fruit length and thickness of the fruit flesh; P5 (BG 033) for 100-seed weight; and P6 for number of nodes per main vine. The SCA effect as well as reciprocal effect was also significant for most of the important characters in different crosses.


Resumo A análise da capacidade de combinação fornece informações úteis para a seleção dos pais, também informações sobre a natureza e a magnitude das ações dos genes envolvidos. A melhoria das safras envolve estratégias para aumentar a potencialidade da produção e os componentes de qualidade. Visando ao aprimoramento dos respectivos caracteres em cabaça-amarga, capacidade de combinação e parâmetros genéticos para 19 caracteres, foram estimados a partir de uma técnica de análise dialélica completa 6 × 6. Os resultados revelaram que as variâncias, devido à capacidade geral de combinação (GCA) e capacidade específica de combinação (SCA), foram altamente significativas para a maioria dos caracteres importantes. Indicou a importância das ações gênicas aditivas e não aditivas. As variâncias GCA foram maiores em magnitude do que as variâncias SCA para todos os caracteres estudados, indicando a predominância dos efeitos do gene aditivo em sua herança. O pai P2 (BG 009) apareceu como o melhor combinador geral para o início; P1 (BG 006) para número de frutos, peso médio de um único fruto e produção de frutos; P4 (BG 027) para número de nó da primeira flor fêmea e dias para a maturidade do fruto da semente; P3 (BG 011) para comprimento do fruto e espessura da polpa do fruto; P5 (BG 033) para peso de 100 sementes; e P6 para o número de nós por videira principal. O efeito SCA, bem como o efeito recíproco, também foi significativo para a maioria dos personagens importantes em cruzamentos diferentes.


Assuntos
Momordica charantia , Produtos Agrícolas , Flores , Melhoria de Qualidade , Frutas/genética
2.
Mayo Clin Proc ; 97(8): 1551-1571, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35933139

RESUMO

Perioperative medical management is challenging because of the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources use recommendations derived from individual studies and do not include a multidisciplinary focus on formal consensus. The Society for Perioperative Assessment and Quality Improvement identified a lack of authoritative clinical guidance as an opportunity to use its multidisciplinary membership to improve evidence-based perioperative care. The Society for Perioperative Assessment and Quality Improvement seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this consensus statement is to provide practical guidance on the preoperative management of immunosuppressive, biologic, antiretroviral, and anti-inflammatory medications. A panel of experts including hospitalists, anesthesiologists, internal medicine physicians, infectious disease specialists, and rheumatologists was appointed to identify the common medications in each of these categories. The authors then used a modified Delphi process to critically review the literature and to generate consensus recommendations.


Assuntos
Artrite Reumatoide , Infecções por HIV , Consenso , Infecções por HIV/tratamento farmacológico , Humanos , Assistência Perioperatória/métodos , Melhoria de Qualidade
3.
BMJ Open Qual ; 11(3)2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35940697

RESUMO

BACKGROUND: Surgery is recommended within 48 hours of hip fractures for better perioperative outcomes. Yet, such targets still commonly remain a challenge. Our institution is no exception.As part of a hospital-wide initiative, our anaesthesia department focused on improving perioperative processes with aims to reduce the time to first anaesthesia consult and surgery for hip fracture patients. Acknowledging multiple causes for surgical delay, we decided first to address anaesthesia-specific factors-(a) first anaesthetist contact usually happens after surgery is offered which leaves a short runway for preoptimisation, (b) this is compounded by varying degrees of anaesthetist involvement for follow-up thereafter. (c) There is a need to calibrate our perioperative care standards and (d) enforce more consistent auditing in quality assurance. This project was conducted in a 1000-bed hospital serving eastern Singapore. INTERVENTION: We created an integrated anaesthesia consultant-led outreach service for hip fracture patients, based on a perioperative workflow system to provide proactive anaesthetist consults within 24 hours of admission in advance of surgical decision. This was streamlined with a coordinated follow-up system for preoptimisation until surgery. METHODS: Our quality improvement project applied the iterative Plan-Do-Study-Act model from pilot to sustainability stage. We collected data at baseline followed by 6-monthly audits from electronic databases.Primary outcomes measured were time to first anaesthesia consult and surgery. Secondary outcomes included rate of critical care reviews and admission, mortality rate, length of stay and time to nerve blocks. RESULTS: Post implementation, our service reviewed >600 hip fracture patients. Median time to anaesthesia consult reduced significantly from 35.3 hours (2019) to 21.5 hours (2021) (p=0.029). Median time to surgery was reduced from 61.5 hours (2019) to 50 hours (2021) (p=0.897) with a 13.6% increase in patients operated <48 hours. Critical care admissions, 6-monthly and 12-monthly mortality rates and time to nerve block were reduced with a greater percentage of patients discharged within 10 days. CONCLUSION: Our project focused on improving anaesthesia perioperative processes to address surgical delays in hip fracture patients. Our consultant-led anaesthesia service ensured that proactive anaesthesia care was delivered to provide sufficient time for preoptimisation with greater standardisation to follow-up, better communication and quality assurance.


Assuntos
Fraturas do Quadril , Bloqueio Nervoso , Consultores , Fraturas do Quadril/cirurgia , Humanos , Alta do Paciente , Melhoria de Qualidade
4.
BMC Womens Health ; 22(1): 338, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941606

RESUMO

BACKGROUND: Most women undergoing screening examinations in the U.S. do not receive immediate results and for many this results in increased stress, inconvenience, delayed diagnosis, and potential loss to follow-up. OBJECTIVE: To study the impact of same appointment mammogram results on breast cancer screening experience and patient satisfaction. MATERIALS AND METHODS: A 6-question survey with questions focused on breast cancer screening experience with our new service of same appointment mammogram results was distributed to 200 patients, with 185 patients returning their responses. Patients evaluated their current experience on receiving their screening results during the same appointment with their prior breast cancer screening experience. Patients who did not respond to their satisfaction score either before or after same appointment results were excluded from the patient cohort analyzing satisfaction score. Remaining questions were analyzed separately as additional satisfaction assessment tools. RESULTS: About 48% of the patients indicated an improvement in their screening experience with same appointment mammography results service, while 47% of the patients reported no significant difference in their experience. CONCLUSION: Although not statistically significant, same appointment mammogram results were able to make a positive impact on breast cancer screening experience among 48% of the patients. Further research elucidating barriers to screening and other ways to improve patient satisfaction will be required to increase breast cancer screening compliance.


Assuntos
Neoplasias da Mama , Detecção Precoce de Câncer , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Mamografia , Programas de Rastreamento , Satisfação Pessoal , Melhoria de Qualidade
6.
J Gerontol Nurs ; 48(8): 6-9, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914076

RESUMO

Montessori for Dementia and Ageing (MDA) is a philosophy to support person-centered care (PCC) and autonomy of older adults. This quality improvement project documented outcomes of implementation of the MDA philosophy in a long-term care memory neighborhood. After an initial training session, MDA was implemented with weekly, 2-hour on-site coaching sessions over the course of two semesters (28 weeks) with a community of 20 female persons living with dementia (PWD). Primary outcomes were negative responsive behaviors of PWD, whereas the secondary outcome included percentage of active engagement of PWD. Mean number of negative responsive behaviors was 62.21 at baseline, which decreased to 33.82 at the end of the project per the Cohen-Mansfield Agitation Inventory. At baseline, PWD were actively engaged in 18.15% of observed opportunities, according to the Engage portion of the Resident-Centered Assessment of Interactions with Staff and Engagement Tool. At the end of the project, PWD were actively engaged in 40.56% of observed opportunities. Results suggest that MDA is feasible to implement PCC in a long-term care memory neighborhood. [Journal of Gerontological Nursing, 48(8), 6-9.].


Assuntos
Demência , Idoso , Envelhecimento , Ansiedade , Demência/terapia , Feminino , Humanos , Assistência de Longa Duração , Melhoria de Qualidade
7.
J Gerontol Nurs ; 48(8): 43-51, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914081

RESUMO

The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A's Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Prevalence of delirium according to clinical impression was 3.3% (n = 4), whereas prevalence was 12.4% (n = 17) according to DSM-5 criteria and 13.8% (n = 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 (p < 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults. [Journal of Gerontological Nursing, 48(8), 43-51.].


Assuntos
Delírio , Idoso , Delírio/diagnóstico , Delírio/epidemiologia , Humanos , Programas de Rastreamento , Estudos Prospectivos , Melhoria de Qualidade
8.
BMJ Glob Health ; 7(8)2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35914831

RESUMO

All around the world, health systems fail to provide good quality of care (QoC). By developing learning systems, health systems are able to better identify good practices and to explain how to sustain and scale these good practices. To facilitate the operationalisation of national learning systems, the Network for Improving Quality of Care for Maternal Newborn and Child Health (the Network) developed a conceptual framework for national learning systems to support QoC at scale. The Network facilitated an iterative process to reach consensus on a conceptual framework for national learning systems to sustain and scale up delivery of quality healthcare. Following a landscape analysis, the Network Secretariat and WHO convened two consultative meetings with country partners, technical experts and stakeholders. Based on these inputs, we developed a conceptual framework for national learning systems to support QoC at scale. National learning systems use a variety of approaches to identify practices that have improved QoC at the patient and provider levels. They also facilitate scale up and sustain strategies used successfully to support quality improvement. Despite growing consensus on the importance of learning for QoC, no one has yet detailed how this learning should be operationalised nationally. Our conceptual framework is the first to facilitate the operationalisation of national learning systems so that health systems can begin to develop, adapt and implement mechanisms to learn about what works or fails and to scale up and sustain this learning for QoC.


Assuntos
Melhoria de Qualidade , Qualidade da Assistência à Saúde , Criança , Atenção à Saúde , Humanos , Recém-Nascido
10.
BMJ Open Qual ; 11(3)2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35922090

RESUMO

The American Academy of Pediatrics recommends that healthcare professionals model their safe infant sleeping environment recommendations, yet adherence to safe sleep practices within our community hospital mother-baby unit was low. We used quality improvement (QI) methodology to increase adherence to infant safe sleep practices, with a goal to improve the proportion of infants sleeping in an environment that would be considered 'perfect sleep' to 70% within a 1-year period. The project occurred while the hospital was preparing for Baby Friendly certification, with increased emphasis on rooming in and skin to skin at the same time.Multiple Plan-Do-Study-Act cycles were performed. Initial cycles targeted nurse and parental education, while later cycles focused on providing sleep sacks/wearable blankets for the infants.While we did not meet our goal, the percentage of infants with 'perfect sleep' increased from a baseline of 41.9% to 67.3%, and we also saw improvement in each of the individual components that contribute to this composite measure. Improvements were sustained over 12 months later, suggesting that QI interventions targeting infant safe sleep in this inpatient setting can have long-lasting results. This project also suggests that infant safe sleep QI initiatives and preparation towards Baby Friendly Hospital Certification can be complementary.


Assuntos
Melhoria de Qualidade , Morte Súbita do Lactente , Criança , Humanos , Lactente , Cuidado do Lactente/métodos , Recém-Nascido , Segurança do Paciente , Sono , Morte Súbita do Lactente/prevenção & controle , Estados Unidos
11.
J Infus Nurs ; 45(4): 210-219, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35820126

RESUMO

In 2014, a large urban community hospital adopted protected clinical indication practices as a quality improvement project. It then undertook a research study to examine bedside practices with short peripheral catheters, which included direct observation at the bedside once weekly for 6 months. A total of 4305 catheters were observed and remained in place for a total of 23 423 days. Fifty six percent of devices remained in place beyond 96 hours. The overall rate of peripheral bloodstream infection in patients enrolled in the study was 0.12/1000 peripheral intravenous days. Significant differences were noted based on which department placed the catheter, as well as which department cared for the patient during hospitalization. Patients admitted to step-down critical care units had the highest completion of therapy rates; however, those being cared for in medical/surgical units had the best outcomes. Devices placed in the emergency department had a higher successful dwell rate than those placed in critical care units. Twenty-gauge catheters were found to have the highest successful dwell rate, as well as insertion sites that were observed to be within normal limits during the weekly observation. Dressings that were noted to be clean, dry, and intact had a stronger association with completion of therapy than those that were not fully intact. Emphasis was placed on ensuring consistent practices with insertion, care, and maintenance, which contributed to more consistent outcomes between settings that insert, care for, and maintain devices. Nonmodifiable risk factors may remain.


Assuntos
Cateterismo Periférico , Sepse , Cateteres de Demora/efeitos adversos , Cuidados Críticos , Humanos , Melhoria de Qualidade
12.
J Dr Nurs Pract ; 15(2): 105-111, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35820786

RESUMO

BACKGROUND: In teen pregnancy prevention (TPP) evidence-based program replication, fidelity toolkits (FTKs) provide structure to ensure that essential curricular components are delivered as intended. OBJECTIVE: The purpose of this project was to extend quality improvement efforts (Flinders, 2017) through analysis of FTKs from four years of TPP implementation. METHODS: An evidence-based TPP program was delivered to females, 15-19 years of age (n = 1,658) from four suburban Ohio counties. Fidelity rates were calculated by agency staff and undergraduate nursing students. Grounded theory was used to identify themes from the narrative sections of the FTKs. Plan-Do-Study-Act methodology (Agency for Healthcare Research and Quality, 2008) guided this quality improvement work. RESULTS: Staff fidelity was reported as 98.38%. Student fidelity was reported at 99.05%. Key themes, identified as a result of the qualitative analysis, were categorized as participant factors, site factors, or presenter factors. CONCLUSIONS: Toolkits created an effective safeguard to ensure the replication of the evidence-based TPP program, with fidelity. IMPLICATIONS FOR NURSING: Undergraduate students are capable of implementing evidence-based programming, with fidelity, to meet the educational needs of their communities. Analysis of narrative comments from toolkits can influence FTK revisions to improve program delivery.


Assuntos
Bacharelado em Enfermagem , Gravidez na Adolescência , Estudantes de Enfermagem , Adolescente , Feminino , Seguimentos , Humanos , Gravidez , Gravidez na Adolescência/prevenção & controle , Melhoria de Qualidade
13.
BMC Health Serv Res ; 22(1): 857, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35787273

RESUMO

BACKGROUND: To evaluate quality improvement sustainment for Transient Ischemic Attack (TIA) and identify factors influencing sustainment, which is a challenge for Learning Healthcare Systems. METHODS: Mixed methods were used to assess changes in care quality across periods (baseline, implementation, sustainment) and identify factors promoting or hindering sustainment of care quality. PREVENT was a stepped-wedge trial at six US Department of Veterans Affairs implementation sites and 36 control sites (August 2015-September 2019). Quality of care was measured by the without-fail rate: proportion of TIA patients who received all of the care for which they were eligible among brain imaging, carotid artery imaging, neurology consultation, hypertension control, anticoagulation for atrial fibrillation, antithrombotics, and high/moderate potency statins. Key informant interviews were used to identify factors associated with sustainment. RESULTS: The without-fail rate at PREVENT sites improved from 36.7% (baseline, 58/158) to 54.0% (implementation, 95/176) and settled at 48.3% (sustainment, 56/116). At control sites, the without-fail rate improved from 38.6% (baseline, 345/893) to 41.8% (implementation, 363/869) and remained at 43.0% (sustainment, 293/681). After adjustment, no statistically significant difference in sustainment quality between intervention and control sites was identified. Among PREVENT facilities, the without-fail rate improved ≥2% at 3 sites, declined ≥2% at two sites, and remained unchanged at one site during sustainment. Factors promoting sustainment were planning, motivation to sustain, integration of processes into routine practice, leadership engagement, and establishing systems for reflecting and evaluating on performance data. The only factor that was sufficient for improving quality of care during sustainment was the presence of a champion with plans for sustainment. Challenges during sustainment included competing demands, low volume, and potential problems with medical coding impairing use of performance data. Four factors were sufficient for declining quality of care during sustainment: low motivation, champion inactivity, no reflecting and evaluating on performance data, and absence of leadership engagement. CONCLUSIONS: Although the intervention improved care quality during implementation; performance during sustainment was heterogeneous across intervention sites and not different from control sites. Learning Healthcare Systems seeking to sustain evidence-based practices should embed processes within routine care and establish systems for reviewing and reflecting upon performance. TRIAL REGISTRATION: Clinicaltrials.gov ( NCT02769338 ).


Assuntos
Ataque Isquêmico Transitório , Medicina Baseada em Evidências , Prática Clínica Baseada em Evidências , Humanos , Ataque Isquêmico Transitório/terapia , Avaliação de Programas e Projetos de Saúde/métodos , Melhoria de Qualidade
14.
BMC Health Serv Res ; 22(1): 869, 2022 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-35790960

RESUMO

BACKGROUND: The number and efficacy of indicators used to monitor and improve the quality of care in Intensive Care Units (ICU) is debatable. This study aimed to select a consensus-based core set of indicators for effective quality improvement in the ICU. METHODS: A Delphi study with a panel of intensivists, ICU nurses, and former ICU patients or relatives (n = 34) from general, teaching, and academic hospitals. Panelists completed a questionnaire in which they scored 69 preselected quality indicators on relevance using a nine-point Likert scale. Indicators were categorized using the rated relevance score into: 'accepted, 'equivocal' and 'excluded'. Questionnaire results were discussed in focus groups to reach consensus on the final set. RESULTS: Response rates for the questionnaire and focus groups were 100 and 68%, respectively. Consensus was reached on a final set of 17 quality indicators including patient reported outcome measures (PROMs) and patient reported experience measures (PREMs). Other quality indicators relate to the organization and outcome of ICU care, including safety culture, ICU standardized mortality ratio, and the process indicator 'learning from and improving after serious incidents'. CONCLUSIONS: ICU clinicians and former patients and relatives developed a consensus-based core set of ICU quality indicators that is relatively short but comprehensive and particularly tailored to end-users needs.


Assuntos
Dieta , Melhoria de Qualidade , Cuidados Críticos , Técnica Delfos , Humanos , Unidades de Terapia Intensiva
15.
J Wound Ostomy Continence Nurs ; 49(4): 347-351, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35809010

RESUMO

PURPOSE: A quality improvement project was undertaken that evaluated the results of a group inpatient ostomy education class designed to reinforce information provided by the WOC nurse. A secondary goal was to provide emotional support during the immediate postoperative period following ostomy surgery. PARTICIPANTS AND SETTING: Participants were inpatients undergoing fecal ostomies (ileostomies, jejunostomies, or colostomies) and their families. This project took place in an inpatient colorectal unit at the project hospital in Northeast, Ohio. APPROACH: The Plan, Do, Check, Act process was used to guide the quality improvement. Using feedback from postoperative patients, a multidisciplinary team designed an inpatient group ostomy class with education targeting patient-identified needs. Educational content was created with feedback from postoperative patients. The 1-hour class was offered twice weekly and was facilitated by a dietician, a pharmacist, and an RN. Content included general postoperative discharge information, appliance self-care, nutrition guidelines, medications, and resources for support. OUTCOMES: From 2016 to 2019, more than 1500 patients and family members participated in the educational offerings. During this time, length of hospital stay for ostomy patients decreased from 7.299 to 5.938 days. Readmission rates for patients undergoing fecal ostomies declined from 12.9% to a postclass rate of 11.2%. Written/verbal feedback from class attendees, physicians, and nurses was positive. IMPLICATIONS FOR PRACTICE: Project outcomes validated the need for a structured, ongoing inpatient, postoperative, group education for ostomy patients during the immediate postoperative period. Next steps will be to resume the class as it was paused due to COVID-19 restrictions, to continue to revise content, and to implement supplementary materials such as DVDs and online resources.


Assuntos
COVID-19 , Estomia , Humanos , Pacientes Internados , Poder Psicológico , Melhoria de Qualidade
17.
BMJ Open Qual ; 11(3)2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35851037

RESUMO

INTRODUCTION: Hip fractures are common, serious and costly fractures in the elderly population. Several guidelines seeking to ensure best practice have been introduced. Although our institution complied with national guidelines for early surgery of hip fractures, no assessment of other evidence-based measures existed. We wanted to assess, test, implement and measure the impact of a quality improvement (QI) programme consisting of key elements proven to be important in the treatment of hip fractures. METHODS: We formed a multidisciplinary QI team, consisting of several specialists in different fields. The QI team assessed multiple possible process measures for inclusion in the programme and selected six measurable interventions for implementation: early surgery, correct administration of prophylactic antibiotics, surgery using proven methods and expertise, a multidisciplinary patient pathway and secondary fracture prevention. The improvement process was monitored by a statistical process control chart (SPC). Complications, reoperations and mortality were compared before (n=293) and after (n=182) the intervention. RESULTS: The SPC analyses indicated increasing adherence with all interventions throughout the improvement programme, and sustainability 7 years later. The last four periods showed a stable adherence above 90%. We found 60% reduction in major complications after the implementation of the improvement programme, from 19.1% to 7.7% (HR: 0.38 (95% CI: 0.23 to 0.61, p=0.0007). The need for reoperations due to complications fell from 12.6% to 4.9% (HR: 0.37 (95% CI: 0.21 to 0.67, p=0.0054). We did not find a difference in post-operative mortality after the implementation of the QI programme (HR: 0.95 (95% CI: 0.74 to 1.2, p=0.645). CONCLUSION: Our multiprofessional improvement programme achieved almost full adherence within 2 years and was sustainable 7 years later. The quality and safety of the care process were improved and led to a substantial and sustainable decrease in complications and reoperations.


Assuntos
Fraturas do Quadril , Idoso , Fraturas do Quadril/cirurgia , Humanos , Melhoria de Qualidade , Reoperação
19.
Wound Manag Prev ; 68(6): 18-26, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35895032

RESUMO

BACKGROUND: Pressure ulcers/injuries are not only prevalent in the long-term care facilities but also in the acute care setting. Pressure ulcer development has many contributing factors, including prolonged high surface interface pressure between the skin and mattress surface. PURPOSE: The purpose of this quality improvement project was to measure the pressure redistribution properties of 4 hospital surfaces. METHODS: Pressure measurements were performed on 8 participants lying on 1) standard mattress; 2) standard mattress with a static, air-filled bed overlay placed on top of it; 3) mattress with pulsing technology; and 4) mattress with immersing technology. Participants were volunteers measured while lying in the supine position and, in one instance, in the prone position. Pressures were measured with a full-body interface pressure mapping system. RESULTS: Of the 4 surfaces evaluated, the surface that provided the most effective pressure redistribution properties was the combination of the standard viscoelastic mattress with the static, air-filled overlay. CONCLUSION: These results can help guide surface choice for providing the best pressure redistribution properties in order to help prevent pressure ulcers/injuries.


Assuntos
Lesão por Pressão , Leitos , Hospitais , Humanos , Lesão por Pressão/prevenção & controle , Melhoria de Qualidade , Pele
20.
BMC Anesthesiol ; 22(1): 239, 2022 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-35896959

RESUMO

BACKGROUND: Opioid-sparing multimodal analgesic approach has been shown to provide effective postoperative pain relief and reduce postoperative opioid consumption and opioid-associated adverse effects. While many studies have evaluated analgesic strategies for elective cesarean delivery, few studies have investigated analgesic approaches in emergent cesarean deliveries under general anesthesia. The primary aim of this quality improvement project is to evaluate opioid consumption with the use of a multimodal opioid-sparing pain management pathway in patients undergoing emergent cesarean delivery under general anesthesia. METHODS: Seventy-two women (age > 16 years) undergoing emergent cesarean delivery under general anesthesia before (n = 36) and after (n = 36) implementation of a multimodal opioid-sparing pain management pathway were included. All patients received a standardized general anesthetic. Prior to implementation of the pathway, postoperative pain management was primarily limited to intravenous patient-controlled opioid administration. The new multimodal pathway included scheduled acetaminophen and non-steroidal anti-inflammatory medications and ultrasound-guided classic lateral transversus abdominis plane blocks with postoperative opioids reserved only for rescue analgesia. Data obtained from electronic records included demographics, intraoperative opioid use, and pain scores and opioid consumption upon arrival to the recovery room, at 2, 6, 12, 24, 48, and 72 h postoperatively. RESULTS: Patients receiving multimodal opioid sparing analgesia (AFTER group) had lower opioid use for 72 h, postoperatively. Only 2 of the 36 patients (5.6%) in the AFTER group required intravenous opioids through patient-controlled analgesia while 30 out of 36 patients (83.3%) in the BEFORE group required intravenous opioids. CONCLUSIONS: Multimodal opioid-sparing analgesia is associated with reduced postoperative opioid consumption after emergent cesarean delivery.


Assuntos
Analgésicos Opioides , Manejo da Dor , Adolescente , Analgesia Controlada pelo Paciente , Anestesia Geral , Feminino , Humanos , Dor Pós-Operatória/tratamento farmacológico , Gravidez , Melhoria de Qualidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...