... implement changes in individual intensive care units.” Indeed, physicians want to improve their delivery of care, but often lack an understanding of the basic theories that are necessary for their quality ... understanding of pathophysiology and pharmacokinetics, few clinicians or researchers possess formalized training in systems thinking, the process of quality improvement, concepts regarding changing ... Terrace, Illinois: Joint Commission; 1998 Berwick DM: Developing and testing changes in delivery of care Ann Intern Med 1998, 128:651-656 Reinertsen JL: Physicians as leaders inthe improvement...
... Hudson LD, Steinberg KP: Epidemiology of acute lung injury and ARDS Chest 1999, 116:74S-82S 21 Quartin AA, RM HS: Acute lung injury: is the intensive careunitthe tip of the iceberg? Crit Care Med ... ALI /ARDS, we continued to screen enrolled patients daily for the development of other clinical risk conditions Screening for ALI /ARDS diagnosis was continued for days unless another clinical insult developed, ... ALI /ARDS; 108 (13.3%) received careinthe ICU, whereas 707 (86.7%) were cared for only on another ward (Figure 1) Demographic information and data collected on the day that the clinical insult...
... for bias inthe results and is a limitation of the study Medical errors are among the leading causes of death inthe United States In its highly publicised report, the Institute of Medicine estimates ... using the Clinical Informacomputerised physician order entry (CPOE) using the Clinical Information System with 95% confidence intervals Hand-written prescribing (HWP) data collection began on the ... those reported in a recent study of prescription errors in UK critical care units [12] There was no difference inthe mean APACHE II score inthe HWP and CPOE periods, indicating that it is unlikely...
... these units, usually on a one-week basis One month after the completion of the study, the ICIS was implemented inthe two other remaining units Approval of the ethics committee was obtained; informed ... defined as calculated creatinine clearance less than 50 ml/minute The parameters needed to calculate the creatinine clearance were always available in both the PB-U and the C-U In addition to the ... intensive care and general care units Crit Care Med 1997, 25:1289-1297 12 Herout PM, Erstad BL: Medication errors involving continuously infused medications in a surgical intensive careunit Crit Care...
... D insufficient However, the prevalence of vitamin D insufficiency is even higher in subjects admitted to the intensive careunit with critical illness We also demonstrate that vitamin D binding ... 25-hydroxyvitamin D lost inthe urine [24] This process is facilitated by megalin, a protein located on the renal epithelial cell which binds to the DBP-25-hydroxyvitamin D complex to facilitate the recovery ... Actin binding with DBP results in lowered DBP concentrations which in turn further lowers 25(OH)D due to renal wasting of vitamin D and its metabolites, providing another mechanism to explain...
... characteristics of pathogens causing HAP inthe Intensive careunit of Bach Mai Hospital which is the area with the highest incidence density of healthcare associated infections among Vietnamese HCFs ... characteristics of pathogens causing HAP These findings suggest areas for intervention and for developing guideline for prevention and control of HAP in HCFs THESIS STRUCTURE The thesis consists of 129 ... be inhaled by susceptible individuals through the dissemination of either airborne droplet nuclei or small particles (< 5μm )in the respirable size range containing infectious agents that remain...
... tamponade following cardiothoracic surgery inthe intensive careunit Journal of Cardiothoracic Surgery 2011 6:79 Competing interests The authors declare that they have no competing interests Received: ... echocardiography, one examination showed a clot next to the right ventricle without compression and no other abnormalities, while theother echo showed a clot behind the left atrium with ten Tusscher ... the intensive careunit (ICU), in order to study predictors of success of rethoracotomy [9] The amount of pericardial fluid recovered at rethoracotomy was inthe same range as found in other...
... hepatitis C virus; ICU: intensive care unit; IV: intravenous; NE: norepinephrine; RCT: randomized controlled trial Competing interests The authors declare that they have no competing interests Authors' ... continue for a long time without obvious adverse effects or major organ toxicity is, in our opinion, the most interesting finding in our report Therefore, we believe that this report is a meaningful ... minute, was treated with intravenous atropine and/or continuous isoproterenol infusion Meanwhile, their tachycardia, which is defined as having a heart rate of >110/min, was treated with continuous...
... 163) was evidenced in 176 patients (96%) The bronchoscopic findings revealed a localized active endobronchial bleeding in 53 patients and a localized endobronchial clotting in 41 Otherwise, a localized ... either maintaining conservative measures in patients or to surgery in six; of these 15 patients died within the first month (4/9 patients managed conservatively and 1/6 undergoing surgery) In ... control the bleeding, using cold saline solution lavage, instillation of topical vasoconstrictive agents and/or balloon tamponade therapy As the administration of systemic terlipressin may interfere...
... if they initiated the request or if another physician requested the administration of red cells Physicians requesting the transfusion were then asked to identify the most important reason for the ... haemoglobin concentrations during the first 10 days of intensive careunit (ICU) stay There was an average decrease of 16 g/l in haemoglobin concentrations in all patients admitted to the ICU over the ... Variation in red cell transfusion practice inthe intensive careunit Hébert et al For the bedside questionnaire, we determined the response rate at each institution by cross checking recorded...
... existing monitors inthe intensive careunit Crit Care Med 1997, 25:614–619 Chambrin MC, Ravaux P, Calvelo D, Jaborska A, Chopin C, Boniface B: Multicentric study of monitoring alarms inthe adult ... of the patient from the ventilator produces the same audible alarm as a high level of minute ventilation Inthe first case, the alarm is vital for the patient and independent of any setting The ... setting For a given parameter, this default setting can vary from one monitoring system to another [10] In some cases, the last settings are taken into account as defaults for the new use of the...
... reduction in its use, a sustained reduction inthe Kollef et al examined the influence of a scheduled change in antibiotic on the incidence of nosocomial infections among patients undergoing cardiac ... improve the efficacy of antimicrobial therapy by increasing the likelihood for adequate initial treatment of infections [6] Antimicrobial de-escalation There is increasing clinical evidence suggesting ... Care 10 11 12 13 14 15 16 17 18 19 20 21 22 August 2001 Vol No Kollef of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care...
... cholinesterase, the interindividual variability in effect is as wide as with succinylcholine [18] Many studies have shown that rocuronium is a highly acceptable replacement for succinylcholine inthe ICU; therefore, ... [16] Furthermore, succinylcholine increases plasma noradrenaline (norepinephrine) concentrations, resulting in cardiovascular effects Finally, the histamine-releasing properties of muscle relaxants ... succinylcholine administration, caused by stimulation of nicotinic receptors inthe autonomic ganglia (sympathetic and parasympathetic) and of cardiac muscarinic receptors [16] Furthermore, succinylcholine...
... demeaning the clinical training of students and house officers, I Competing interests None declared Acknowledgements I am indebted to the medical, nursing, and respiratory therapy staffs of the Intermountain ... within the healthcare delivery system Human decision-making limitations, perceptual inaccuracies, and variation inthe use and inthe interpretation of important clinical variables all make clinicians ... Intermountain Respiratory Intensive CareUnit and of the ShockTrauma/Intermountain Respiratory ICU, and to the Respiratory Care Department of the LDS Hospital, for collaboration during the past...
... resistances are questionable considering the remarkable stability of mecA inthe MRSA, vancomycinresistant determinants inthe enterococci, or integrons in nature, even inthe absence of antibiotic pressure ... and transposons, the more recently described integrons can capture multiple gene cassettes, express them, and then integrate them into the chromosome [7] The genes found in integrons often encode ... numerous other molecular mechanisms of resistance, representing additional threats to the rotation strategy For instance, the combination of quinolone and methicillin resistance is often observed in...
... Japan) The treating clinicians were blinded to the PCT results, and those performing the PCT assays were blinded to the clinical status of the patient The PCT results were not available during the ... aminotransferase, alanine aminotransferase, prothrombin time, activated partial thromboplastin time, albumin, transferrin and CRP); and arterial blood gas analysis The final determination of the ... diseases in an intensive careunit (ICU) Method The study was approved by the Institutional Ethics Committees of the Pamukkale University Medical School Written informed consent was obtained from...
... strides have been made in defining ethical principles to guide end-of-life careinthe 35 years since a panel reached consensus on guidelines to define brain death [20] Nevertheless, it is important ... responsible clinicians asked to provide a rationale for this inconsistent level of care Although providing some life-sustaining treatments while withholding others may reflect informed decisions on the ... and sedation in dying intensive careunit patients BMC Med Ethics 2002, 3:3 [http://www.biomedcentral.com/1472-6939/3/3] Campbell ML: Forgoing life-sustaining therapy: how to care for the patient...
... and bilirubin, alanine aminotransferase and creatinine (Vitalab Flexor, Dieren, The Netherlands) were determined at baseline (15 before start of the study), immediately after sedative infusion ... Pitfalls of monitoring sedation inthe ICU with the bispectral index Anesthesiology 1998, 89:A461 Simmons LE, Riker RR, Prato BS, Fraser GL: Assessing sedation during intensive careunit mechanical ... sites of the body No inotropic agent was administered during the study ProtocolThe study was prospective, randomized, double blind, and placebo-controlled Randomization was conducted according to...
... an international perspective on the outcome following sepsis is becoming increasingly important The Kingdom of Saudi Arabia has some unique features in this regard First, the Kingdom hosts the ... gather in Makkah [5] Many of these pilgrims are elderly with underlying chronic illnesses, making them especially susceptible to infectious illnesses Second, the health care system inthe Kingdom ... approaches in risk stratification have been utilized, including the use of severity of illness scoring systems and the use of certain inflammatory markers (e.g interleukin-1, interleukin-6, tumour...