scholarly journals Improvement in Lung Insufflation in Spontaneously Breathing Tracheostomized Patients by Using a New Pulmonary Expansion Device: A Pilot Study

2020 ◽  
Vol 14 (4) ◽  
Author(s):  
Oscar I. Quintero ◽  
Paola A. Chavarro ◽  
William Martínez ◽  
Carlos García ◽  
Andrés M. Castro ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Deep Inspiration ◽  
Interventional Study ◽  
Relief Valve ◽  
Adult Intensive Care Unit ◽  
Lung Expansion ◽  
Unidirectional Valve ◽  
Spontaneously Breathing ◽  
The Impact ◽  
Maximum Inspiration

Abstract Lung expansion techniques (LETs) are a key component of pulmonary rehabilitation. Nevertheless, these can be limited in tracheostomized patients because of the infraglottic position of tracheostomy cannulas. We propose a novel pulmonary expansion device (PED) that allows deep inspiration with a postinspiratory pause for a few seconds by means of a unidirectional valve and an occlusion/flow release cap. It is equipped with a relief valve that opens at 60 cm H2O in cases in which this threshold is attained. We aimed to evaluate the impact on lung volume and pressure in spontaneously breathing tracheostomized patients subjected to LETs. A single-arm pilot interventional study was conducted in an adult intensive care unit (ICU), including spontaneously breathing tracheostomized patients. 80 treatments were performed on 10 patients with tracheostomies with PED over a period of 3 months. The maximal inspiratory volume (MIV) was significantly increased by using PED (MIV-PED) at both day 1 (725 (600–820) mL versus 1550 (1250–1700) mL, P < 0.001) and day 3 (870 (750–950) mL versus 1662 (1550–1900) mL, P < 0.001). Inspiratory pause pressure (PIP-PED) did not significantly change from day 1 to day 3 (18 (14–20) cm H2O versus 14 (12–22) cm H2O, P = 0.36). The use of the PED in tracheostomy patients acted as an artificial glottis by performing a novel pulmonary re-expansion maneuver, and increased volumes and intrapulmonary pressure with prolongation of maximum inspiration were achieved.

scholarly journals Deep inspiration breath-hold for left-sided breast irradiation: Analysis of dose-mass histograms and the impact of lung expansion

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Markus Oechsner ◽  
Mathias Düsberg ◽  
Kai Joachim Borm ◽  
Stephanie Elisabeth Combs ◽  
Jan Jakob Wilkens ◽  
...  
Keyword(s):  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Irradiation ◽  
Deep Inspiration Breath Hold ◽  
Lung Expansion ◽  
The Impact

scholarly journals Dose variability in different lymph node levels during locoregional breast cancer irradiation: the impact of deep-inspiration breath hold

2018 ◽  
Vol 195 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Montserrat Pazos ◽  
Alba Fiorentino ◽  
Aurélie Gaasch ◽  
Stephan Schönecker ◽  
Daniel Reitz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Dose Variability ◽  
The Impact ◽  
Cancer Irradiation

Team-Based Intervention to Reduce the Impact of Nonactionable Alarms in an Adult Intensive Care Unit

2020 ◽  
Vol 35 (2) ◽  
pp. 115-122
Author(s):  
Justin Yeh ◽  
Ruth Wilson ◽  
Lufei Young ◽  
Lisa Pahl ◽  
Steven Whitney ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adult Intensive Care Unit ◽  
The Impact

scholarly journals Staphylococcus aureus - selective reporting of antibiogram results and its impact on antibiotic use: Interventional study with a reference group on the effect of switching from non-selective to selective antibiotic reporting

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Franka Lestin-Bernstein ◽  
Ramona Harberg ◽  
Ingo Schumacher ◽  
Lutz Briedigkeit ◽  
Oliver Heese ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Selective Reporting ◽  
Beta Lactams ◽  
Interventional Study ◽  
Patient Level ◽  
Narrow Spectrum ◽  
Bed Days ◽  
The Impact

Abstract Background Antimicrobial stewardship (AMS) strategies worldwide focus on optimising the use of antibiotics. Selective susceptibility reporting is recommended as an effective AMS tool although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use. The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections. Methods This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin, instead of reporting all tested antibiotics. The impact of implementing selective reporting was analysed by monitoring total monthly antibiotic consumption in our hospital and in a reference hospital (recommended daily dose/100 occupied bed days: RDD/100 BD), as well as on an individual patient level by analysing days of therapy adjusted for bed days (DOT/ 100 BD) for patients with S. aureus bacteremia (SAB) and respectively skin and soft tissue infections (SSTI). Results MSSA-antibiograms were acquired for 2836 patients. The total use of narrow-spectrum beta-lactams more than doubled after implementing selective reporting (from 1.2 to 2.8 RDD/100 BD, P < 0.001). The use of intravenous flucloxacillin/cefazolin for SAB rose significantly from 52 to 75 DOT/100 BD (plus 42%), just as the use of oral cefalexin for SSTI (from 1.4 to 9.4 DOT/100 BD, from 3 to 17 of 85/88 patients). Considering the overall consumption, there was no decrease in antibiotics omitted from the antibiogram. This was probably due to their wide use for other infections. Conclusions As narrow-spectrum beta-lactams are not widely used for other infections, their increase in the overall consumption of the entire hospital was a strong indicator that selective reporting guided clinicians to an optimised antibiotic therapy of S. aureus infections. On a patient level, this assumption was verified by a significant improved treatment of S. aureus infections in the subgroups of SAB and SSTI. As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

scholarly journals Length of Initial Prescription at Hospital Discharge and Long-Term Medication Adherence for Elderly, Post-Myocardial Infarction Patients: Protocol for an Interrupted Time Series Study (Preprint)

2020 ◽  
Author(s):  
J D Schwalm ◽  
Noah M Ivers ◽  
Zachary Bouck ◽  
Monica Taljaard ◽  
Madhu K Natarajan ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Usual Care ◽  
Intervention Group ◽  
Interrupted Time Series ◽  
Interventional Study ◽  
Cardiac Medication ◽  
The Impact ◽  
To Receive ◽  
Discharge Prescription

BACKGROUND Based on high-quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to avoid recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a longer duration at discharge from hospital are associated with greater long-term medication adherence. The following is a proposal for the first interventional study to evaluate the impact of longer prescription duration at discharge post-MI on long-term medication adherence. OBJECTIVE The overarching goal of this study is to reduce morbidity and mortality among post-MI patients through improved long-term cardiac medication adherence. The specific objectives include the following. First, we will assess whether long-term cardiac medication adherence improves among elderly, post-MI patients following the implementation of (1) standardized discharge prescription forms with 90-day prescriptions and 3 repeats for recommended cardiac medication classes, in combination with education and (2) education alone compared to (3) usual care. Second, we will assess the cost implications of prolonged initial discharge prescriptions compared with usual care. Third, we will compare clinical outcomes between longer (&gt;60 days) versus shorter prescription durations. Fourth, we will collect baseline information to inform a multicenter interventional study. METHODS We will conduct a quasiexperimental, interrupted time series design to evaluate the impact of a multifaceted intervention to implement longer duration prescriptions versus usual care on long-term cardiac medication adherence among post-MI patients. Intervention groups and their corresponding settings include: (1) intervention group 1: 1 cardiac center and 1 noncardiac hospital allocated to receive standardized discharge prescription forms supporting the dispensation of 90 days’ worth of cardiac medications with 3 repeats, coupled with education; (2) intervention group 2: 4 sites (including 1 cardiac center) allocated to receive education only; and (3) control group: all remaining hospitals within the province that did not receive an intervention (ie, usual care). Administrative databases will be used to measure all outcomes. Adherence to 4 classes of cardiac medications — statins, beta blockers, angiotensin system inhibitors, and secondary antiplatelets (ie, prasugrel, clopidogrel, or ticagrelor) — will be assessed. RESULTS Enrollment began in September 2017, and results are expected to be analyzed in late 2020. CONCLUSIONS The results have the potential to redefine best practices regarding discharge prescribing policies for patients post-MI. A policy of standardized maximum-duration prescriptions at the time of discharge post-MI is a simple intervention that has the potential to significantly improve long-term medication adherence, thus decreasing cardiac morbidity and mortality. If effective, this low-cost intervention to implement longer duration prescriptions post-MI could be easily scaled. CLINICALTRIAL ClinicalTrials.gov NCT03257579; https://clinicaltrials.gov/ct2/show/NCT03257579 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18981

scholarly journals Staphylococcus Aureus: Selective Reporting of Antibiogram Results and Its Impact on Antibiotic Use. Interventional Study with a Reference Group on the Effect of Switching from Non-Selective to Selective Antibiotic Reporting

2020 ◽  
Author(s):  
Franka Lestin-Bernstein ◽  
Ramona Harberg ◽  
Ingo Schumacher ◽  
Lutz Briedigkeit ◽  
Oliver Heese ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Selective Reporting ◽  
Care Hospital ◽  
Beta Lactams ◽  
Interventional Study ◽  
Narrow Spectrum ◽  
The Impact

Abstract Background:Antimicrobial stewardship (AMS) strategies worldwide focus on optimised antibiotic use. Selective susceptibility reporting is recommended as an effective AMS tool, although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use.The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections.Methods:This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period, susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/oral cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin; instead of reporting all tested antibiotics during the year before the intervention and in the reference clinic. The impact of the intervention was analysed by monitoring antibiotic consumption (recommended daily dose/100 occupied bed days: RDD/100 BD).Results:MSSA-antibiograms were reported for 2836 patients. Total use of narrow-spectrum beta-lactams more than doubled during the intervention (from 1.2 to 2.8 RDD/100 BD, P<0.001; P<0.001 compared to the reference clinic); the percentage of total antibiotic use increased from 2.6% to 6.2%. A slight, but significant increase in the use of trimethoprim-sulfamethoxazole was also observed (+ 0.37 RDD/100 BD).There was no decrease in antibiotics withdrawn from the antibiogram, probably as a consequence of their wide use for indications other than S. aureus infections.Conclusions:As narrow-spectrum beta-lactams are not widely used for other infections, there is a strong indication that selective reporting guided clinicians to optimised antibiotic therapy of S. aureus infections.As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

scholarly journals Impact Of Wounds In The Assistance To Basic Human Needs In Intensive Care

10.3823/2385 ◽  
2017 ◽  
Vol 10 ◽  
Author(s):  
Jocelly De Araújo Ferreira ◽  
Nayda Babel Alves de Lima ◽  
Glenda Agra ◽  
Priscilla Tereza Lopes de Souza ◽  
Cecilia Jéssica Azevedo da Silva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Positive Impact ◽  
Soft Tissue Injuries ◽  
Quantitative Character ◽  
Adult Intensive Care Unit ◽  
Human Needs ◽  
Positive Effects ◽  
Basic Human Needs ◽  
The Impact

Objective: to understand the impact of soft tissue injuries in the provision of assistance to Basic Human Needs of customers by the nursing staff in the Adult Intensive Care Unit of a hospital in Pernambuco, Brazil. Methodology: this is a descriptive study with quantitative character, performed with 104 nurses in December 2015. A questionnaire drawn from Wanda Horta's theory was used for data collection. Results: the most judicious care provided by the multidisciplinary team (81.7%) and the establishment of bond between professionals and clients (57.7%) were found to be the main positive effects. However, negative effects were outstanding, indicated by increased hospital stay (86.5%) and feeling of anxiety (72.1%). Despite the interference of lesions, body care (86%), communication (63.3%), and religiosity/spirituality (43.3%) needs were referred to as met. Conclusion: the presence of wounds represents a difficulty to meet needs, although they bring some positive impact on the client. However, while recognizing the importance of valuing the customer subjectivity, this aspect is not yet addressed with proper attention. Keywords: Intensive Care Unit; Injuries; Nursing Care; Basic needs.  

PACS Quality Dimensions

2010 ◽  
pp. 140-153
Author(s):  
Carrison K.S. Tong ◽  
Eric T.T. Wong
Keyword(s):  
Process Analysis ◽  
Radiology Department ◽  
Success Factor ◽  
Healthcare Organizations ◽  
Adult Intensive Care Unit ◽  
It Systems ◽  
Number Of Factors ◽  
Other Information ◽  
The Impact

A large number of studies have attempted to identify the factors that contribute to good PACS quality, such as that shown by Reiner et al (2003). Results from these studies (Bauman, 2000; Ralston, 2000) reveal that the success of PACS requires healthcare organizations and managers to adequately address various types of challenges: technological (e.g., integration with other information systems), managerial (e.g., project management), organizational (e.g., availability of resources), behavioural (e.g., change management), and political (e.g., alignment among key participants). Most investigations have considered a single, or at best, a small number of factors contributing to a fragmented view of PACS success. Broadly, these studies may be classified into those that consider the impact of PACS on radiologists’ workload and productivity (Gale, 1999), those that consider its clinical implications (Hertzberg, 2000) and those associated with performance of the radiology department (Hayt, 2001). Rather than measuring the quality of the PACS performance, other researchers have preferred to focus on the quality of the information, that the system produces, primarily in the form of images and reports. For instance, Lou et al. (1997) considered the data integrity and completeness of acquired images. Quality of images in terms of timeliness, accuracy, completeness, and so forth, was also considered to be a key success factor in several evaluative studies (Cox, 2002; Pavlicek, 1999; Pilling, 2003; Blado, 2002). Indeed, Cox’s work was part of a wider evaluation exercise undertaken to assess the impact of the introduction of a PACS on the adult intensive care unit (AICU) at the Royal Brompton NHS Trust in London. The objectives of the research were to evaluate the perceptions of PACS of the medical and ancillary staff working within AICU as well as to undertake a preliminary assessment of its impact on the workload of radiographers. Questionnaires, interviews and a process analysis were undertaken. The research findings indicate that the overall perception of staff towards the introduction of the PACS was positive. The impact of the system on the workload of radiographers was significant, reducing the time taken to obtain an image from 90 to 60 minutes. However, lessons to be learned for future PACS implementations include the need to ensure compatibility with existing IT systems and adequate IT support. In short, once this expanded, but rather fragmented view of PACS success is recognized, it is not surprising to find that there are so many different measures of PACS quality in the literature depending upon which aspect of PACS the researcher focused his or her attention.

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