scholarly journals Febre Escaro-Nodular: Revisão Retrospetiva de Casos Hospitalizados e Fatores Preditores de Doença Severa

2015 ◽  
Vol 28 (5) ◽  
pp. 624 ◽  
Author(s):  
Mariana Meireles ◽  
Rui Magalhães ◽  
Arlindo Guimas
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Spotted Fever ◽  
Severe Disease ◽  
Elevated Serum ◽  
Lactic Dehydrogenase ◽  
Clinical Findings ◽  
Mediterranean Spotted Fever ◽  
General Infirmary ◽  
The Mean

<strong>Introduction:</strong> Mediterranean spotted fever, an ancient zoonotic disease raising current issues. This study aims to reevaluate the disease clinical picture and to identify prognostic factors related to severe disease.<br /><strong>Material and Methods:</strong> We evaluate cases admitted to a central hospital during 12-year period. The risk factors were determined by uni and multivariate analysis, comparing patients admitted in general infirmary versus intermediate/intensive care units or in case of death.<br /><strong>Results:</strong> We reviewed 71 cases of Mediterranean spotted fever. The mean age was 63.3 ± 16.7 years and 52.1% were male. The eschar was observed in 62.0%. Fever and rash were the most common clinical findings. Forty five percent of patients developed complications and 22.5% were admitted to intermediate and/or intensive care units. Apyrexia, dyspnea, renal failure and elevated lactic dehydrogenase levels at admission were predictors of severe disease development (p &lt; 0.034). Alcoholism was related with prolonged hospitalization (p = 0.020). Absence of fever (p = 0.019) and elevated serum creatinine levels (p = 0.028) were identified as independent factors associated with severe outcome. The mortality rate was 2.8%.<br /><strong>Discussion:</strong> Although Mediterranean spotted fever is usually assumed to be benign, severe cases are emerging.<br /><strong>Conclusion:</strong> Early identification of the infection and continuous patient surveillance are crucial, particularly in those with greater risk of developing severe or fatal disease.

scholarly journals Candidemia in an intensive care unit

Medicina ◽  
2008 ◽  
Vol 45 (5) ◽  
pp. 351
Author(s):  
Dalia Adukauskienė ◽  
Aida Kinderytė ◽  
Asta Dambrauskienė ◽  
Astra Vitkauskienė
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Urinary Bladder ◽  
Intensive Care Units ◽  
Severe Disease ◽  
Candida Spp ◽  
Lethal Outcome ◽  
Bladder Catheter

Candidemia is becoming more actual because of better survival of even critically ill patients, wide use of antimicrobials, and increased numbers of invasive procedures and manipulations. Diagnosis of candidemia remains complicated, and costs of treatment and mortality rates are increasing. Objective. To evaluate the pathogens of candidemia, risk factors and their influence on outcome. Material and methods. Data of 41 patients with positive blood culture for Candida spp., who were treated in the intensive care units at the Hospital of Kaunas University of Medicine, were analyzed retrospectively. Results. Candidemia was caused by Candida albicans (C. albicans) in 48.8% (n=20) of patients and by non-albicans Candida in 51.2% (n=21) of patients. The main cause of candidemia was C. albicans in 2004 (83.3%, n=5), but in 2005 (63.6%, n=7), in 2006 (57.1%, n=4), and in 2007 (52.9%, n=9), the main cause was non-albicans Candida spp. The number of candidemia cases caused by C. albicans was decreased in 2005, 2006, and 2007 as compared with 2004, and the number of candidemia caused by non-albicans Candida spp. was decreased, respectively (P<0.05). More than 65% (n=34) of patients had severe disease (P<0.05). Lethal outcome was recorded in 58.5% of patients with candidemia. Mechanical ventilation was used in 76.9% (n=20) and urinary bladder catheter in 72.1% (n=19) of non-survivors and in 23.1% (n=6) and 26.9% (n=7) of survivors, respectively (P<0.05). Conclusions. There is an increase in the prevalence of candidemia in the intensive care units during the 4-year period; half of candidemia cases were caused by non-albicans Candida spp., and patients with candidemia caused by non-albicans Candida spp. are at higher risk of mortality. Therefore, for the empirical treatment of septic conditions in an intensive care unit, when invasive fungal infection is suspected, we recommend using an antifungal agent of non-azole class until a pathogen of candidemia is determined. Severe disease is evaluated as a risk factor for candidemia. Patients with oncological diseases are at significantly higher risk for candidemia caused by non-albicans Candida spp. Use of mechanical ventilation and urinary bladder catheter is a risk factor for lethal outcome.

The prevalence of potentially beneficial and harmful drug-drug interactions in intensive care units

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Hossein Ali Mehralian ◽  
Jafar Moghaddasi ◽  
Hossein Rafiei
Keyword(s):  
Intensive Care ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Intensive Care Units ◽  
Medical Records ◽  
Potential Ddis ◽  
Cross Sectional ◽  
Text Book ◽  
The Mean ◽  
Potential Interactions

Abstract Background The present study was conducted with the aim of investigating the prevalence of potentially beneficial and harmful drug-drug interactions (DDIs) in intensive care units (ICUs). Methods The present cross-sectional prospective study was conducted in two ICUs in Shahr-e Kord city, Iran. The study sample was consisted of 300 patients. The Drug Interaction Facts reference text book [Tatro DS. Drug interaction facts. St Louis, MO: Walters Kluwer Health, 2010.] was used to determine the type and the frequency of the DDIs. Results The participants consisted of 189 patients men and 111 women. The mean age of patients was 44.2 ± 24.6 years. Totally, 60.5% of patients had at least one drug-drug interaction in their profile. The total number of DDIs found was 663 (the mean of the total number of drug-drug interactions was 2.4 interactions per patient). Of all the 663 interactions, 574 were harmful and others were beneficial. In terms of starting time, 98 of the potential interactions were rapid and 565 of them were delayed. In terms of severity, 511 of the potential interactions were moderate. Some of the drugs in the patients’ medical records including phenytoin, dopamine, ranitidine, corticosteroid, dopamine, heparin, midazolam, aspirin, magnesium, calcium gluconate, and antibiotics, the type of ventilation, the type of nutrition and the duration of hospital stay were among the factors that were associated with high risk of potential DDIs (p < 0.05). Conclusions The prevalence of potentially beneficial and harmful DDIs, especially harmful drug-drug interactions, is high in ICUs and it is necessary to reduce these interactions by implementing appropriate programs and interventions.

scholarly journals Effect of Evidence-Based Nursing Care Guidelines on the Quality of Care of Patients in Neurosurgical Intensive Care Units

2020 ◽  
Vol 24 (1) ◽  
pp. 56-67
Author(s):  
Zahra Tayebi Myaneh ◽  
◽  
Maryam Azadi ◽  
Seyedeh Zahra Hosseinigolafshani ◽  
Farnoosh Rashvand ◽  
...  
Keyword(s):  
Intensive Care ◽  
Quality Of Care ◽  
Intensive Care Units ◽  
Nursing Care ◽  
Evidence Based ◽  
Neurosurgical Intensive Care ◽  
Care Guidelines ◽  
The Mean ◽  
Evidence Based Nursing

Background: Evidence-based nursing care guidelines are important tools for increasing the quality of nurses’ clinical work. Objective: The aim of this study was to investigate the effect of implementing evidence-based nursing care guidelines on the quality of care of patients admitted to the Neurosurgical Intensive Care Units (NICUs). Methods: This is a quasi-experimental study on 54 nurses in NICUs of hospitals affiliated to Qazvin University of Medical Sciences selected using a convenience sampling technique and divided into two groups of intervention and control. The intervention included the teaching of evidence-based nursing guidelines and their implementation by the nurses. Before and two months after the intervention, the demographic characteristics and the quality of nurses’ patient care in both groups was evaluated by using a demographic form and a standard checklist with 37 items designed based on the standards of practice for All Registered Nurses (ANA). Data were analyzed in SPSS software using descriptive statistics (Mean±SD), and paired t-test, independent t-test and chi-square test. Findings: The mean score of nursing care quality in the two groups was not significantly different before intervention (P>0.05). After intervention, the mean score was 25.11±6.2 in the intervention group and 20.29±5.3 in the control group, and the difference was statistically significant (P<0.05). Conclusion: Implementation of evidence-based nursing care guidelines can improve the quality of nursing care. Therefore, it is recommended that the teaching of evidence-based nursing care guidelines should be on the agenda of the hospitals’ education unit and related departments.

scholarly journals Perception of the Futile Care and its Relationship With Moral Distress in Nurses of Intensive Care Units

2021 ◽  
Vol 31 (2) ◽  
pp. 85-92
Author(s):  
Somayeh Moaddaby ◽  
◽  
Masoomeh Adib ◽  
Sadra Ashrafi ◽  
Ehsan Kazemnezhad Leili ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Regression Model ◽  
Intensive Care Units ◽  
Work Experience ◽  
Logistic Regression Model ◽  
Moral Distress ◽  
Cross Sectional ◽  
Futile Care ◽  
The Mean

Introduction: The development of science and technology has provided more opportunities for patients to live and even receiving futile medical care or treatment with no hope of recovery. This process leads to awkward experiences and moral distress in nurses who frequently deliver with such care. Objective: This study aimed to determine the perception of futile care and its relationship with moral distress in nurses working in intensive care units Materials and Methods: This is a cross-sectional study conducted on 155 nurses working in Intensive Care Units (ICUs) employed in educational-therapeutic centers and hospitals of Guilan Province, Iran. They were selected by convenience sampling method. The study data were collected using the researcher-made questionnaire and Corley moral distress questionnaire. The obtained data were analyzed using descriptive statistics and inferential statistics the Kolmogorov-Smirnov test, nonparametric Mann-Whitney U, Kruskal-Wallis, Fisher exact and Backward logistic regression model. Results: The mean±SD age of the samples was 34.71±6.68 years; their mean±SD work experience was 10.24±5.63 years, and the mean±SD work experience in the ICU was 6.76±4.64 years. The results indicated that their mean±SD perception of futile care was 63±7, and their mean±SD moral distress was 92±54. The score of moral distress showed a low but significant and positive correlation with the legal and organizational aspects of futile care (r=0. 279, P=0.001) and the total score of perception futile care (r=0.2, P=0.012). In the multivariate analysis based on the logistic regression model of futile care, only the relationship between the legal and organizational score in care had a significant relationship with moral distress. So that by increasing one unit in the legal and organizational aspect of care, the chances of scoring above the mean of moral distress increases 1.2 times (P=0.0001, 95% CI; 1.077-1.324). Conclusion: Perhaps by familiarizing nurses with the legal and organizational nature of patient’s care, the moral distress of caring can be reduced.

Is Clostridium difficile infection an increasingly common severe disease in adult intensive care units? A 10-year experience

2015 ◽  
Vol 30 (3) ◽  
pp. 543-549 ◽  
Author(s):  
E. Bouza ◽  
M. Rodríguez-Créixems ◽  
L. Alcalá ◽  
M. Marín ◽  
V. De Egea ◽  
...  
Keyword(s):  
Intensive Care ◽  
Clostridium Difficile ◽  
Intensive Care Units ◽  
Clostridium Difficile Infection ◽  
Severe Disease

scholarly journals Investigation of Intensive Care Nurses’ Organizational Innovation Levels

2020 ◽  
Author(s):  
Elif Gezginci ◽  
Bediye Öztaş ◽  
Gönül Kurt
Keyword(s):  
Intensive Care ◽  
Marital Status ◽  
Intensive Care Units ◽  
Organizational Innovation ◽  
Educational Status ◽  
Intensive Care Nurses ◽  
Significant Difference ◽  
Training And Research ◽  
The Mean ◽  
One Way Anova

Aim: The aim of this study was to investigate intensive care nurses’ organizational innovation levels. Methods: This descriptive study was conducted with 90 nurses working in the Intensive Care Units of a Training and Research Hospital in Ankara. Data were collected by Descriptive Information Form and Organizational Innovation Scale. Descriptive statistics, One-Way ANOVA test, Mann-Whitney U test and Kruskal-Wallis test were used to evaluate the data. Results: The mean age of participants was 28.01±5.6. It was found that most of the participants (68.9%) did not use resources effectively for innovative practices and 66.7% of them did not intend to develop a project related to innovative practices. Eighty-eight percent of participants stated that intensive care units are suitable places for innovative practices. There was no statistically significant difference between age, marital status, educational status, occupational year, working year in intensive care unit with organizational innovation sub-scales (p<0.05). Conclusion: According to this study, intensive care nurses’ socio-demographic characteristics such as age, marital status, education level, occupational year and working time in intensive care did not affect their organizational innovation tendencies.

scholarly journals Vigilance in Iranian Nurses Working in Intensive Care Units

2021 ◽  
Author(s):  
Mojgan Najafi ◽  
Mehdi Ajri ◽  
Mansoureh Karimollahi
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Decision Making ◽  
Essential Element ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Demographic Characteristics ◽  
Cross Sectional ◽  
The Mean

Abstract Background and aim: Vigilance is an essential element in intensive care nursing. This study was conducted to determine nursing vigilance in nurses working in the intensive care units of educational and medical centers in Ardabil, IranMethods: This was a cross-sectional descriptive-analytical study with 192 ICU nurses as the participants. The data were obtained through questionnaires regarding demographic characteristics and nursing vigilance. SPSS software version 24 was used for the statistical analysis.Results: The mean total vigilance score was 3.86 ± 0.23 of 5. The mean scores of the timely diagnosis of changes, pattern recognition, and clinical decision-making subscales were 4.07 ± 0.26, 04.04 ± 0.41, and 3.44 ± 0.25, respectively. No significant relationships were observed between the total or subscale vigilance scores and other demographic characteristics.Conclusion: We assessed ICU nurses’ vigilance behaviors and found that their mean vigilance score was higher than the expected average, indicating our participants had a high level of clinical vigilance. These results suggest a need for effective educational interventions to boost clinical decision-making skills in ICU nurses, especially younger nurses.

scholarly journals The Age-AST-D Dimer (AAD) Regression Model Predicts Severe COVID-19 Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Fátima Higuera-de-la-Tijera ◽  
Alfredo Servín-Caamaño ◽  
Daniel Reyes-Herrera ◽  
Argelia Flores-López ◽  
Enrique J. A. Robiou-Vivero ◽  
...  
Keyword(s):  
Intensive Care ◽  
Liver Injury ◽  
Clinical Course ◽  
Severe Disease ◽  
Lactic Dehydrogenase ◽  
Icu Patients ◽  
Derivation Cohort ◽  
Icu Admission ◽  
Admission Time ◽  
D Dimer

Aim. Coronavirus disease (COVID-19) ranges from mild clinical phenotypes to life-threatening conditions like severe acute respiratory syndrome (SARS). It has been suggested that early liver injury in these patients could be a risk factor for poor outcome. We aimed to identify early biochemical predictive factors related to severe disease development with intensive care requirements in patients with COVID-19. Methods. Data from COVID-19 patients were collected at admission time to our hospital. Differential biochemical factors were identified between seriously ill patients requiring intensive care unit (ICU) admission (ICU patients) versus stable patients without the need for ICU admission (non-ICU patients). Multiple linear regression was applied, then a predictive model of severity called Age-AST-D dimer (AAD) was constructed ( n = 166 ) and validated ( n = 170 ). Results. Derivation cohort: from 166 patients included, there were 27 (16.3%) ICU patients that showed higher levels of liver injury markers ( P < 0.01 ) compared with non-ICU patients: alanine aminotrasnferase (ALT) 225.4 ± 341.2 vs. 41.3 ± 41.1 , aspartate aminotransferase (AST) 325.3 ± 382.4 vs. 52.8 ± 47.1 , lactic dehydrogenase (LDH) 764.6 ± 401.9 vs. 461.0 ± 185.6 , D-dimer (DD) 7765 ± 9109 vs. 1871 ± 4146 , and age 58.6 ± 12.7 vs. 49.1 ± 12.8 . With these finding, a model called Age-AST-DD (AAD), with a cut-point of <2.75 ( sensitivity = 0.797 and specificity = 0.391 , c − statistic = 0.74 ; 95%IC: 0.62-0.86, P < 0.001 ), to predict the risk of need admission to ICU ( OR = 5.8 ; 95% CI: 2.2-15.4, P = 0.001 ), was constructed. Validation cohort: in 170 different patients, the AAD   model < 2.75 ( c − statistic = 0.80 (95% CI: 0.70-0.91, P < 0.001 ) adequately predicted the risk ( OR = 8.8 , 95% CI: 3.4-22.6, P < 0.001 ) to be admitted in the ICU (27 patients, 15.95%). Conclusions. The elevation of AST (a possible marker of early liver injury) along with DD and age efficiently predict early (at admission time) probability of ICU admission during the clinical course of COVID-19. The AAD model can improve the comprehensive management of COVID-19 patients, and it could be useful as a triage tool to early classify patients with a high risk of developing a severe clinical course of the disease.

scholarly journals Injury profile and healthcare expenditure of cyclists admitted in intensive care units

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Papadakaki ◽  
C h Gnardellis ◽  
A Tsalkanis ◽  
M A Stamouli ◽  
E Petelos ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Injury Severity ◽  
Road Traffic ◽  
Diagnosis Related Groups ◽  
Health Care Expenditure ◽  
Public Hospitals ◽  
High Dependency ◽  
Hospitalization Costs ◽  
The Mean

Abstract Background The current paper is part of the EU-funded REHABILAID Project and aims to describe the profile of cyclists sustaining severe injuries in a road traffic incident as well as the healthcare costs associated with their injury, including hospitalization costs and out-of-pocket expenditure. Methods Seven public hospitals were involved; Greece=5, Italy=1 and Germany=1. Both the intensive care units (ICU) and sub-intensive care units (as high-dependency areas) were involved. Participants enrolled during a 12-month period starting from April 2013 and were followed for one year from admission date. The study used widely recommended classifications for injury severity (AIS-Update 2008, MAIS). Information on the injury was retrieved upon patients’ consent, from medical records while interviews were carried out at months 1,6,12 for personal and cost-related information. Health Care Expenditure was assessed through the MUARC’s framework. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results 120 subjects enrolled in the study in total and 14 were cyclists(Greece=1, Germany=3, Italy=10). Most of them were men(n = 9, 64.3%), with a mean age of 55.5 years (SD16.3;min 32-max 84). As for the current incidents, the majority occurred at city roads (n = 10;71.4%), straight roads (n = 9;64.3%) and intersections (n = 3;21.4%). Many were single-vehicle (n = 4;28.6%), lateral (n = 4;28.6%) and front-lateral (n = 3;21.4%). Half of the cyclists sustained an injury of MAIS3+ severity (n = 7;50.0%). A major injury was primarily sustained at the lower extremities (n = 10;71.4%), head (n = 7;50.0%), face (5=35.7%) and upper extremities (n = 5;35.7%). The mean total hospitalization cost was 5815,6(min 209,00-max 20.647,00) and the mean direct costs arising from injury was 4.047,5(min 0,0-max 24.670,00). Conclusions Individual differences need to be taken into account in future injury prevention efforts as well as in attempts to improve healthcare system’s response to road victims. Key messages Systematic collection of data relevant to health condition and economics of the victims is necessary at European level. Personalized rehabilitation plans are necessary to facilitate the recovery process of victims.

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