Cytomegalovirus infection in critically ill patients: a systematic review

Cytomegalovirus infection in critically ill patients: a systematic
review. Critical Care 2009, 13: R68 [Article]

Osawa, R., Singh, N.

http://ccforum.com/content/13/3/R68

The precise role of cytomegalovirus (CMV) infection in contributing to outcomes in critically ill immunocompetent patients has not been fully defined. Studies in which critically ill
immunocompetent adults were monitored for CMV infection in the intensive care unit (ICU) were reviewed. Potential risk factors for CMV infection include sepsis, requirement of mechanical ventilation, and transfusions. CMV infection frequently occurs in critically ill immunocompetent patients and may be associated with poor outcomes.

Dexmedetomidine vs haloperidol in delirious, agitated, intubated patients

Dexmedetomidine vs. haloperidol in delirious, agitated, intubated
patients: a randomised open-label trial. Critical Care 2009 13:R75 [Journal article]

Reade, M.C., O'Sullivan, K., Bates, S., Goldsmith, D., StJ Ainslie, W.R., Bellomo, R.

http://ccforum.com/content/13/3/R75

Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and
dexmedetomidine in facilitating extubation. In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICU-associated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre trial.

Model for predicting short-term mortality of severe sepsis

Model for predicting short-term mortality of severe sepsis. Critical Care 2009, 13:R72 [journal article].

Adrie, C., Francais, A., Alvarez-Gonzalez, A., Mounier, R., Azoulay, E., Zahar, J.R., Clec'h, C., Godgran-Toledano, D., Hammer, L., Descorps-Declere, A., Jamali, S., Timsit, J.F.

http://ccforum.com/content/13/3/R72

Development of a prognostic model for predicting 14-day mortality in ICU patients with severe sepsis.

Risk factors for delirium in intensive care patients: a prospective cohort study

Risk factors for delirium in intensive care patients: a prospective cohort study. Critical Care 2009, 13:R77 [journal article]

Van Rompaey, B., Elseviers, M.M., Schuurmans, M.J., Shortridge-Baggett, L.M., Truijen, S., Bossaert, L.

http://ccforum.com/content/13/3/R77

This multicenter study indicated risk factors for delirium in the intensive care unit related to patient characteristics, chronic pathology, acute illness and the environment. Several factors are suitable for preventive action.

Evaluation of pain in ICU patients

Evaluation of pain in ICU patients. CHEST vol 135(4), April 2009, p.1069-1074 [journal article].

Puntillo, K., Pasero, C., Li, D., Mularski, R.A., Grap, J.M., Erstad, B.L., Varkey, B., Gilbert, H.C., Medina, J. Sessler, C.N.

http://www.chestjournal.org/content/135/4/1069.short?rss=1

Pain is a common and distressing symptom in ICU patients. Yet a major challenge exists in assessing and evaluating the pain. Although the patient's self-report of pain is the "gold standard" for pain assessment, other methods must be considered when patients are unable
to self-report.

Pain management principles in the critically ill

Pain management principles in the critically ill. CHEST vol. 135(4), April 2009, p.1075-1086. [journal article]

Erstad, B.L., Puntillo, K., Gilbert. H.C., Grap, M.J., Li, D., Medina, J., Mularski, R.A. Pasero, C., Varkey, B., Sessler, C.N.

http://www.chestjournal.org/content/135/4/1075.short?rss=1

This article addresses conventional pharmacologic and nonpharmacologic treatment of pain in patients in ICUs.

Pain management within the palliative and end-of-life care experience in the ICU.

CHEST vol 135(5), May 2009, p1360-1369 [journal article]. Pain management within the palliative and end-of-life care experience in the ICU.

Mularski, R. A., Puntillo, K., Varkey, B., Erstad, B. L., Grap, M. J., Gilbert, H. C., Li, D., Medina,
J., Pasero, C., Sessler, C. N.

http://www.chestjournal.org/content/135/5/1360.full.pdf+html

High-quality pain management is a part of optimal therapy and requires knowledge and skill in
pharmacologic, behavioral, social, and communication strategies grounded in the holistic palliative care approach. This contemporary review article focuses on pain management within comprehensive palliative and end-of-life care.

Infection prevention and control: minimum standards

Infection prevention and control: minimum standards. [Care Guideline] These are the minimum standards that the Royal College of Nursing and the Infection Control Nurses' Association believe should be accepted and mandated by Government, UK departments of health and, where applicable, all independent health care organisations.
http://www.rcn.org.uk/downloads/publications/public_pub/002725.pdf

Ryl Coll of Nursing, 01 Jan 2009.

National Library for Health - Change of Name

The National Library for Health has changed its name to NHS Evidence.

The web address is: http://www.library.nhs.uk

The link to NHS Evidence - surgery, anaesthesia, perioperative and critical care
specialist collection (previously specialist library) is:

http://www.library/nhs.uk/theatres

Medication errors in an intensive care unit

Medication errors in an intensive care unit.
Bohomol, E., Ramos, L.H., D'Innocenzo, M.

Report of a study to investigating the incidence types and causes of medication errors (MEs) and the consequences for patients. Background. Medication errors are a common problem in hospitals around the world, including those in Brazil.Method. An exploratory, quantitative survey design was used and 44 adult inpatients were studied over a 30-day period in 2006. Findings. A total of 305 MEs was observed. Conclusion. There is a need to develop a culture of safety and quality in patient care. An understanding of the profile of ME types and frequencies in an institution is fundamental to raise awareness and implement measures to avoid them. Structural and procedural changes in hospital organization, with a focus on the efficacy, efficiency, and effectiveness of the medication system are needed to reduce MEs.

Infection, prevention and control

Infection, prevention and control
Theory and practice for healthcare professionals [Book]
Debbie Wilson
614.48 Macc HS Library

End of life treatment and care: good practice in decision-making - a consultation

End of life treatment and care: good practice in decision-making - a consultation

The General Medical Council (GMC) is consulting on new draft guidance, 'End of life treatment and care: good practice in decision-making'. The guidance is intended mainly for doctors but may also help patients and the public and other health and social care staff to understand what they can expect from doctors involved in caring for patients who are dying. The consultation runs until 13 July 2009. (GMC - news)

Hand hygiene adherence is influenced by the behavior of role models.

Pediatr Crit Care Med. 2009 Mar 25. [Epub ahead of print] LinkOut
Hand hygiene adherence is influenced by the behavior of role models.
Schneider J, Moromisato D, Zemetra B, Rizzi-Wagner L, Rivero N, Mason W, Imperial-Perez F, Ross L.

From the Department of Anesthesiology Critical Care Medicine (JS, DM, BZ, LR-W, NR, FI-P); Division of Infectious Diseases (WM, LR); Department of Pediatric Critical Care Medicine (JS), Childrens Hospital Los Angeles, Los Angeles, CA.

OBJECTIVE:: Proper hand hygiene (HH) reduces nosocomial infections. Therefore, factors that influence HH behavior of healthcare workers are of great interest. We hypothesized that strict HH adherence by supervisor role models would improve the HH behavior of junior staff.

DESIGN:: Prospective observational study.
SETTING:: Pediatric and cardiac intensive care units of a tertiary care children's hospital. SUBJECTS:: Two critical care fellows and four nurse orientees.
INTERVENTIONS:: First, we observed and recorded HH adherence of the fellows and nurse orientees and their respective supervising attending physician or nurse preceptor during daily patient care. Subsequently, we paired the same fellows and nurse orientees with a different supervisor who maintained strict HH adherence, and again noted HH adherence. We used measures of HH opportunities and HH adherence consistent with guidelines set by the Centers for Disease Control and Association for Professionals in Infection Control and Epidemiology.

MEASUREMENTS AND MAIN RESULTS:: HH adherence by fellows and nurse orientees at baseline was 22% of 200 HH opportunities, and improved to 56% of 234 opportunities as a result of role modeling-an average increase of 34% points (95% confidence interval, 18.7-51; p < 0.01 by linear regression), representing a HH adherence rate greater than 1.5 times that of the baseline. The control senior practitioners' HH adherence rate was 20% of 180 opportunities compared with the study senior practitioners' HH adherence of 94% of 187 opportunities-an average difference of 72%points higher compared with the control senior practitioners (95% confidence interval, 56-88.3; p < 0.01 by linear regression).

CONCLUSIONS:: HH adherence of junior practitioners improved under the supervision of adherent role models. These results suggest that HH behavior of senior practitioners plays a crucial influence on other staff. Senior healthcare practitioners should consider the important role they may play in reinforcing or weakening a culture of patient safety and proper HH.
PMID: 19325501 [PubMed - as supplied by publisher]

Readmission to the intensive care unit: An indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensiv

Surgery Today. 2009;39(4):295-9. Epub 2009 Mar 25. LinkOut
Readmission to the intensive care unit: An indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit.
Chan KS, Tan CK, Fang CS, Tsai CL, Hou CC, Cheng KC, Lee MC.
Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan.

PURPOSE: To investigate the characteristics and outcomes of surgical patients who were readmitted to the intensive care unit (ICU).

METHODS: The data were collected for all readmissions to the surgical ICUs in a tertiary hospital in the year 2003.

RESULTS: Of all the 945 ICU discharges, 110 patients (11.6%) were readmitted. They had a longer initial ICU stay (8.05 +/- 7.17 vs 5.22 +/- 4.95, P < p =" 0.049)." p =" 0.001)" p =" 0.010).">

CONCLUSION: The mortality of surgical patients with ICU readmission was high with respiratory complications being the most important issue.
PMID: 19319635 [PubMed - in process]

Considerations in Caring for the Critically Ill Older Patient.

JOURNAL OF INTENSIVE CARE MEDICINE
VOL 24; NUMB 2; 2009
ISSN 0885-0666
pp. 83-95
Considerations in Caring for the Critically Ill Older Patient.
Pisani, M.A.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN247950331&field=zid