Nurses' Beliefs and Self-Reported Practices Related to Pain Assessment in Nonverbal Patients

This study explored the beliefs and self-reported practices of nurses related to pain assessment in nonverbal patients. A convenience sample of 74 nurses from one Midwestern community hospital responded to a researcher-developed questionnaire based on established pain standards and clinical practice recommendations. Areas of nonverbal pain assessment beliefs and practices with low scores were identified. One-way analysis of variance with Tukey post hoc tests showed a significant difference in belief scores based on unit worked. No significant differences in beliefs or practices were found based on age, years of experience, or degree. Paired t tests showed significant differences between general pain beliefs and nonverbal pain beliefs, between general pain beliefs and practices, and between nonverbal pain beliefs and practices. Additional testing using Pearson correlation coefficients demonstrated that only three out of seven questions relating to beliefs were significantly correlated with similar questions related to practices. Good reliability of the instrument was demonstrated by Cronbach alpha coefficient α = 0.82. Recommendations include further education for hospital nurses related to pain assessment standards in nonverbal patients, as well as utilization of techniques to integrate this knowledge into nurses' belief systems and practice environment.     

Improving Sleep Hygiene to Decrease Delirium Among Critically Ill Patients

A sleep hygiene protocol to reduce risks for delirium among critically ill patients in a transplant intensive care unit was implemented in an urban hospital in the Upper Midwest. The project occurred over a 1-month time frame. The project evaluated the number of hours of uninterrupted sleep, overall participation in therapies and activity, agitation, and confusion scores using standard, validated tools. Staff education was provided pre- and postproject implementation. Pre- and postimplementation surveys were used to assess the knowledge of staff and evaluation of the project. Project results demonstrated effectiveness in reducing sleep disturbance and the risk for delirium.     

亚低温治疗在危重症中的应用

报告１９９５年６月至１９９７年９月运用亚低温疗示治疗危重症合并脑功能障碍６例的临床结果。结合治疗体会，讨论了亚低温治疗的适应症，温度的选择，亚低温持续的时间和复温时机，亚低温治疗的监测和辅助治疗及其并发症的处理。     

Hypoglycemia and Outcome in Critically Ill Patients

OBJECTIVE: To determine whether mild or moderate hypoglycemia that occurs in critically ill patients is independently associated with an increased risk of death.PATIENTS AND METHODS: Of patients admitted to 2 hospital intensive care units (ICUs) in Melbourne and Sydney, Australia, from January 1, 2000, to October 14, 2004, we analyzed all those who had at least 1 episode of hypoglycemia (glucose concentration, <81 mg/dL). The independent association between hypoglycemia and outcome was statistically assessed.RESULTS: Of 4946 patients admitted to the ICUs, a cohort of 1109 had at least 1 episode of hypoglycemia (blood glucose level, <81 mg/dL). Of these 1109 patients (22.4% of all admissions to the intensive care unit), hospital mortality was 36.6% compared with 19.7% in the 3837 nonhypoglycemic control patients (P<.001). Even patients with a minimum blood glucose concentration between 72 and 81 mg/dL had a greater unadjusted mortality rate than did control patients (25.9% vs 19.7%; unadjusted odds ratio, 1.42; 95% confidence interval, 1.12-1.80; P=.004.) Mortality increased significantly with increasing severity of hypoglycemia (P<.001). After adjustment for insulin therapy, hypoglycemia was independently associated with increased risk of death, cardiovascular death, and death due to infectious disease.CONCLUSION: In critically ill patients, an association exists between even mild or moderate hypoglycemia and mortality. Even after adjustment for insulin therapy or timing of hypoglycemic episode, the more severe the hypoglycemia, the greater the risk of death.APACHE = Acute Physiology and Chronic Health Evaluation; AUC = area under the curve; CI = confidence interval; ICU = intensive care unit; IIT = intensive insulin therapy; NICE-SUGAR = Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation; OR = odds ratioUntil recently, intensive insulin therapy (IIT) had been recommended to improve patient outcome^1-3 despite its association with an increased risk of hypoglycemia.^4-11 However, hypoglycemia, like hyperglycemia,^12-16 has emerged as a possible predictor of mortality and morbidity in critically ill patients.^5,17-21The NICE-SUGAR (Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation) trial found that IIT increased 90-day mortality compared with conventional treatment in critically ill patients.^22,23 In that trial, the incidence of severe hypoglycemia (blood glucose level, ≤40 mg/dL (to convert to mmol/L, multiply by 0.0555) was significantly higher with IIT. Furthermore, the relative risk of severe hypoglycemia was 13.7, more than twice that seen in prior randomized controlled trials.^5,9-11 Thus, the incidence of hypoglycemia might be a key element of blood glucose control in critically ill patients, although no causal link between hypoglycemia and mortality has been demonstrated. However, no consensus exists on the definition of hypoglycemia in patients with critical illness.²⁴ Studies thus far have mainly focused on severe hypoglycemia.For editorial comment, see page 215We sought to determine the epidemiology and independent association of hypoglycemia in the intensive care unit (ICU). We hypothesized that mild or moderate hypoglycemia would be common and would be independently associated with an increased risk of death.