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1.
Objective
To determine whether prehospital point-of-care lactate (pLA) is associated with mortality, admission, and duration of hospital stay.Design
A retrospective clinical audit, where elevated lactate was defined as ≥2 mmol/L.Setting
The ambulance service and primary referral hospital in the Australian Capital Territory from 1st July 2014 to 30th June 2015.Participants
Adult patients (≥18 years) who had pLA measured and were transported to the primary referral hospital.Main outcome measures
Mortality, admission, and duration of hospital stay.Results
Two hundred fifty-three patients with a median pLA of 2.5 mmol/L (interquartile range [IQR]: 1.5–3.7) were analysed. Overall mortality was 8.3%; 68% were admitted to the hospital; 8.3% to the intensive care unit (ICU). pLA was non-significantly higher in those who died compared to survivors (3.5 [IQR: 2.75–5.85] vs 2.4 [1.5–3.6]; W = 1631.5; p = 0.053). pLA was higher for those admitted to the hospital (2.9 [1.9–3.9] vs 2.0 [1.4–3.1]; W = 5094.5, p = 0.001) and the ICU (3.2 [2.4–5.7] vs 2.4 [1.5–3.6]; W = 1578.5; p = 0.008). There was no relationship between pLA and duration of stay. Considered as a screening tool, at a cut-off of 2.5 mmol/L, pLA had a likelihood ratio+ of 1.61 for mortality and 1.44 for ICU admission; the odds ratio for mortality was 3.76 (95% confidence interval = 1.30, 13.89).Conclusions
Elevated prehospital lactate was associated with significantly increased ICU and hospital admissions. There may be value in pLA as a screening tool. 相似文献2.
Hsieh-Chun Hsieh 《Archives of physical medicine and rehabilitation》2019,100(4):591-597
Objective
To evaluate a personal computer (PC) gaming platform as a means of improving postural balance in stroke patients.Participants
Stroke patients (N=54) were enrolled and randomly divided into experimental and control groups.Design
The experimental group underwent 12 weeks of rehabilitation involving playing PC games with the proposed gaming platform, whereas the control group played PC games with a computer mouse in the standing position.Interventions
The experimental PC gaming platform allowed trunk movements in 3 directions, including lateral, downward, or upward reaching.Main Outcome Measures
Balance control was assessed before and after the intervention with the Midot Posture Scale Analyzer (a pressure platform) by measuring the center of pressure during quiet stance. The Berg Balance Scale, Fullerton Advanced Balance Scale, and timed Up and Go tests were used to evaluate functional balance.Results
Analysis of covariance was used to assess how the PC games improve balance abilities. There were significant differences between the experimental and control groups in the results of sway kinematics and functional balance tests. The experimental group showed greater improvement than the control group.Conclusion
This new gaming platform with adaptive PC games could be a useful therapy to stroke rehabilitation in patients with postural imbalance. 相似文献3.
Gabrielle Alvarez Stacy J. Suskauer Beth Slomine 《Archives of physical medicine and rehabilitation》2019,100(4):687-694
Objectives
To investigate behavioral and demographic features of levels of consciousness in young children with brain injury, including the classifications of consciousness: conscious state (CS), minimally conscious state (MCS), and vegetative state (VS), and to investigate the course of recovery in children with disorders of consciousness (DOC).Design
Retrospective chart review and post hoc analysis.Setting
Pediatric inpatient rehabilitation unit.Participants
Children aged 6 months to 5 years (N=54) admitted for inpatient rehabilitation directly from an acute care hospital following new neurologic injury from 2011 to 2016.Interventions
Not applicable.Main Outcome Measures
Clinically abstracted behavioral features of DOC and levels of consciousness at admission and discharge, based on established guidelines from the Aspen Neurobehavioral Conference Workgroup.Results
Children in MCS were younger than children in CS. Commonly observed behaviors in children in VS were mouth movements or vocalizations, flexion withdrawal or motor posturing, visual or auditory startle, and localization to sound. Common features of MCS were contingent affect, visual fixation or pursuit, automatic motor behavior, and contingent communicative intent. No children in MCS showed command following or intelligible verbalizations. All children in CS showed functional object use, while functional communication was observed in a subset. By discharge, more than half of children in VS emerged to MCS, and a third emerged from MCS to CS. No child emerged from VS to CS.Conclusions
Visual and motor skills may be most applicable, and language-based skills may be least applicable for the assessment of DOC in very young children. Accurate classifications of consciousness may have important prognostic implications, and additional research is needed to develop clear guidelines for assessment of DOC in this population. 相似文献4.
Ting-ting Yeh Ku-chou Chang Ching-yi Wu 《Archives of physical medicine and rehabilitation》2019,100(5):821-827
Objective
To investigate the efficacy of a sequential combination of aerobic exercise and cognitive training on cognitive function and other health-related outcomes in stroke survivors with cognitive decline.Design
Intervention study and randomized controlled trial.Setting
Hospital-based rehabilitation units.Participants
Survivors of stroke with cognitive decline (N=30) were randomized to sequential combination training (SEQ) (n=15) or an active control (n=15) group.Interventions
The SEQ group received 30 minutes of aerobic exercise, followed by 30 minutes of computerized cognitive training. The control group received 30 minutes of nonaerobic physical exercise, followed by 30 minutes of unstructured mental activities.Main Outcome Measures
The primary outcome measure was cognitive function. Secondary outcome measures included physical function, social participation, and quality of life.Results
Compared with the control group, the SEQ group had significantly improved Montreal Cognitive Assessment scores (P=.03) and Wechsler Memory Scale span scores (P=.012) after training. The endurance and mobility level measured by the 6-minute walk test (P=.25) was also enhanced in the SEQ group relative to the control group. However, the transfer of sequential training to social participation (Community Integration Questionnaire) and quality of life (EuroQoL questionnaire) was limited (P>.05 for both).Conclusions
Aerobic exercise combined with computerized cognitive training has better effects on the cognitive functional status of survivors of stroke than an active control. The cognitive functional status of stroke survivors was better after participation in aerobic exercise combined with computerized training than after active control therapy, demonstrating the clinical significance of this combination therapy. 相似文献5.
Background
Despite the evidence and available guidelines about endotracheal suction (ETS), a discrepancy between published guidelines and clinical practice persists. To date, ETS practice in the adult intensive care unit (ICU) population across New Zealand and Australia has not been described.Objective
To describe ICU nurses' ETS practice in New Zealand and Australia including the triggers for performing endotracheal suction.Methods
A single day, prospective observational, binational, multicentre point prevalence study in New Zealand and Australian ICUs. All adult patients admitted at 10:00 on the study day were included.Main outcome measures
In addition to patient demographic data, we assessed triggers for ETS, suction canister pressures, use of preoxygenation, measures of oxygenation, and ETS at extubation.Results
There were 682 patients in the ICUs on the study day, and 230 were included in the study. Three of 230 patients were excluded for missing data. A total of 1891 ETS events were performed on 227 patients during the study day, a mean of eight interventions per patient. The main triggers reported were audible (n = 385, 63%) and visible (n = 239, 39%) secretions. Less frequent triggers included following auscultation (n = 142, 23%), reduced oxygen saturations (n = 140, 22%), and ventilator waveforms (n = 53, 9%). Mean suction canister pressure was ?337 mmHg (standard deviation = 189), 67% of patients received preoxygenation (n = 413), and ETS at extubation was performed by 84% of nurses.Conclusion
Some practices were inconsistent with international guidelines, in particular concerning patient assessment for ETS and suction canister pressure. 相似文献6.
Kiran Satpute Toby Hall Richa Bisen Pramod Lokhande 《Archives of physical medicine and rehabilitation》2019,100(5):828-836
Objectives
To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.Design
A double-blind randomized controlled trial.Setting
General hospital.Participants
Adults (N=60; mean age 44y) with subacute lumbar radiculopathy.Interventions
Participants were randomly allocated to receive SMWLM, exercise and electrotherapy (n=30), or exercise and electrotherapy alone (n=30). All participants received 6 sessions over 2 weeks.Main Outcome Measures
The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM). Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up.Results
Significant and clinically meaningful improvement occurred in all outcome variables. At 2 weeks the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.0; 95% confidence interval [95% CI], 1.4-2.6) and disability (MD 3.9; 95% CI, 5.5-2.2). Similarly, at 6 months, the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.6; 95% CI, 1.9-3.2) and disability (MD 4.7; 95% CI, 6.3-3.1). The SMWLM group also reported greater improvement in the GROC and in SLR ROM.Conclusion
In patients with lumbar radiculopathy, the addition of SMWLM provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. 相似文献7.
Tessa Hart John Whyte Monica Vaccaro Amanda R. Rabinowitz 《Archives of physical medicine and rehabilitation》2019,100(5):987-989
Objective
Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population.Design
Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records.Setting
Rehabilitation center providing outpatient TBI therapies.Participants
Sixty-five people with severe TBI living in the community provided 6-month data (N=65); 54 provided 12-month data.Interventions
Not applicable.Main Outcome Measures
Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation coefficients (ICCs), with linear regression used to predict accuracy from demographic variables and cognitive status.Results
ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months.Conclusions
People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs scheduled) sessions. 相似文献8.
Jessica M. Jarvis Karen Choong Mary A. Khetani 《Archives of physical medicine and rehabilitation》2019,100(4):703-710
Objective(s)
Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over 6 months post-PICU discharge.Design
Substudy of a data from Wee-Cover, a prospective cohort study.Setting
Two PICU sites.Participants
Caregivers (N=168) of children 1-17 years old admitted into a PICU for ≥48 hours.Main Outcome Measures
Data were collected from caregivers at enrollment and 3 and 6 months post-PICU discharge. Caregiver stress was assessed using the Pediatric Inventory for Parents. Having strategies to support their child’s participation in home-based activities was assessed using the Participation and Environment Measure (PEM). In PEM, caregivers report on strategies used to support their child’s participation in home-based activities. Data were dichotomized (yes, no) to denote having participation-focused strategies and if their child received PICU rehabilitation services. Additional covariates were history of a preexisting condition, child age, length of PICU stay, and change in functional capacities at PICU discharge.Results
History of a preexisting condition, time, and change in functional capacities significantly predicted caregiver stress frequency and difficulty. The interaction of having strategies-by-rehabilitation-by-time significantly predicted caregiver stress frequency and difficulty.Conclusion(s)
Results highlight the role of early rehabilitation and the importance of working with caregivers to develop participation-focused strategies to support their child’s functioning post-PICU. Families of children with a preexisting condition or those who experience a decrease in function during a PICU stay are susceptible to higher levels of stress and may be a priority population to target for rehabilitation services. 相似文献9.
Heather A. Feldner Darrin Howell Valerie E. Kelly Sarah Westcott McCoy Katherine M. Steele 《Archives of physical medicine and rehabilitation》2019,100(4):663-675
Objective
To examine the perceived value, benefits, drawbacks, and ideas for technology development and implementation of surface electromyography recordings in neurologic rehabilitation practice from clinical stakeholder perspectives.Design
A qualitative, phenomenological study was conducted. In-depth, semistructured interviews and focus groups were completed. Sessions included questions about clinician perspectives and demonstrations of surface electromyography systems to garner perceptions of specific system features.Setting
The study was conducted at hospital systems in a large metropolitan area.Participants
Adult and pediatric physical therapists, occupational therapists, and physiatrists from inpatient, outpatient, and research settings (N=22) took part in the study.Interventions
Not applicable.Main Outcome Measures
Interviews and focus groups were audio-recorded, transcribed verbatim, then coded for analysis into themes.Results
Four major themes emerged: (1) low-tech clinical practice and future directions for rehabilitation; (2) barriers to surface electromyography uptake and potential solutions; (3) benefits of surface electromyography for targeted populations; and (4) essential features of surface electromyography systems.Conclusions
Surface electromyography systems were not routinely utilized for assessment or intervention following neurologic injury. Despite recognition of potential clinical benefits of surface electromyography use, clinicians identified limited time and resources as key barriers to implementation. Perspectives on design and surface electromyography system features indicated the need for streamlined, intuitive, and clinically effective applications. Further research is needed to determine feasibility and clinical relevance of surface electromyography in rehabilitation intervention. 相似文献10.
Joseph J. Gallo Martha Abshire Seungyoung Hwang Marie T. Nolan 《Journal of pain and symptom management》2019,57(3):556-565
Context
Stability of preferences for life-sustaining treatment may vary depending on personal characteristics.Objective
We estimated the stability of preferences for end-of-life treatment over 12 years and whether advance directives and medical conditions were associated with change in preferences for end-of-life treatment.Design
Mailed survey of older physicians.Methods
Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. Eight hundred ninety eight physicians who completed the life-sustaining treatment questionnaire anytime in 1999, 2002, 2005, and 2011 (mean age 68.2 years at baseline). Preferences for life-sustaining treatment were assessed using a checklist questionnaire in response to a standard “brain injury” scenario and considered as a package using the latent class transition model.Results
End-of-life preferences grouped into three classes: most aggressive (wanting most interventions; 14% of physicians), least aggressive (declining most interventions; 61%), and an intermediate class (declining most interventions except intravenous fluids and antibiotics; 25%). Physicians without an advance directive were more likely to desire more treatment and were less likely to transition out the most aggressive class. Transition probabilities from class to class did not vary over time. Persons with cancer expressed preference for the least aggressive treatment, whereas persons with cardiovascular disease and depression had preferences for more aggressive treatment.Conclusion
Transitions in end-of-life preferences and the factors influencing change and stability suggest that periodic reassessment for planning end-of-life care is needed. 相似文献11.
Cody Andrews Sean Smith Maggi Kennel Steve Schilling Claire Kalpakjian 《Archives of physical medicine and rehabilitation》2019,100(4):606-612
Objective
Determine the relationship between functional status and degree of specific organ involvement, physical performance, and subjective well-being chronic graft-vs-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation.Design
Observational cohort.Setting
Outpatient clinic.Participants
Adult patients (N=121) with cGVHD with 634 assessments.Interventions
Not applicable.Main Outcome Measures
Karnofsky Performance Status (KPS). Skin, fascia/joints, lungs, upper and lower extremity range of motion, liver, eye, mucosal, and gastrointestinal involvement were measured using the National Institutes of Health GVHD scale. Physical performance was assessed with the 2-minute walk test (2MWT) and hand grip strength. Subjective measures were the Patient Health Questionnaire 9 (PHQ-9) and Lee Symptom Burden (LSB) scale.Results
Myofascial (P<.001) and lung (P=.001) involvement, 2MWT (P<.001), LSB (P<.001), and PHQ-9 (P=.03) had the largest associations with KPS with liver (P=.05) and hand grip strength (P<.001) more modest associations with KPS.Conclusions
Patients with cGVHD experience multifactorial impairment in function associated with potentially modifiable symptoms physiatrists have the expertise to address to enhance function. More research is needed to determine rehabilitation interventions to mitigate the impact of cGVHD on function. 相似文献12.
Jordan R. Atkins J. Frank Titch William P. Norcross Julie A. Thompson Virginia C. Muckler 《Nursing for Women's Health》2019,23(2):105-113
Objective
To decrease hospital expenses by administering oral acetaminophen rather than intravenous (IV) acetaminophen to women who undergo laparoscopic hysterectomy.Design
A quality improvement project using a between-groups, pre-/postimplementation design for women undergoing total laparoscopic hysterectomy. Retrospective chart review was used to compare data of women who received intraoperative IV acetaminophen before implementation versus women who received oral acetaminophen after implementation. Pain scores and opioid consumption in morphine equivalents were recorded at four time points.Setting/Local Problem
A 369-bed hospital in the southeastern United States, where, in 2016, nearly $260,000 was spent on perioperative IV acetaminophen for all operating room cases.Participants
Women between the ages of 18 and 55 years scheduled to have total laparoscopic hysterectomy were included. Excluded were women with a history of chronic pain, opioid use, or liver pathology; women with a contraindication to nonsteroidal anti-inflammatory drugs; and women whose procedures were converted from laparoscopic to open.Intervention/Measurements
Women were instructed to take oral acetaminophen the day before surgery in divided doses, with 1 g every 6 hours, for a total dose of 3 g. On the day of surgery, women received the final 1-g dose of oral acetaminophen.Results
There were no significant differences between groups for pain scores or total opioids received before implementation (mean = 3.28, standard deviation = 2.05) compared with after implementation (mean = 3.65, standard deviation = 1.63; t [18] = –.043, p = .674). The preimplementation cost per individual was $30.03 for 1 g of IV acetaminophen, and the postimplementation cost was $0.36 for 2 500-mg oral acetaminophen tablets, a 98.8% relative cost decrease per woman.Conclusion
Replacing IV acetaminophen with preemptive oral acetaminophen has the potential to save money without compromising care. 相似文献13.
Jorge L. Candiotti Deepan C. Kamaraj Brandon Daveler Cheng-Shiu Chung Garrett G. Grindle Rosemarie Cooper Rory A. Cooper 《Archives of physical medicine and rehabilitation》2019,100(4):627-637
Objective
To compare the Mobility Enhancement roBotic (MEBot) wheelchair’s capabilities with commercial electric-powered wheelchairs (EPWs) by performing a systematic usability evaluation.Design
Usability in effectiveness, efficacy, and satisfaction was evaluated using quantitative measures. A semistructured interview was employed to gather feedback about the users’ interaction with MEBot.Setting
Laboratory testing of EPW driving performance with 2 devices in a controlled setting simulating common EPW driving tasks.Participants
A convenience sample of expert EPW users (N=12; 9 men, 3 women) with an average age of 54.7±10.9 years and 16.3± 8.1 years of EPW driving experience.Interventions
Not applicable.Main Outcome Measures
Powered mobility clinical driving assessment (PMCDA), Satisfaction Questionnaire, National Aeronautics and Space Administration’s Task Load Index.Results
Participants were able to perform significantly higher number of tasks (P=.004), with significantly higher scores in both the adequacy-efficacy (P=.005) and the safety (P=.005) domains of the PMCDA while using MEBot over curbs and cross-slopes. However, participants reported significantly higher mental demand (P=.005) while using MEBot to navigate curbs and cross-slopes due to MEBot’s complexity to perform its mobility applications which increased user’s cognitive demands.Conclusions
Overall, this usability evaluation demonstrated that MEBot is a promising EPW device to use indoors and outdoors with architectural barriers such as curbs and cross-slopes. Current design limitations were highlighted with recommendations for further improvement. 相似文献14.
Neda Tadayon Hassan Yousefnia Ali Ramazani Samaneh Zolghadri Behrooz Alirezapour Amir Reza Jalilian Hossein Afarideh Mahdokht Vaez-Tehrani 《Journal of Medical Imaging and Radiation Sciences》2019,50(1):142-148
Introduction
In this study, 68Ga-PDTMP was introduced as a novel agent for PET bone scanning.Methods
68Ga-PDTMP was prepared with radiochemical purity of higher than 98% at the optimized conditions.Results
Stability tests showed no decrease in radiochemical purity, even after 120 min. The capacity binding of 76.3% ± 0.7% after 10 min incubation for 68Ga-PDTMP was observed.Conclusion
Biological studies in normal mice demonstrated that most of the remained activity is transmitted from blood into bones. The results show that 68Ga-PDTMP can be considered as a potential radiolabelled complex for PET bone scanning. 相似文献15.
Anson B. Rosenfeldt Susan M. Linder Sara Davidson Cynthia Clark Nicole M. Zimmerman John J. Lee Jay L. Alberts 《Archives of physical medicine and rehabilitation》2019,100(5):923-930
Objective
The aim of this project was to determine the effects of lower extremity aerobic exercise coupled with upper extremity repetitive task practice (RTP) on health-related quality of life (HRQOL) and depressive symptomology in individuals with chronic stroke.Design
Secondary analysis of data from 2 randomized controlled trials.Setting
Research laboratory.Participants
Individuals (N=40) with chronic stroke.Interventions
Participants received one of the following interventions: forced exercise+RTP (FE+RTP, n=16), voluntary exercise+RTP (VE+RTP, n=16), or stroke education+RTP (EDU+RTP, n=8). All groups completed 24 sessions, each session lasting 90 minutes.Main Outcome Measures
The Center for Epidemiological Studies-Depression Scale (CES-D) and Stroke Impact Scale (SIS) were used to assess depressive symptomology and HRQOL.Results
There were no significant group-by-time interactions for any of the SIS domains or composite scores. Examining the individual groups following the intervention, those in the FE+RTP and VE+RTP groups demonstrated significant improvements in the following SIS domains: strength, mobility, hand function, activities of daily living, and the physical composite. In addition, the FE+RTP group demonstrated significant improvements in memory, cognitive composite, and percent recovery from stroke. The HRQOL did not change in the EDU+RTP group. Although CES-D scores improved predominantly for those in the FE+RTP group, these improvements were not statistically significant. Overall, results were maintained at the 4-week follow-up.Conclusion
Aerobic exercise, regardless of mode, preceding motor task practice may improve HRQOL in patients with stroke. The potential of aerobic exercise to improve cardiorespiratory endurance, motor outcomes, and HRQOL poststroke justifies its use to augment traditional task practice. 相似文献16.
Pia Seppänen Reijo Sund Tero Ala-Kokko Mervi Roos Jukka Uotila Mika Helminen Tarja Suominen 《Australian critical care》2019,32(2):116-121
Background
Intensive care admissions during pregnancy, childbirth, and postpartum period are relatively well investigated. However, very little is known about these obstetric patients' health-related quality of life (HRQoL) before and after critical care.Objective
The objective of this study was to assess obstetric patients' HRQoL before intensive care admission (baseline) and at 6 months after discharge (follow-up)Design
This was a retrospective database study. In a 5-year period, the data of all women admitted to the intensive care unit (ICU) during pregnancy, delivery, or up to 42 days postpartum were analysed.Methods
Four multidisciplinary ICUs of Finnish University hospitals participated. The HRQoL was assessed using the EuroQol-5D (EQ-5D) instrument with utility score (EQsum) and visual analogue scale (EQ-VAS).Results
A total of 283 obstetric patients were identified from the clinical information system. Of these, 99 (35%) completed the EQ-5D questionnaires both at baseline and follow-up, and 65 of them (23%) completed EQ-VAS. The comparison of patients' EQsum scores before intensive care admission and after discharge showed that patients' HRQoL remained good (0.970 vs 0.972) (max 1.0) or increased (0.788 vs 0.982) in 80.8% of the patients. Patients reported improved overall health on the EQ-VAS at 6 months follow-up (EQ-VAS mean, 71.86 vs 88.20; p ≤ 0.001) (max 100). However, 19.2% of the patients had lower HRQoL (EQsum mean 0.987 vs 0.798) at follow-up. Following intensive care, 15% of the patients had more pain/discomfort, and 11% expressed more depression/anxiety. Multiparous patients were more likely to suffer from worsened depression/anxiety (p = 0.024).Conclusion
In the majority of the obstetric patients, HRQoL at 6 months follow-up remained good or had increased from baseline. However, nearly one-fifth of the patients had impaired HRQoL after discharge. Thus, intensive care management should take in to consideration follow-up program after intensive care of ICU-admitted obstetric patients. 相似文献17.
Jill Chamberlain Susan McCarty Joanne Sorce Betsy Leesman Sarah Schmidt Elizabeth Meyrick Simone Parlier Linda Kennedy Debra Crowley Lori Coultas 《Journal of neonatal nursing : JNN》2019,25(2):74-77
Objective
Determine impact delayed newborn bathing for 24 hours has on exclusive breastfeeding rates, temperature and glucose stability, and percentage of weight loss and, to determine if there was a difference in the nurses’ knowledge and comfort levels regarding delayed bathing pre and post implementation.Design
Pre-post retrospective chart review and, pre-post survey.Setting
Midwestern health system with three hospitals that has a combined average delivery rate of 2100 births.Participants
330 charts were reviewed pre-implementation, 330 charts were reviewed post-implementation, and 100 RNs were asked to participate in the pre and post-survey.Methods
Newborn baths were delayed 24 hours after birth unless contraindicated by a blood borne pathogen or upon parental requests.Results
Post-intervention there was a significant decrease in the number of blood glucose level checks (p?=?.002) and the amount of blood glucose levels equal or below 45 (p?=?.001). There was a trend in decreased weight loss post-intervention, but was not significant (p?=?.227). Cold stress significantly decreased (p?<?.001) post-intervention. Exclusive breastfeeding rates did not change. Nurses’ perception of comfort and knowledge level increased post-intervention.Conclusion
Delaying an infant's bath until 24 hours after birth seems to have positive impact on the infant's temperature regulation as well as glucose stability. 相似文献18.
Elke Pucks-Faes Heinrich Matzak Gabriel Hitzenberger Eleonora Genelin Lucas-Michael Halbmayer Elena Fava Josef Fritz Leopold Saltuari 《Archives of physical medicine and rehabilitation》2019,100(5):837-843
Objective
To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation.Design
Retrospective open label study. Mean duration of follow-up 64 months.Setting
Primary-care and referral center, ambulatory and hospitalized care.Participants
Patients (N=116) undergoing continuous ITB trials between 2006 and 2017.Interventions
Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump.Main Outcome Measures
Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events.Results
A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up.Conclusions
Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events. 相似文献19.
Maureen E. Lyon Leah Squires Lawrence J. DAngelo Debra Benator Rachel K. Scott Isabella H. Greenberg Patricia Tanjutco Melissa M. Turner Tara E. Weixel Yao I. Cheng Jichuan Wang 《Journal of pain and symptom management》2019,57(3):607-616
Context
No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS.Objective
To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record.Methods
Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N = 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition).Results
Patients (n = 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P < 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio = 6.58, 95% CI: 3.21–13.51, P < 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P < 0.0001).Conclusions
The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices. 相似文献20.
Sarah E. Reedman Roslyn N. Boyd Stewart G. Trost Catherine Elliott Leanne Sakzewski 《Archives of physical medicine and rehabilitation》2019,100(4):676-686