共查询到20条相似文献，搜索用时 31 毫秒
1.
Hannah Kempton Ruan Vlok Christopher Thang Thomas Melhuish Leigh White 《The American journal of emergency medicine》2019,37(3):511-517
Introduction
Out of hospital cardiac arrest (OHCA) is a time critical and heterogeneous presentation. The most appropriate management strategies remain an issue for debate. The aim of this systematic review and meta-analysis was to determine the association of epinephrine versus placebo with return of spontaneous circulation, survival to hospital admission, survival to hospital discharge and neurological outcomes in out of hospital cardiac arrest.Methods
A systematic review of five databases was performed from inception to August 2018. Only randomised controlled trials were considered eligible for inclusion. The primary outcome was survival to hospital discharge. Secondary outcomes were ROSC, survival to hospital admission, neurological function on discharge and three-month survival. All studies were assessed for level of evidence and risk of bias.Results
Five randomised controlled trials with 17,635 patients were identified for inclusion. Use of epinephrine was associated with increased ROSC (OR?=?3.10; 95% CI?=?2.16 to 4.45; I2?=?74%; p?<?0.0001) and increased survival to hospital admission OR?=?2.52; 95% CI?=?1.63 to 3.88; I2?=?94%; p?<?0.0001). However, epinephrine was not associated with increased survival to discharge (OR?=?1.09; 95% CI?=?0.48 to 2.47; I2?=?77%; p?=?0.84) or differences in neurological outcomes (OR?=?0.81; 95% CI?=?0.34 to 1.96).Discussion
This study was a systematic review and meta-analysis of epinephrine versus placebo in OHCA. The use of epinephrine was associated with improved ROSC and survival to hospital admission. However, use of epinephrine was not associated with a significant difference in survival to hospital discharge, neurological outcomes or survival to 3?months. Further research is required to control for the confounders during inpatient management. 相似文献2.
Background
Within nursing education research, protection of students as human subjects must be the highest priority. This protection can be provided via student anonymity. A subject-generated identification code, comprised of responses to a series of questions, can link data across time points while protecting student anonymity.Method
Two studies, focused on palliative care education, used a subject-generated identification code to link student data across multiple time points. Refinements to the code were made between studies to further enhance anonymity and response consistency.Results
The subject-generated identification code fostered linking of student responses across three time points in study one and two time points in study two.Conclusion
There are many benefits to utilizing a subject-generated identification code in nursing education studies. Researchers must consider the need for a data management expert and balancing transposition errors and the power to differentiate between responses. 相似文献3.
4.
Itay Zmora Yonit Wiener-Well Evan Avraham Alpert 《The American journal of emergency medicine》2019,37(5):1006.e5-1006.e7
Background
Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge.Case report
An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a significant pericardial effusion. His condition quickly deteriorated and the resuscitation included emergent bedside pericardiocentesis. The drainage was purulent and later cultures grew out Streptococcus pneumoniae.Why should an emergency physician be aware of this?
Purulent pericarditis is extremely rare but should be considered in the patient with a fulminant infectious process (particularly pneumonia) and signs of pericardial effusion. Treatment should include appropriate antibiotics and early drainage. 相似文献5.
6.
Introduction
Transgender and gender non-conforming (TGNC) people in the United States face disproportionate rates of mental health disorders, including suicidality, depression, anxiety, and substance use disorders than the general population. Patients' experiences utilizing mental healthcare is a determinant in their care-seeking behaviors and treatment success.Aim/question
The purpose of this integrative review is to better understand the firsthand mental healthcare experiences of TGNC persons.Method
The authors sought to locate recent English-language articles that described the mental healthcare experiences of TGNC persons. To do so, only articles that conducted data collection with a TGNC sample were considered for review.Results
Seven articles met criteria for review. Four themes emerged that depicted experiences of health promotion (welcoming environments, staff knowledge and response) and health prevention (enacted stigma, racial disparities and intersectional insensitivity).Discussion
Themes indicated that TGNC persons have mixed experiences (excellent to harmful/damaging) when receiving mental healthcare. There is room for healthcare provider growth in skills to increase TGNC cultural competency.Implications for practice
Mental healthcare providers and nurses would benefit from interventions to promote TGNC culturally competent care, including in-service training or continuing education for the current work force as well as incorporating TGNC content into pre-licensure educational curricula. 相似文献7.
8.
Objectives
This study examined the incidence of symptomatological post-traumatic stress disorder (PTSD) in bereaved Tibetan adolescents 3?years after the 2010 Yushu earthquake, then to identify possible and relational risk factors of PTSD by a cross-sectional study.Methods
A total of 867 bereaved Tibetan adolescents seriously impacted by the 2010 earthquake were investigated. Symptomatological PTSD was evaluated by the PTSD Checklist–Civilian Version. And coping styles were evaluated by the Coping Styles Scale. Exposure of trauma to the 2010 Yushu earthquake was evaluated by a checklist about earthquake containing sociodemographic variables.Results
3?years after the Yushu earthquake, 24.4% of the bereaved Tibetan adolescents had symptomatological PTSD. The results also indicated that coping styles and disaster-related experiences after the 2010 earthquake were connected with PTSD among survivors. When the 2010 earthquake struck, those having symptomatological PTSD were more probably to be buried/injured/amputated, and to witness burial/injury/death, and to have property damage. An individual who adopted positive coping skill was probably to have less symptomatological PTSD.Conclusions
The results showed that the existence of PTSD in bereaved Tibetan adolescents in the Yushu earthquake was very prevailing after 3?years. Effective psychological rescue work should be carried out, especially targeting bereaved Tibetan adolescents with more severe PTSD. 相似文献9.
Cynthia M Thomas Diana L Bantz Constance E. McIntosh 《Teaching and Learning in Nursing》2019,14(2):111-116
Background
Eight out of ten Americans report they experience job stress. Nurses (74%) are reporting acute and chronic stress as a contributing factor to nurse burnout. Stress can be the result of organizational, interpersonal or individual/personal factors and could eventually lead to burnout if ignored. It has long been reported about the shortage of nursing faculty but very little about how current nurse faculty experience burnout. Faculty burnout can be due to a variety of reasons (e.g., employment requirements, working in understaffed environment, lack of support).Problem
Although stress at work has become common nurses may avoid acknowledging stress. Nurse faculty have not received as much attention related to chronic stress and burnout or recognize personal chronic stress potentially leading to burnout.Approach
This paper discusses how to recognize the chronic stress that may lead to nurse faculty burnout, provides a case study for reflection and learning, and offers strategies to reduce and avoid burnout.Conclusion
Nurse faculty may gain greater understanding of stressors leading to burnout, determine if they are experiencing symptoms of burnout and apply strategies to reduce or prevent burnout. Burnout, Nurse Faculty, Chronic Stress, Work/Life Balance. 相似文献10.
Jenna Garlock Leborah Lee Michaelia Cucci Lawrence A. Frazee Chanda Mullen 《The American journal of emergency medicine》2019,37(5):884-889
Background
In the ED, patients are treated empirically for suspected gonorrhea and/or chlamydia (GC). Limited studies have evaluated the treatment of sexually transmitted diseases (STDs) in conjunction with predictor variables. This study will allow providers to better identify patients with potential GC to streamline antibiotic treatment.Objectives
The primary objective was to determine the incidence of positive assay in patients that underwent GC screening. The secondary objectives included the proportion of patients assayed that received empiric therapy and the predictive value of risk factors to identify positive assays.Methods
This retrospective cohort study included adult patients who presented to the health-system EDs and underwent GC screening. Subjects were excluded if they were victims of sexual assault, left AMA or eloped.Results
A total of 490 assayed patients were included, of which 84 (17%) were found to be positive for GC assay. Of the 278 patients treated empirically, 74% had a negative assay. Of the entire sample (n?=?490), risk factors found to predict a positive assay (p?<?0.05) included male, women <25?years of age, concomitant bacterial vaginosis, pelvic inflammatory disease or trichomonas, penile discharge, inconsistent condom use, previous/coexisting STDs, and uninsured.Conclusions
Compared to previous reports, this study found a higher incidence of positive GC assays for patients with suspected infection. This is the first study to evaluate GC testing in both men and women in the ED, and risk factors not previously reported by the CDC were identified. 相似文献11.
12.
Nicholas Ralph Coralie Graham Lisa Beccaria Cath Rogers 《Collegian (Royal College of Nursing, Australia)》2019,26(1):140-145
Background
Entrance requirements for undergraduate nursing programs have been under government scrutiny in recent times. To date, no Australia studies have reported nurse academics’ perspectives of entry requirements for Bachelor of Nursing programs.Study aim
The aim of this study is to examine nursing academics’ perceptions of entry requirements for Australian Bachelor of Nursing Programs.Methods
A total of 223 nurse academics responded to questions in an online national survey on pre-requisite subject areas, minimum tertiary entrance scores, English proficiency, and inherent requirements for clinical practice.Findings
English, Maths and Science were seen as important pre-requisite subject areas for students commencing a Bachelor of Nursing Program. Nurse academics believed that increasing the tertiary entrance score and English proficiency, was necessary to increase entrance standards and that a minimum score be consistently applied across universities. There were mixed views as to the disclosure of inherent requirements by students.Conclusion
Nationally, dialogue needs to occur about how universities can apply a consistent approach to ensure that the necessary foundation skills, knowledge and abilities are in place prior to admission into programs. 相似文献13.
Tulay Basak Semra Aciksoz Vesile Unver Ozlem Aslan 《Collegian (Royal College of Nursing, Australia)》2019,26(1):49-54
Background
Standardized patient was useful for knowledge acquirement, communication skills, self-efficacy, learning motivation and clinical skill acquirement in the literature.Aim
The aim of this study was to compare the effects of standardized patient and low-fidelity mannequin use in teaching hygiene care.Methods
This study was conducted as a randomized controlled study. The study was conducted on first-year nursing students in a nursing school in Turkey. The study inclusion criteria were as follows: voluntary acceptance of study participation, and participation in theoretical lectures on hygiene education. Eighty students were recruited for the study population. The students were divided into two groups consisting of 40 students in each group. The intervention group performed the simulation using a standardized patient, and the control group performed the simulation using a low-fidelity mannequin. The same simulation scenarios were used for both groups.Results
The hygiene care performance scores and students’ satisfaction and self-confidence scale and simulation design scale scores of the students in the standardized patient group were significantly higher than in the low-fidelity mannequin group. The students in the standardized patient group also showed less stress-related physical reactions in the actual environment and with an actual patient, experienced less difficulty during practice, felt more adequate, and better transferred the skills they had learned in the laboratory to clinical practice.Conclusion
Simulation with standardized patient is an effective teaching method for improving outcomes hygiene care skills of nursing students. 相似文献14.
Introduction
The Ratu's Model is a nursing model to prevent postpartum depression, is a product of Ratu's dissertation. Depression is one of the common psychological problem experienced by postpartum women. The number is estimated to reach 20% in Indonesia, 15–20% in the Riau Province, and must to be pressed to 1%.Objectives
This study aims to identify the effectiveness of Ratu's Model to prevent postpartum depression.Method
Quasi-experiment research alongside with pre–post test analysis of the control group, number of the respondents was undergone among 54 women pregnant and the spouses in each intervention and control group. Educational intervention was given toward intervention group for 3 times, with 3 times monitoring, and 3 times measurement.Result
A significant correlation between Ratu's Model with lowered postpartum depression incidence.Conclusion
The Ratu's Model is effective lowering the incidence of postpartum depression. 相似文献15.
Takayuki Otani Hirotaka Sawano Tomoaki Natsukawa Reiko Matsuoka Masaya Morita Yasuyuki Hayashi 《The American journal of emergency medicine》2017,35(5):685-691
Purpose
The aim of this study was to assess the usefulness of the Global Registry of Acute Coronary Events (GRACE) risk score in predicting in-hospital mortality and neurological outcome of patients resuscitated after out-of-hospital cardiac arrest (OHCA).Methods
We retrospectively analyzed the data of patients admitted to our hospital between October 2009 and October 2015 with OHCA and shockable initial cardiac rhythm who were resuscitated via conventional cardiopulmonary resuscitation. We calculated the GRACE risk score on admission and assessed its usefulness in predicting in-hospital mortality and neurological outcome.Results
Among 91 patients, 42 (46%) had acute myocardial infarction (AMI), 19 (21%) died in-hospital, and 52 (57%) had favorable neurological outcome. Among all the study patients, GRACE risk score was lower in survivors than in non-survivors (median 211 [interquartile range 176–240] vs. 266 [219–301], p < 0.001, respectively) and in favorable than in unfavorable neurological outcome group (202 [167–237] vs. 242 [219–275], p < 0.001, respectively). Multivariate analysis showed significant association between GRACE risk score and favorable neurological outcome (odds ratio, 0.975; 95% confidence interval, 0.961–0.990). Areas under receiver-operating characteristic curves, that describe the accuracy of GRACE risk score in predicting in-hospital mortality and favorable neurological outcome, were both 0.79.Conclusion
GRACE risk score may predict the in-hospital mortality and neurological outcome associated with resuscitated patients with OHCA and shockable initial cardiac rhythm, regardless of the cause of arrest. 相似文献16.
Cheryl Ross Cath Rogers Christine King 《Collegian (Royal College of Nursing, Australia)》2019,26(1):1-7
Background
Nursing workload remains an issue in current health care contexts. The use of quantitative methodologies, methods and tools to measure workload has not produced adequate data to inform workforce policy to resolve workforce concerns about workload.Objective
This study aimed to identify the influence of both culture and climate as factors in nursing workload.Methods
This research used an overall critical ethnographic methodology to investigate the real lifeworkload issues of nurses. Methods included fieldwork observations and informal discussions over a 3 year period and 11 in-depth interviews.Results
The study identifies the impact of safety mandates on nursing workload as an invisible phenomenon within current workload methodologies. Such mandates add to nursing roles and routines, and become a ‘taken-for-granted’ activity that is not always directly related to patient care, nor is a visible factor in workload measurement.Conclusion
Given that workload measurements are formulated on direct patient care activities, indirect and unrecognised activities may create additional nursing workload. 相似文献17.
R. Jouffroy A. Saade P. Alexandre P. Philippe P. Carli B. Vivien 《The American journal of emergency medicine》2019,37(3):387-390
Background
Epinephrine is recommended for the treatment of non-shockable out of hospital cardiac arrest (OHCA) to obtain return of spontaneous circulation (ROSC). Epinephrine efficiency and safety remain under debate.Objective
We propose to describe the association between the cumulative dose of epinephrine and the failure of ROSC during the first 30?min of advanced life support (ALS).Methodology
A retrospective observational cohort study using the Paris SAMU 75 registry including all non-traumatic OHCA. All OHCA receiving epinephrine during the first 30?min of ALS were enrolled. Cumulative epinephrine dose given during ALS to ROSC was retrieved from medical reports.Results
Among 1532 patients with OHCA, 776 (51%) had initial non-shockable rhythm. Fifty-four patients were excluded for missing data.The mean value of cumulative dose of epinephrine was 10?±?4?mg in patients who failed to achieve ROSC (ROSC?) and 4?±?3?mg (p?=?0.04) for those who achieved ROSC.ROC curve analysis indicated a cut-off point of 7?mg total cumulative epinephrine associated with ROSC? (AUC?=?0.89 [0.86–0.92]).Using propensity score analysis including age, sex and no-flow duration, association with ROSC? only remained significant for epinephrine?>?7?mg (p?≤10–3, OR [CI95]?=?1.53 [1.42–1.65]).Conclusion
An association between total cumulative epinephrine dose administered during OHCA resuscitation and ROSC? was reported with a threshold of 7?mg, best identifying patients with refractory OHCA. We suggest using this threshold in this context to guide the termination of ALS and early decide on the implementation of extracorporeal life support or organ harvesting in the first 30?min of ALS. 相似文献18.
19.
Jay D. Fisher Robert J. Bechtel Korrina N. Siddiqui David G. Nelson Ahmad Nezam 《The American journal of emergency medicine》2019,37(5):933-936
Previously undiagnosed pediatric cardiac disease represents a clinical challenge for the emergency physician. The clinical presentation of these disorders can mimic other conditions of the respiratory, gastrointestinal and neurologic systems at a time when the need for early identification and treatment is at a premium. A high index of suspicion and superb clinical acumen is required to make a timely diagnosis and initiate optimal care.
Methods
A retrospective chart review using explicit criteria and a structured data collection process was performed on all children presenting with previously undiagnosed cardiac disease over a five and half year period.Results
Thirty-six patients were identified over a five and a half year period representing one patient per 4838 pediatric ED presentations. A diverse set of chief complaints, triage categories, clinical presentations and diagnoses were identified. Undiagnosed congenital lesions, acquired cardiac disease, dysrhythmias and infectious diseases of the heart were represented. The need for surgical intervention (22%) and mortality (6%) was substantial.Conclusion
In the aggregate, these conditions occur at an important rate and represent a high risk subset of pediatric patients presenting to the emergency department. Individually, the conditions occur infrequently and ‘pattern recognition’ may not aid the clinician. Early diagnosis and prompt intervention is important in this population. 相似文献20.
Michelle Ng Jerrold Perrott Sarah Burgess 《The American journal of emergency medicine》2019,37(3):444-449