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1.
Joanne Molloy Naomi Pratt Ravindranath Tiruvoipati Cameron Green Virginia Plummer 《Australian critical care》2018,31(1):42-46
Background
The Rapid Response Call (RRC) is a system designed to escalate care to a specialised team in response to the detection of patient deterioration. To date, there have been few studies which have explored the relationship between time of day of RRC and patient outcome.Objective
To examine the relationship between the time of RRC activations and patient outcome.Method
All adult inpatients with a RRC in non-critical care wards of a metropolitan Australian hospital in 2012 were retrospectively reviewed. RRCs occurring between 18:00–07:59 were defined as ‘out of hours’.Results
There were 892 RRC during the study period. RRCs out of hours were associated with a higher rate of ICU admissions immediately after the RRC (19.4% vs. 12.3%, p < 0.001). Patients experiencing an out-of-hours RRC were more likely to have an in-hospital cardiopulmonary arrest (OR = 1.7, p < 0.04). In-hospital mortality rate was significantly higher for patients with out-of-hours RRCs (35.5% vs. 25.0%, p = 0.014). After adjusting for confounders out-of-hours RRC were independently associated with increased need for ICU admissions and in-hospital mortality.Conclusion
The diurnal timing of RRCs appears to have significant implications for patient mortality and morbidity, patient outcomes are worse if RRC occurs out of hours. This finding has implications for staffing and resource allocation. 相似文献2.
Introduction
Early Warning Score (EWS) systems have been developed for detecting hospital patients clinical deterioration. Many studies show that a National Early Warning Score (NEWS) performs well in discriminating survival from death in acute medical and surgical hospital wards. NEWS is validated for Portugal and is available for use. A simpler EWS system may help to reduce the risk of error, as well as increase clinician compliance with the tool.Objectives
The aim of the study was to evaluate whether a simplified NEWS model will improve use and data collection.Methods
We evaluated the ability of single and aggregated parameters from the NEWS model to detect patients’ clinical deterioration in the 24 h prior to an outcome. There were 2 possible outcomes: Survival vs Unanticipated intensive care unit admission or death. We used binary logistic regression models and Receiver Operating Characteristic Curves (ROC) to evaluate the parameters’ performance in discriminating among the outcomes for a sample of patients from 6 Portuguese hospital wards.Results
NEWS presented an excellent discriminating capability (Area under the Curve of ROC (AUCROC) = 0.944). Temperature and systolic blood pressure (SBP) parameters did not contribute significantly to the model. We developed two different models, one without temperature, and the other by removing temperature and SBP (M2). Both models had an excellent discriminating capability (AUCROC: 0.965; 0.903, respectively) and a good predictive power in the optimum threshold of the ROC curve.Conclusions
The 3 models revealed similar discriminant capabilities. Although the use of SBP is not clearly evident in the identification of clinical deterioration, it is recognized as an important vital sign. We recommend the use of the first new model, as its simplicity may help to improve adherence and use by health care workers. 相似文献3.
Objectives
To investigate how a virtual cultural simulation experience and guided reflection influenced physiotherapy students’ intrapersonal and interpersonal cultural empathy, and to explore students’ satisfaction with the learning experience.Design
Three research arms within a single cohort: 1) pre-test post-test investigation of intrapersonal cultural empathy; 2) quasi-experimental investigation of interpersonal cultural empathy; 3) post-test measurement of satisfaction.Setting
An Australian university.Participants
Bachelor and Master physiotherapy students, response rate 98% (162/165).Interventions
A self-directed online virtual simulation in which the student assumed the role of a patient who has been hospitalised in a developing country. Students were then guided to reflect on the experience via online questions.Main outcome measures
The primary measure was the Comprehensive State Empathy Scale (CSES) of intrapersonal cultural empathy. Secondary measures were the Theory of Planned Behaviour:Cultural Competence Questionnaire (TPB:CCQ) of interpersonal cultural empathy; and the Satisfaction with Cultural Simulation Experience Scale (SCSES).Results
Intrapersonal cultural empathy improved after the virtual simulation, shown in overall CSES scores [pre-test: 95 (81–109) vs post-test: 106 (89–117); median difference 11; P = <0.001]. For the TPB:CCQ, the post-simulation (‘intervention’) group demonstrated greater ‘Perceived Behavioural Control’ interpersonal empathy compared to the presimulation (‘control’) group [4.41 (0.54) vs 4.59 (0.53); mean difference = 0.19; 95% confidence interval = 0.01 to 0.36; P = 0.020]. Satisfaction with the experience was high (mean SCSES score = 40/56 (71%)).Conclusions
A virtual cultural simulation experience and guided reflection led to significant increases in students’ intrapersonal cultural empathy, with some influence on interpersonal cultural empathy. Students were highly satisfied with this learning experience. 相似文献4.
5.
Susie Cartledge Lahn D. Straney Janet E. Bray Rachel Mountjoy Judith Finn 《Collegian (Royal College of Nursing, Australia)》2018,25(3):303-306
Background
Residential aged care facilities are common locations for out-of-hospital cardiac arrests to occur, yet survival to hospital discharge is poor.Aim
This study aims to examine preferences and perceived outcomes of cardiopulmonary resuscitation among Australians receiving aged care.Methods
A brief survey was provided to 187 residential aged care facilities and 34 home care providers throughout Australia for completion by aged care residents. Respondents were asked to answer three questions about understanding and desire for cardiopulmonary resuscitation on a five-point scale (from strongly agreed to strongly disagreed).Findings
A total of 1985 residents in 163 residential aged care facilities across Australia, and 277 older Australians receiving care in the home from 24 providers responded. The majority of respondents were female (67.4%), and respondents in residential aged care facilities were significantly older (82.6% > 75 years) than those receiving care in the home (70.4% > 75 years) (p < 0.001). Among 2262 respondents over 80% expressed a good understanding of cardiopulmonary resuscitation and its implications. Over half of respondents desired cardiopulmonary resuscitation if they were to experience an out-of-hospital cardiac arrest, and the desire for cardiopulmonary resuscitation was strongly associated and correlated (Pearson’s R test = 0.759) with a view that they would likely fully recover.Conclusion
These findings highlight the need for older people to be better informed about cardiopulmonary resuscitation, including a clear understanding of what is involved in cardiopulmonary resuscitation and a realistic perception of outcomes. 相似文献6.
Maria Hadjibalassi Ekaterini Lambrinou Evridiki Papastavrou Elizabeth Papathanassoglou 《Australian critical care》2018,31(2):73-86
Objectives
Guided imagery (GI) is a relaxation technique that is being increasingly explored in various patients’ populations. We systematically reviewed evidence on the effects of GI on physiological and psychological outcomes of adult critically ill patients and extracted implications for future research.Review method used
Systematic literature review of published studies based on the Cochrane Guidelines.Data sources
Studies were located through literature searches of CINAHL, PubMed, Embase, Cochrane Database of Systematic Reviews and Psych-Info.Review methods
We explored effects of GI in critically illness. The outcome measures included pain, anxiety, hemodynamic measurements, stress neuropeptides, length of stay, sleep quality, inflammatory markers, patient satisfaction and cost of care. The Cochrane Collaboration’s tool for assessing risk of bias was employed. Extracted data included pathophysiological framework, sample, diagnoses of participants, specifics of intervention, design, experimental groups, analyses and main outcomes.Results
Based on the selection criteria, 10 studies were identified, involving N = 1391 critically ill patients. The main limitations include incomplete outcome data and selective reporting, incomplete blinding and lack of experimental group allocation concealment. Due to heterogeneity and incomplete reporting, a meta-analysis was not feasible. Our findings included: (a) favourable effects of the intervention with regard to decrease of pain, anxiety and LOS; (b) many studies employing randomised controlled trial designs; (c) a predominant focus on patients with cardiac surgery; (d) large heterogeneity in measurement of outcomes. Moreover, the evidence suggests that improvements in sleep quality, patient satisfaction and cost of care merit further investigation. Methodological implications include the need to clarify the underlying physiological framework, the use of repeated measure designs and the adjustment for confounders.Conclusions
On the basis of these results, and of the absence of reported side-effects, we conclude that GI is a promising patient-centered approach for the improvement of a number of patients’ outcomes that merits further investigation in critical care. 相似文献7.
J. Broderick C. Mc Grath K. Cullen D. Talbot J. Gilmor M. Baily-Scanlan T. O’Dwyer 《Physiotherapy》2018,104(2):248-250
Objectives
To explore the influence of obesity on outcomes of exercise capacity and disease impact in patients with chronic obstructive pulmonary disease (COPD) in response to pulmonary rehabilitation (PR) and to compare outcomes to those of normal weight and overweight counterparts.Design
Secondary data analysis of clinical database.Setting
St. James’s Hospital, Dublin, Ireland.Participants
155 participants with a primary diagnosis of COPD who completed a PR programme between 2012 and 2014.Main Outcome Measures
Exercise capacity evaluated using the Six Minute Walk Test (6MWT) and the COPD Assessment Test (CAT) evaluated disease impact.Results
Walking distance in the 6MWT improved significantly [mean difference of 55 m (95% CI: 42 to 68; p < 0.001)] and similarly [F(2, 92) = 1.434, p = 0.24] across all BMI categories, although the level of improvement reached clinical significance in the normal/underweight and overweight categories only. Disease impact on the CAT score improved across all body mass index (BMI) classifications by 2.3 points (95% CI: 0.9 to 3.6; p < 0.050) which reached clinical significance and did not vary across BMI categories [F(2, 80) = 0.534, p = 0.58].Conclusion
Exercise capacity and self-report disease impact of individuals with COPD improved similarly in response to PR irrespective of BMI. 相似文献8.
Background
Pain and sedation protocols are suggested to improve the outcomes of patients within paediatric intensive care. However, it is not clear how protocols will influence practice within individual units.Objectives
Evaluate a nurse led pain and sedation protocols impact on pain scoring and analgesic and sedative administration for post-operative cardiac patients within a paediatric intensive care unit.Methods
A retrospective chart review was performed on 100 patients admitted to a tertiary paediatric intensive care unit pre and post introduction of an analgesic and sedative protocol. Stata12 was used to perform Chi-squared or Student’s t-test to compare data between the groups.Results
Post protocol introduction documentation of pain assessments increased (pre protocol 3/24 h vs post protocol 5/24 h, p = 0.006). Along with a reduction in administration of midazolam (57.6 mcg/kg/min pre protocol vs 24.5 mcg/kg/min post protocol, p = 0.0001). Children’s pain scores remained unchanged despite this change, with a trend towards more scores in the optimal range in the post protocol group (5 pre protocol vs 12 post protocol, p = 0.06).Conclusions
Introducing a pain and sedation protocol changed bedside nurse practice in pain and sedation management. The protocol has enabled nurses to provide pain and sedation management in a consistent and timely manner and reduced the dose of midazolam required to maintain comfort according to the patients COMFORT B scores. Individual evaluation of practice change is recommended to units who implement nurse led analgesic and sedative protocols to monitor changes in practice. 相似文献9.
Background
Compassion satisfaction and compassion fatigue influence nurses’ intention to stay or leave nursing. Identification of compassion satisfaction or fatigue in critical care nurses is important in this high turnover workforce.Objectives
The aim of this study was to examine factors predicting and contributing to compassion satisfaction and compassion fatigue experienced by critical care nurses in Australian intensive care units.Methods
A self-reported cross-sectional survey using an established tool collected data from critical care nurses of two adult Australian intensive care units.Results
Overall, these critical care nurses reported what Professional Quality of Life Scale guidelines designated as ‘average’ levels of compassion satisfaction and burnout, and ‘low’ levels of Secondary Traumatic Stress (STS). Compared to Site B, nurses at Site A had significantly higher compassion satisfaction (p = 0.008) and lower STS scores (p = 0.025), with site significantly predictive for compassion satisfaction (p < 0.024) and STS (p < 0.002). Nurses with postgraduate qualifications had significantly higher compassion satisfaction scores (p = 0.027), and compassion satisfaction significantly increased with increasing duration of practice (p = 0.042) as a nurse and in their current ICU (p = 0.038). Burnout scores significantly reduced with increasing age, years of tenure and practice; burnout was predicted by lower years of tenure (p < 0.016).Conclusion
These critical care nurses revealed profiles that, whilst not in crisis, fell short of the ideal high compassion satisfaction and moderate/low fatigue. More recent tenure flags those potentially at higher risk of compassion fatigue, whilst the better scores associated with postgraduate education and from one site need further exploration. Further research should develop understanding and interventions to enhance compassion satisfaction and support retention of this crucial nursing workforce. 相似文献10.
11.
Question
What is the effectiveness and what are the adverse effects.Design
Systematic review with meta-analysis.Participants
Patients with shoulder or upper extremity pain or dysfunction.Intervention
Trigger point dry needling (TDN) compared to control, another intervention or another needling technique.Outcome measures
Primary outcome measures included shoulder or upper limb pain, shoulder or upper limb dysfunction.Results
Eleven randomized trials involving 496 participants were appraised. There was very low evidence that trigger point dry needling of the shoulder region is effective for reducing pain and improving function in the short term. There is some evidence that needling both active and latent trigger points is more effective than needling an active trigger point alone for pain immediately and 1-week after treatment (SMD = ?0.74, 95%CI = ?1.2 to ?0.3; and SMD = ?1.0, 95%CI = ?1.52 to ?0.59).Conclusion
There is very low evidence to support the use of TDN in the shoulder region for treating patients with upper extremity pain or dysfunction. Two studies reported adverse effects to TDN interventions. Most common adverse effects included bruising, bleeding, and pain during or after treatment. Future studies are likely to change the estimates of the effectiveness of TDN for patients with upper extremity pain or dysfunction.PROSPERO: CRD42016045639. 相似文献
12.
13.
Objective
To estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity (PA) compared with standard medical care in patients with moderate chronic obstructive pulmonary disease (COPD).Design
Randomised controlled trial.Setting
Primary care physiotherapy.Participants
Consecutive patients with stable COPD at Gold Stage II with a score of two or more on the Medical Research Council Dyspnoea Scale.Intervention
Ten-week combined exercise training and home-based walking programme compared with standard medical care.Main outcomes
At baseline and after 10 weeks, daily PA was evaluated by accelerometry using three levels of intensity and expressed as metabolic equivalent of task. In addition, daily activities (Physical Activity Scale for the Elderly), functional exercise capacity (6-minute Walk Test), health-related quality of life (Chronic Respiratory Questionnaire) and exercise self-efficacy (Exercise Self-Regulatory Efficacy Scale) were measured.Results
Fifty-two patients {34 females; mean age 70.2 [standard deviation (SD) 9.5] years; mean forced expiratory volume in 1 second 67% (SD 9.2) of predicted} were randomised. PA, adjusted for baseline differences, increased significantly in the intervention group compared with the control group, by 26.1 minutes/day [95% confidence interval (CI) 7.3 to 44.9]. The increase in functional capacity between groups was clinically relevant (34.0 m, 95% CI 2.3 to 65.6) in favour of the intervention group.Conclusions
A combined exercise training and home-based walking programme in primary care physiotherapy improved PA in patients with moderate COPD.Clinical trial registration number NL24766.018.08. 相似文献14.
15.
16.
Jake L. Nowicki Daniel Mullany Amy Spooner Tracy A. Nowicki Peta M. Mckay Amanda Corley Paul Fulbrook John F. Fraser 《Australian critical care》2018,31(5):257-263
Background
Pressure injuries contribute significantly to patient morbidity and healthcare costs. Critically ill patients are a high risk group for pressure injury development and may suffer from skin failure secondary to hypoperfusion. The aim of this study was to report hospital acquired pressure injury incidence in intensive care and non-intensive care patients; and assess the clinical characteristics and outcomes of ICU patients reported as having a hospital acquired pressure injury to better understand patient factors associated with their development in comparison to ward patients.Methods
The setting for this study was a 630 bed, government funded, tertiary referral teaching hospital. A secondary data analysis was undertaken on all patients with a recorded PI on the hospital’s critical incident reporting systems and admitted patient data collection between July 2006 to March 2015.Results
There were a total of 5280 reports in 3860 patients; 726 reports were intensive care patients and 4554 were non-intensive care patients, with severe hospital acquired PI reported in 22 intensive care patients and 54 non-intensive care patients. Pressure injury incidence increased in intensive care patients and decreased in non-intensive care patients over the study period. There were statistically significant differences in the anatomical location of severe hospital acquired pressure injuries between these groups (p = 0.008).Conclusion
Intensive care patients have greater than 10-fold higher hospital acquired pressure injury incidence rates compared to other hospitalised patients. The predisposition of critically ill patients leaves them susceptible to pressure injury development despite implementation of pressure injury prevention strategies. Skin failure appears to be a significant phenomenon in critically ill patients and is associated with the use of vasoactive agents and support systems such as extra corporeal membrane oxygenation and mechanical ventilation. 相似文献17.
The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study
Background
Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges. However little is known about the care of these patients in intensive care.Objective
To explore medical and nursing practices and attitudes in intensive care when caring for critically ill morbidly obese patients.Methods
A focused ethnographic approach was adopted. Participant observation of care practices and interviews with intensive care doctors and nurses were undertaken over a four month period. Qualitative analysis was conducted using constant comparison.Setting
An 18 bedded tertiary intensive care unit in New Zealand.Participants
Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40 kg/m2.Findings
Morbidly obese patients present significant physical and language challenges for intensive care practice. The physical shape of morbidly obese patients did not appropriately fit the different equipment used. Staff used specific knowledge of the patient’s body size and shape to adapt care practices and keep patients safe and comfortable. There were also specific language challenges where staff expressed concern about what words were most appropriate to use to describe body mass when in the presence of morbidly obese patients.Conclusions
Bariatric care pathways need to be developed that use more suitable body measurements to inform the use of bariatric equipment. Intensive care staff need to engage in debate about what is acceptable, respectful, and appropriate language in the delivery of bariatric patient care. 相似文献18.
Swati Jha Stephen J. Walters Oscar Bortolami Simon Dixon Abualbishr Alshreef 《Physiotherapy》2018,104(1):91-97